Appendix 10
CHIP Eligibility Determination Key Performance Requirements
| CHIP Key Performance Requirement | Earnback Category (indicates Priority) | Performance Standard | Active? |
Measurement: January - April 2006 |
|---|---|---|---|---|
| 3 | A | CHIP Error Rate: Prevent or minimize dual enrollment with Medicaid | Not active: Performance Threshold "To Be Determined" | "TAA will request a meeting with the State to identify and agree upon a Performance Standard for evaluating CHIP error rate." |
| 45 | A | Meet or exceed standards for processing inbound and outbound documents as included in the Vendor's Performance Measurement Plan. | Not Active | "Intent of this KPR is under review. Measurement is To Be Determined." |
| 61 | C | Produce Monthly Quality Management Report: Perform monthly audits on services and operations to identify and report compliance with laws and regulations | Active | Deliver report by 15th of month. No requirement for quality metrics reported to meet any performance threshold. |
| 96 | A | Mail notice of eligibility determination: 100% mailed within 50 working days from the application file date, excluding days during which the application was suspended. | Not Active: "Suspended/No Assessment" | None. |
| 97 | A+ | Complete 99% of redeterminations within three working days from receipt of a completed application. | Not Active: Performance Threshold "To Be Determined" | Measurement reported despite not being active. Accenture never met 99% standard: Jan 43%, February 1%, March 1%, April 20% |
| 98 | A | CHIP Appeals Timeliness: 100% completed and letter sent to the client within 12 days | Active | Accenture never met 100% standard: January 98%, February 72%, March 7.45%, April 4.36% |
| 102 | A | Notice of eligibility determination: 100% mailed within three days. | Not Active: "This KPR is being finalized" | None. |
| 104 | A | Mail information and documentation necessary for client to file an appeal within one mailing day of client inquiry 98% of the time. | Active | Accenture never met 98% standard: February 4%, March 8%, April 4.55% |
Sources: Integrated Eligibility and Enrollment Services Agreement between Health and Human Services Commission and Accenture, Schedule 3 and Texas Access Alliance, Texas Integrated Eligibility and Enrollment Services KPR 68 Monthly Monitoring Report for January, February and March 2006.