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

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