3 Colo. Code Regs. § 702-4-2-96-9
Current through Register Vol. 47, No. 24, December 25, 2024
Section 3 CCR 702-4-2-96-9 - Aligned Quality Measure SetsA. Carriers must include the aligned quality measures for Adult and Pediatric populations set forth in Appendix C in a quality measure set utilized in an APM for primary care services. 1. Provider performance on measures in the aligned measure set must impact payment in a meaningful way, while still allowing for prospective, upfront payments. Carriers may not incorporate any measure that is part of the aligned measure set into a payment arrangement such that performance on the measure lacks meaningful financial implications to the provider. a. Nothing in this Section 9(A) requires a carrier to include one or more of the measures in the aligned measure set into the terms of a contract with a specific provider or practice or intermediary. The measures in the aligned quality measure set must be included in the set of quality measures that are utilized in an APM, and available for selection by payers and providers, but carriers and providers should mutually determine the appropriate measures that will be included in the terms of a specific contract. b. Carriers and providers must determine appropriate thresholds for provider or practice's performance, based on practice capacity and experience reporting quality measures. 2. Carriers must follow the measure steward specifications for all measures included in the aligned measure set. Any deviations or exceptions must be mutually agreed upon with the provider. 3. Carriers must include the Adult measure set, the Pediatric measure set, or both in the overarching quality measure set utilized in an APM for primary care services based on the age composition of the practice's full practice panel. a. For practices with a majority (greater than 80%) of adults in their practice panel, carriers must include the aligned Adult measure set. b. For practices with a majority of pediatric patients (greater than 80%) in their practice panel, carriers must include the aligned Pediatric measure set.c. For practices with a pediatric population of 20%-80% of their practice panel, carriers must include both the Adult and Pediatric measure sets. B. Carriers may include measures in addition to the aligned quality measure set at the mutual agreement of the carrier and the provider. Additional measures should consider a provider's patient panel needs, practice priorities, other state and federal requirements, and feasibility of reporting. C. A carrier may petition the Commissioner to modify or waive one or more of the requirements of Section 9(A). Any request to waive or modify one or more of the requirements must include a clear rationale supporting the request and must demonstrate how the waiver will advance the quality, accessibility, and/or affordability of healthcare services. D. The aligned measure set will be reviewed annually by the Commissioner.1. The Division will seek input on proposed modifications to the aligned quality measure set through a stakeholder process that includes the Primary Care Payment Reform Collaborative, carriers and providers participating in APMs that are not participating in the Primary Care Payment Reform Collaborative, relevant state agencies and programs including the Department of Health Care Policy and Financing, and consumers. 2. The Division will provide notice of stakeholder meetings on the Division website, at least two weeks in advance, and all meetings will be open to the public. 46 CR 24, December 25, 2023, effective 1/30/2024