Carried-Over Prioritized Problems

7.1.2.4.1 – Carried-Over Prioritized Problems (Rev. 599, Issued: 06-26-15, Effective: 12-07-15, Implementation: 12-07-15) In addition to the requirements listed above, the MAC shall address the following elements for problems that are carried over from previous contract year’s IPRS or SAR to the current contract year’s IPRS. These sections shall include problem-specific discrete figures and measurements: • The effectiveness or ineffectiveness of the MR, POE, and other improper payment interventions in reducing the baseline problem measurements. The MAC shall document the progress made towards achieving the goal, or an explanation of why the goal was partially met or not met within the specified timeframe. If there is lack of progress towards accomplishment of an improvement goal, the MAC shall clearly document the obstacles contributing to the lack of progress towards accomplishment of an improvement goal. The MAC shall also offer rationale for either not taking the next steps in progressive corrective action or for continuing current interventions. A continuous lack of progress towards goal completion and failure to provide a justification for the lack of progress will be considered unacceptable and require revisions to the IPRS. • Whether modification to the plan is required. A modified plan, if appropriate, shall be developed by the MAC to remedy the obstacles that inhibited progress towards accomplishment of the improvement goals. This section shall describe how the MAC is revising or modifying the goals and/or the MR, POE, and other improper payment interventions, as appropriate. No previous prioritized problems may be omitted from the current IPRS without an explanation. CMS must be able to track progress on all prioritized problems and their goals from a previous IPRS. When previous prioritized problems improve or meet their goals, or when priorities shift to other problem areas, the MAC may inactivate the previous prioritized problem or set new improvement goals for that problem.