Regional Generic Provider Agreement - Ohio Department of Job and ...

Appendix L
Covered Families and Children
Page 1
APPENDIX L
DATA QUALITY
CFC ELIGIBLE POPULATION
A high level of performance on the data quality measures established in this appendix is crucial in
order for the Ohio Department of Job and Family Services (ODJFS) to determine the value of the
Medicaid Managed Health Care Program and to evaluate Medicaid consumers’ access to and quality
of services. Data collected from MCPs are used in key performance assessments such as the external
quality review, clinical performance measures, utilization review, care coordination and case
management, and in determining incentives. The data will also be used in conjunction with the cost
reports in setting the premium payment rates. The following measures, as specified in this appendix,
will be calculated per MCP and include all Ohio Medicaid members receiving services from the
MCP (i.e., Covered Families and Children (CFC) and Aged, Blind, or Disabled (ABD) membership,
if applicable): Incomplete Outpatient Hospital Data, Rejected Encounters, Acceptance Rate,
Encounter Data Accuracy, and Generic Provider Number Usage.
Data sets collected from MCPs with data quality standards include: encounter data; case
management data; data used in the external quality review; members’ PCP data; and appeal and
grievance data.
1. ENCOUNTER DATA
For detailed descriptions of the encounter data quality measures below, see ODJFS Methods for
Encounter Data Quality Measures for CFC and ABD.
1.a. Encounter Data Completeness
Each MCP’s encounter data submissions will be assessed for completeness. The MCP is responsible
for collecting information from providers and reporting the data to ODJFS in accordance with
program requirements established in Appendix C, MCP Responsibilities. Failure to do so
jeopardizes the MCP’s ability to demonstrate compliance with other performance standards.
1.a.i. Encounter Data Volume
Measure: The volume measure for each service category, as listed in Table 2 below, is the rate of
utilization (e.g., discharges, visits) per 1,000 member months (MM).
Report Period: The report periods for the SFY 2008 and SFY 2009 contract periods are listed in
Table 1. below.