Prospective Gross Prospective capitation payments, prior to adjustments for Health Capitation Insurer Fee payment, made to Contractors on a monthly basis which includes medical expense, reinsurance offset, administration, risk/contingency and premium tax, and any subsequent amendments thereof. For purposes of this policy, Prospective Gross Capitation is exclusive of Delivery Supplemental, KidsCare and State Only Transplant payments. Quality Contribution A specified percentage of Prospective Gross Contractors’ Capitation payments that will be assessed through a reconciliation process to fund the VBP Initiative. Quality Management Health care quality measures utilized by CQM. Subsets of these measures were selected for use in the VBP Initiative. Performance Measures The report issued by CQM annually which includes results by Quality Management Measurement Report Contractor on QMPMs. Quality Management The minimum standard established by CQM for each QMPM and used in calculating the performance measure score. Minimum Performance Standard Amounts returned to Contractors, by QMPM, based on the Quality Distribution results of the performance measure score and the performance rank score. A factor applied in the calculation of quality Rank Factor Contractor’s distribution amount based on the rank of the Contractor for the performance rank score. Scaling Factor A factor applied in the calculation of quality Contractor’s distribution amount for the performance measurement score.
Prospective Gross Capitation Prospective capitation payments, prior to adjustments for Health Insurer Fee payment, made to Contractors on a monthly basis which includes medical expense, reinsurance offset, administration, risk/contingency and premium tax, and any subsequent amendments thereof. For purposes of this policy, Prospective Gross Capitation is exclusive of Delivery Supplemental, KidsCare and State Only Transplant payments. Quality Contribution A specified percentage of Contractors’ Prospective Gross Capitation payments that will be assessed through a reconciliation process to fund the VBP Initiative. Quality Management Performance Measures Health care quality measures utilized by CQM. Subsets of these measures were selected for use in the VBP Initiative. Quality Management Measurement Report The report issued by CQM annually which includes results by Contractor on QMPMs. Quality Management Minimum Performance Standard The minimum standard established by CQM for each QMPM and used in calculating the performance measure score. Quality Distribution Amounts returned to Contractors, by QMPM, based on the results of the performance measure score and the performance rank score. Rank Factor A factor applied in the calculation of Contractor’s quality distribution amount based on the rank of the Contractor for the performance rank score. Scaling Factor A factor applied in the calculation of Contractor’s quality distribution amount for the performance measurement score.
315-CYE-16-and-CYE-17-Acute-Program-Value-Based-Purchasing-Initiative.docx