13: Mono, Inyo, and Imperial, 14: Kern, 15: Los Angeles County ZIP Codes starting with 906 to 912, inclusive, 915, 917, 918, and 935, 16: Los Angeles County ZIP Codes in other than those identified above, 17: San Bernardino and Riverside, 18: Orange, 19: San Diego In 500 words or less, please 500 words. N/A 9 provide a general description of the program, including its goals, how it represents an advance, and any high-level results to date (attachments permitted). Identify the line(s) of business for Multi, Checkboxes. 50 words. 10 which this program is available? 1: Self-insured commercial, 2: Fully-insured commercial, 3: Medicare, 4: Medicaid, 5: Other – please describe in next column Identify the product(s) for which Multi, Checkboxes. Unlimited. 11 1: PPO, this program is integrated 2: POS, 3: EPO, 4: HMO, 5: HDHP, 6: Other (please describe in next column) What is current stage of Single, Radio group. To the day. 12 implementation. 1: Planning mode, 2: Pilot mode (e.g. only available for a Provide date of implementation subset of members and/or providers), in detail column 3: Expansion mode (e.g. passed initial pilot stage and broadening reach), 4: Full implementation (e.g. available to all intended/applicable providers and members) Which alternative payment Multi, Checkboxes with 50 Multi, List box. 13 1: Of payment models selected in model(s) most accurately words. previous column, note dominant 1: Shared-risk (other than bundled describe(s) the payment reform model in detail box in cell payment) and/or gainsharing with program? Check all that apply. quality, Note most dominant in next 2: FFS-based Shared-savings with column quality, 3: Non-FFS-based Shared-savings with quality,
13: Mono, Inyo, and Imperial, 14: Kern, 15: Los Angeles County ZIP Codes starting with 906 to 912, inclusive, 915, 917, 918, and 935, 16: Los Angeles County ZIP Codes in other than those identified above, 17: San Bernardino and Riverside, 18: Orange, 19: San Diego In 500 words or less, please provide a general description of the program, including its goals, how it represents an advance, and any high-level results to date (attachments permitted). 500 words. N/A 9 Identify the line(s) of business for which this program is available? Multi, Checkboxes. 1: Self-insured commercial, 2: Fully-insured commercial, 3: Medicare, 4: Medicaid, 5: Other – please describe in next column 50 words. 10 Identify the product(s) for which this program is integrated Multi, Checkboxes. 1: PPO, 2: POS, 3: EPO, 4: HMO, 5: HDHP, 6: Other (please describe in next column) Unlimited. 11 What is current stage of implementation. Provide date of implementation in detail column Single, Radio group. 1: Planning mode, 2: Pilot mode (e.g. only available for a subset of members and/or providers), 3: Expansion mode (e.g. passed initial pilot stage and broadening reach), 4: Full implementation (e.g. available to all intended/applicable providers and members) To the day. 12 Which alternative payment model(s) most accurately describe(s) the payment reform program? Check all that apply. Note most dominant in next column Multi, Checkboxes with 50 words. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based Shared-savings with quality, 3: Non-FFS-based Shared-savings with quality, Multi, List box. 1: Of payment models selected in previous column, note dominant model in detail box in cell 13
Qualified%20Health%20Plan%20Certification%20Application%20Fourth%20Quarter%202017%20Smal....docx