Q7: Can the state confirm the number of PMs that R7: See R3 and R5 above must be validated annually for each MCO? Of the number of PMs that must be validated, can the state indicate how many use hybrid versus administrative data collected? Q8: How many of the Performance Measures that R8: All 9 (nine) of the Performance Measures require validation follow HEDIS specifications? follow HEDIS specification. Q9: Do the MCOs contract with a licensed HEDIS audited organization to conduct an audit of their R9: Unknown if all do HEDIS measure reporting? Specifications: A. 24 Q1: How many PIPs are required for validation per R1: There are 5 (five) Performance Detailed Scope of Work, MCO: Improvements to be validated per MCO. Please Deliverables, 3. refer to Centennial Care 2.0 Managed Care Validation of Contract. Section 4.12.4.10 Performance Improvement Projects Q2: How many PIPs per MCO will require annual validation? R2: See R1. Specifications: A, 24-25 Q1: The RFP states that annual validation activities R1: Yes the EQRO will be expected to start the Detailed Scope of Work, must adhere to the protocols upon CMS Validation of Network Adequacy in advance of Deliverables, 4. development. Please confirm the EQRO will be the release of the CMS protocol. Please refer to Validation of Network expected to start the activities using the HSD/MAD Centennial Care 2.0 Managed Care Contract. Adequacy standards in advance of the release of the CMS Section 4.8 Provider Network protocol. R2: Please refer to CFR cited for in this section Q2: Can the State provide the current network and to the Centennial Care 2.0 Managed Care adequacy requirements? Contract. Section 4.8 Provider Network R3: Submissions by the MCO of Policy and Procedures and possibly documents supporting Q3: What are HSD/MAD’s anticipated sources of adherence to internal Policy and Procedures. data for the evaluation? R4: The data should be provided by the MCOs directly to the EQRO.
Q7: Can the state confirm the number of PMs that must be validated annually for each MCO? Of the number of PMs that must be validated, can the state indicate how many use hybrid versus administrative data collected? Q8: How many of the Performance Measures that require validation follow HEDIS specifications? Q9: Do the MCOs contract with a licensed HEDIS audited organization to conduct an audit of their HEDIS measure reporting? R7: See R3 and R5 above R8: All 9 (nine) of the Performance Measures follow HEDIS specification. R9: Unknown if all do Specifications: A. Detailed Scope of Work, Deliverables, 3. Validation of Performance Improvement Projects 24 Q1: How many PIPs are required for validation per MCO: Q2: How many PIPs per MCO will require annual validation? R1: There are 5 (five) Performance Improvements to be validated per MCO. Please refer to Centennial Care 2.0 Managed Care Contract. Section 4.12.4.10 R2: See R1. Specifications: A, Detailed Scope of Work, Deliverables, 4. Validation of Network Adequacy 24-25 Q1: The RFP states that annual validation activities must adhere to the protocols upon CMS development. Please confirm the EQRO will be expected to start the activities using the HSD/MAD standards in advance of the release of the CMS protocol. Q2: Can the State provide the current network adequacy requirements? Q3: What are HSD/MAD’s anticipated sources of data for the evaluation? R1: Yes the EQRO will be expected to start the Validation of Network Adequacy in advance of the release of the CMS protocol. Please refer to Centennial Care 2.0 Managed Care Contract. Section 4.8 Provider Network R2: Please refer to CFR cited for in this section and to the Centennial Care 2.0 Managed Care Contract. Section 4.8 Provider Network R3: Submissions by the MCO of Policy and Procedures and possibly documents supporting adherence to internal Policy and Procedures. R4: The data should be provided by the MCOs directly to the EQRO.
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