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Attachment J-11 Contract Evaluation
Annual Network contract evaluation of this Performance-based contract shall be solely on the performance measures within this document, based on the CMS Dashboard Performance assessment. The Network COR will be monitoring for contract, as opposed to measure, performance throughout the contract period, and may refer the Network to the Contracting Officer at any time that a Network fails to meet the contract requirements. The COR is expected to work through C.3.19.A in conducting the three-tier process, unless it is apparent to the COR that the contract requirement failure necessitates an immediate referral to the CO.
A Network is required to achieve a score of 49 points out of 70 (a 70% threshold) to receive a passing score. However, to be recommended for automatic contract renewal, the Network shall achieve a score of 60. In addition, Networks shall achieve minimum thresholds on all measures. Failure to achieve minimum thresholds on any measure, or failure to achieve an automatic contract renewal evaluation score of 60 score will result in immediate contract action.
Table J-11A. Results of Annual Evaluation Scores and their associated contract actions
| Evaluation Score |
| Score= <49 |
or failure to achieve minimum thresholds on all measures
| Score= 49 to 59.9 |
| Score= 60 to 70 |
| Result |
| Refer to OAGM for contract competition |
| Performance Improvement Plan (PIP) or other contract action per OAGM |
| Automatic contract renewal for next Option Year. |
A weighted score will be used to determine the Performance Improvement score of the evaluation (Table J-11B). A Network shall achieve the Minimum Threshold to receive 1 point; a Network shall achieve the moderate thresholds to receive 3 points, and a Network shall achieve the Maximum Threshold (equivalent to SOW requirements) to receive 5 points. These Minimum, Moderate, and Maximum Thresholds are applicable for all contract years (Base and Option Years). For those measures without a Minimum or Moderate Threshold (that is, those marked N/A), the next highest threshold with a value becomes the minimum threshold that shall be achieved by the Network. All data for the calculations will be derived from the CMS Dashboard based on an evaluation time period as described in the SOW for the various measures.
Table J-11B: Performance Measure Thresholds and Points received within ESRD 2016-20 SOW Sow Section
Topic
Measure Minimum Thresholds (1 Point) Moderate Thresholds (3-Points) Maximum Thresholds (5-Points)
| C.4.1.B.1 |
| Pt. Exp. of Care |
| 1. Timeliness IA’s (5 days) |
| 80% |
| 90% |
| 98% |
| C.4.1.B.1 |
| Pt. Exp. of Care |
| 2. Timeliness Grievances (60 Days) |
| 90% |
| 95% |
| 98% |
| C.4.1.B.1 |
| Pt. Exp. of Care |
| 3. Patient Grievance Satisfaction |
| 67% Highly Satisfied or Satisfied |
| 75% Highly Satisfied or Satisfied |
| 80% Highly Satisfied or Satisfied |
| C.4.1.B.1 |
| Pt. Exp. of Care |
| 4. Grievance QIA |
| 10% RI |
| 15% RI |
| 20% RI |
| C.4.1.B.4 |
| Pt. Exp. of Care |
| 5. ICH CAPHS QIA |
| N/A |
| N/A |
| 5% RI |
| C.4.1.D.1 |
| Vascular Access |
| 6. Long-Term Catheter <90 days |
| 1.5 Points |
| 1.8 Points |
| 2 Points |
| C.4.1.E.3 |
| HAI |
| 7. HAI BSI |
| N/A |
| N/A |
| 5% RI |
| C.4.1.3.4 |
| HAI |
| 8. HAI Vaccination: Hepatitis-B |
| 90% of Required |
| 95% of Required |
| 100% of Required |
| C.4.1.3.4 |
| HAI |
| 9. HAI Vaccination: PPV |
| 90% of Required |
| 95% of Required |
| 100% of Required |
| C.4.2 |
| AIM2 |
| 10. AIM2 PHFPP Network Performance |
| 90% of Required |
| 95% of Required |
| 100% of Required |
| C.4.2 |
| AIM2 |
| 11. AIM2 PHFPP Network Disparity |
| N/A |
| N/A |
| 100% of Required |
| C.4.2 |
| AIM2 |
| 12. AIM2 PHFPP Network Attributes* |
| 4 out of 6 |
| 5 out of 6 |
| 6 out of 6 |
| C.4.2 |
| AIM2 |
| 13. AIM2 Hospital Coordination (OY3/OY4) |
| 90% of Required |
| 95% of Required |
| 100% of Required |
| C.4.2 |
| AIM2 |
| 14. AIM2 Hospital Coord. Disparity (OY3/OY4) |
| N/A |
| N/A |
| 100% of Required |
| C.4.2 |
| AIM2 |
| 15. AIM2 Hospital Coord. Attributes* |
| 4 out of 6 |
| 5 out of 6 |
| 6 out of 6 |
| C.4.3.A |
| AIM3 |
| 16. QIP QIA |
| 15% |
| 20% RI |
| 25% RI |
| C.4.3.B |
| AIM3 |
| 17. CDC Data Quality QIA |
| N/A |
| N/A |
| Report results achieved |
*Note that the AIM2 PHFPP Network Attributes will be provided by the COR only; RI=Relative Improvement 1 | Page