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 Summary/Brief 500 words. N/A description of Program (500 words or less) Identify the line(s) of Multi, Checkboxes. 50 business for this 1: Self-insured program is commercial, available? 2: Fully-insured commercial, 3: Medicare, 4: Medicaid, 5: Other please – describe in next column What is current Single, Radio group. To the day. of implementation? 1: Planning mode, Provide date of 2: Pilot mode (e.g. only implementation in available for a subset of detail column 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 payment Single, Radio group. 65 words. reform model does 1: Shared-risk (other your program most than bundled payment) closely align? and/or gainsharing with For programs that quality, have hybrid 2: FFS-based qualities, review the with quality, list of definitions to 3: Non-FFS-based decide which Shared-savings with payment model best quality, describes your 4: FFS plus pay for program, or is the performance,
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 Summary/Brief description of Program (500 words or less) 500 words. N/A Identify the line(s) of business for 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 What is current 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. To payment reform model does your program most closely align? For programs that have hybrid qualities, review the list of definitions to decide which payment model best describes your program, or is the Single, Radio group. 1: Shared-risk (other than bundled payment) and/or gainsharing with quality, 2: FFS-based with quality, 3: Non-FFS-based Shared-savings with quality, 4: FFS plus pay for performance, 65 words.
2017-QHP-Certification-Application-DRAFT-1-21-16.docx