46 Draft Tech Specs states HHSC will quarterly As noted during the webinar on May 9, 2017, monitor provider fluctuation within counties by HHSC awaits MCO network adequacy comparing counts for the current quarter to the experience data to determine reasonable previous quarter and baseline. Request HHSC thresholds that would prompt additional specify how will be defined in the analysis during the year. HHSC will ‘fluctuation’ context of this report/provider counts, and what coordinate with MCOs as these variables are percentage of change will prompt HHSC to determined. conduct travel time and distance analysis when data indicates a change. “fluctuation” 47 Use of the provider reconciliation file from the Network adequacy analysis is a point in time first week/month of the reporting quarter will analysis that includes a cross-sectional not represent network changes throughout the of the MCO network at the time of “snapshot” reporting quarter, resulting in an incomplete the data collection. review by HHSC of the MCO’s network “current” status for this report. Resulting corrective To more clearly describe the measurement action requests (and/or LDs) may be process, HHSC has revised the technical required/imposed that are the result of this specifications. incomplete analysis of the current quarter. Recommend reconsidering the file used for quarterly access monitoring to reflect network status at the end of the quarter, which would be more representative of the quarterly reporting/analysis. 48 Please specify the threshold for network Network adequacy results will include adequacy performance results that will prompt two decimal places and will not be remedies imposed by HHSC (corrective action rounded. Following the exception and/or LDs), as described on page 9 of the process, remedies may be assessed Tech Specs document. when performance standards are not met. Will adequacy results include decimal Yes, with the exception of Other figures, and will HHSC impose Physician Specialties (which has been remedies on any performance less removed from the Technical than the 75% or 90% standards? Specifications). Yes, performance will be measured for each MCO by county by program.
46 Draft Tech Specs states HHSC will quarterly monitor provider fluctuation within counties by comparing counts for the current quarter to the previous quarter and baseline. Request HHSC specify how ‘fluctuation’ will be defined in the context of this report/provider counts, and what percentage of change will prompt HHSC to conduct travel time and distance analysis when data indicates a “fluctuation” change. As noted during the webinar on May 9, 2017, HHSC awaits MCO network adequacy experience data to determine reasonable thresholds that would prompt additional analysis during the year. HHSC will coordinate with MCOs as these variables are determined. 47 Use of the provider reconciliation file from the first week/month of the reporting quarter will not represent network changes throughout the reporting quarter, resulting in an incomplete review by HHSC of the MCO’s “current” network status for this report. Resulting corrective action requests (and/or LDs) may be required/imposed that are the result of this incomplete analysis of the current quarter. Recommend reconsidering the file used for quarterly access monitoring to reflect network status at the end of the quarter, which would be more representative of the quarterly reporting/analysis. Network adequacy analysis is a point in time analysis that includes a cross-sectional “snapshot” of the MCO network at the time of the data collection. To more clearly describe the measurement process, HHSC has revised the technical specifications. 48 Please specify the threshold for network adequacy performance results that will prompt remedies imposed by HHSC (corrective action and/or LDs), as described on page 9 of the Tech Specs document. Will adequacy results include decimal figures, and will HHSC impose remedies on any performance less than the 75% or 90% standards? Network adequacy results will include two decimal places and will not be rounded. Following the exception process, remedies may be assessed when performance standards are not met. Yes, with the exception of Other Physician Specialties (which has been removed from the Technical Specifications). Yes, performance will be measured for each MCO by county by program.
20170626_MCO_QA.DOCX