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Title: Section 1003.10 - Quality Performance Standards and Reporting

Effective Date

12/31/2014

1003.10 Quality Performance Standards and Reporting

(a) The Department shall collect for dissemination via a statewide health information system, health care data from ACO entities pursuant to the quality assurance reporting requirements developed by the Department in consultation with the National Committee on Quality Assurance (NCQA).

(b) The Department shall thereafter prepare the collected data from the ACO for publication. The Department will provide each ACO with a copy of the data prior to publication. The ACO will be provided an opportunity, in a manner and time determined by the Department, to correct factual inaccuracies, and to file a statement in a form prescribed by the Department concerning the data.

(c) The Department shall thereafter make the collected data from the ACOs, along with any corrections made pursuant to subdivision (b) of this section, organized and segregated by type of product and type of organization offering the product, available on its public website. Such data will be shared with the Superintendent of Financial Services. Information published on the website shall not include patient-identifying information and shall be subject to all applicable provisions of law and regulation regarding confidentiality of patient information.

(d) All ACO data published on the Department’s website shall include the following statement: “THE DATA COLLECTED BY THE DEPARTMENT IS ACCURATE TO THE BEST OF THE KNOWLEDGE OF DEPARTMENT STAFF, BASED ON THE INFORMATION SUPPLIED BY THE ACO WHICH IS THE SUBJECT OF THE DATA.”

(e) Notwithstanding the above, an ACO that has a contractual arrangement with a third party health care payer to cover health care services for a defined population must submit required measures for the eligible population attributed to the ACO.

(f) The ACO’s quality performance shall be equal to or exceed statewide and/or national benchmarks and/or demonstrate improvement over time on multiple performance measures of care to maintain participation in the program.

Volume

VOLUME E (Title 10)

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