Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
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Appendix L<br />
Covered Families <strong>and</strong> Children (CFC) population<br />
Page 14<br />
The designated PCP is the provider who will manage <strong>and</strong> coordinate the overall care for CFC<br />
members, including those who have case management needs. The MCP must submit a<br />
Members’ Designated PCP file every month. Specialists may <strong>and</strong> should be identified as the<br />
PCP as appropriate for the member’s condition per the specialty types specified for the CFC<br />
population in ODJFS Member’s PCP Data File <strong>and</strong> Submission Specifications; however, no<br />
CFC member may have more than one PCP identified for a given month.<br />
4.a. Timely submission <strong>of</strong> Member’s PCP Data<br />
Data Quality Submission Requirement: The MCP must submit a Members’ Designated PCP<br />
Data file on a monthly basis according to the specifications established in ODJFS Member’s<br />
PCP Data File <strong>and</strong> Submission Specifications.<br />
Penalty for noncompliance: See Appendix N, Compliance Assessment System, for the penalty<br />
for noncompliance with this requirement.<br />
4.b. Designated PCP for newly enrolled members (only applicable for report periods prior to<br />
January 2008)<br />
Measure: The percentage <strong>of</strong> MCP’s newly enrolled members who were designated a PCP by<br />
their effective date <strong>of</strong> enrollment.<br />
Report Periods: For the third <strong>and</strong> fourth quarters <strong>of</strong> SFY 2007, performance will be evaluated<br />
using the January – March 2007 <strong>and</strong> April – June 2007 report periods. For the SFY 2008<br />
contract period, performance will be evaluated using the July-September 2007, <strong>and</strong> October –<br />
December 2007 report periods.<br />
Data Quality St<strong>and</strong>ard: SFY 2007 will be informational only. A minimum rate <strong>of</strong> 75% <strong>of</strong> new<br />
members with PCP designation by their effective date <strong>of</strong> enrollment for quarter one <strong>and</strong> quarter<br />
two <strong>of</strong> SFY 2008.<br />
Statewide Approach: MCPs will be evaluated using a statewide result, including all active<br />
regions <strong>and</strong> counties (Mahoning <strong>and</strong> Trumbull) in which an MCP has CFC membership.<br />
Penalty for noncompliance: If an MCP is noncompliant with the st<strong>and</strong>ard, ODJFS will impose a<br />
monetary sanction <strong>of</strong> one-half <strong>of</strong> one percent the current month’s premium payment. Once the<br />
MCP is performing at st<strong>and</strong>ard levels <strong>and</strong> violations/deficiencies are resolved to the satisfaction<br />
<strong>of</strong> ODJFS, the money will be refunded. As stipulated in OAC rule 5101:3-26-08.2, each new<br />
member must have a designated primary care provider (PCP) prior to their effective date <strong>of</strong><br />
coverage. Therefore, MCPs are subject to additional corrective action measures under Appendix<br />
N, Compliance Assessment System, for failure to meet this requirement.<br />
4.b.i. Designated PCP for newly enrolled members (only applicable for report periods after<br />
December 2007)