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

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Appendix L Covered Families and Children (CFC) population Page 2 Table 1. Report Periods for the SFY 2008 and 2009 Contract Periods Quarterly Report Periods Qtr 3 & Qtr 4 2004, 2005, 2006 Qtr 1 2007 Qtr 3 & Qtr 4 2004, 2005, 2006 Qtr 1, Qtr 2 2007 Qtr 4 2004, 2005, 2006 Qtr 1 thru Qtr 3 2007 Data Source: Estimated Encounter Data File Update Quarterly Report Estimated Issue Date July 2007 August 2007 October 2007 November 2007 January 2008 February 2008 Qtr 1 thru Qtr 4: 2005, 2006, 2007 April 2008 May 2008 Qtr 2 thru Qtr 4 2005, Qtr 1 thru Qtr 4: 2006, 2007 Qtr 1 2008 Qtr 3, Qtr 4: 2005, Qtr 1 thru Qtr 4: 2006, 2007 Qtr 1, Qtr 2 2008 Qtr 4: 2005, Qtr 1 thru Qtr 4: 2006, 2007 Qtr 1 thru Qtr 3: 2008 July 2008 August 2008 October 2008 November 2008 January 2009 February 2009 Qtr 1 thru Qtr 4: 2006, 2007, 2008 April 2009 May 2009 Contract Period SFY 2008 SFY 2009 Qtr1 = January to March Qtr2 = April to June Qtr3 = July to September Qtr4 = October to December
Appendix L Covered Families and Children (CFC) population Page 3 Table 2. Standards – Encounter Data Volume (County-Based Approach) Data Quality Standard, County-Based Approach: The standards in Table 2 apply to the MCP’s county-based results (see County-Based Approach below). The utilization rate for all service categories listed in Table 2 must be equal to or greater than the standard established in Table 2 below. Category Inpatient Hospital Emergency Department Measure per 1,000/MM Standard for Dates of Service 7/1/2003 thru 6/30/2004 Standard for Dates of Service 7/1/2004 thru 6/30/2006 Standard for Dates of Service on or after 7/1/2006 Discharges 5.4 5.0 5.4 51.6 51.4 50.7 Description General/acute care, excluding newborns and mental health and chemical dependency services Includes physician and hospital emergency department encounters Non-institutional and Dental 38.2 41.7 50.9 hospital dental visits Non-institutional and Vision Visits 11.6 11.6 10.6 hospital outpatient optometry and ophthalmology visits Primary and Specialist Care 220.1 225.7 233.2 Physician/practitioner and hospital outpatient visits Ancillary Services 144.7 123.0 133.6 Ancillary visits Behavioral Health Service 7.6 8.6 10.5 Inpatient and outpatient behavioral encounters Pharmacy Prescriptions 388.5 457.6 492.2 Prescribed drugs County-Based Approach: All counties with managed care membership as of February 1, 2006, will be included in a county-based encounter data volume measure until regional evaluation is implemented for the county’s applicable region.. Upon implementation of regional-based evaluation for a particular county’s region, the county will be included in the MCP’s regional-based results and will no longer be included in the MCP’s county-based results. County-based results will be determined by MCP (i.e., one utilization rate per service category for all applicable counties) and must be equal to or greater than the standards established in Table 2 above. [Example: The countybased result for MCP AAA, which has contracts in the Central and West Central regions, will include Franklin, Pickaway, Montgomery, Greene and Clark counties (i.e., counties with managed care membership as of February 1, 2006). When the regional-based evaluation is implemented for the Central region, Franklin and Pickaway counties, along with all other counties in the region, will then be included in the Central region results for MCP AAA; Montgomery, Greene, and Clark
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Baseline Covered Families and Child
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APPENDIX A OAC RULES 5101:3-26 The
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Appendix C Covered Families and Chi
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Appendix D Covered Families and Chi
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Appendix D Covered Families and Chi
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APPENDIX E RATE METHODOLOGY CFC ELI
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APPENDIX F REGIONAL RATES 2. AT-RIS
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Appendix G Covered Families and Chi
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Page 111 and 112: PCPs Capacity 1 North East Central
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Page 115 and 116: PCPs Capacity 1 Total Required Adam
Page 117 and 118: County Capacity 1 North West Region
Page 119 and 120: Provider Types Pediatricians 4 Nort
Page 121 and 122: Provider Types Pediatricians 4 Tota
Page 123 and 124: Provider Types Pediatricians 4 Sout
Page 125 and 126: Provider Types Pediatricians 4 Nort
Page 127 and 128: Appendix I Covered Families and Chi
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Page 131 and 132: Appendix J Page 2 h. Prompt Pay Rep
Page 133 and 134: Appendix J Page 4 If the financial
Page 135 and 136: Appendix J Page 6 Penalty for nonco
Page 137 and 138: Appendix J Page 8 6. NOTIFICATION O
Page 139 and 140: Appendix K Covered Families and Chi
Page 141: Appendix L Covered Families and Chi
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Page 157 and 158: Appendix M Covered Families and Chi
Page 177 and 178: Appendix N Covered Families and Chi
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Appendix P Covered Families and Chi
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Appendix P Covered Families and Chi
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