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 M<br />
Covered Families <strong>and</strong> Children (CFC) population<br />
Page 3<br />
active region in which all selected MCPs had at least 10,000 members during each month <strong>of</strong> the<br />
entire report period.<br />
County <strong>and</strong> <strong>Regional</strong>-Based Minimum Performance St<strong>and</strong>ard: For the third <strong>and</strong> fourth quarters <strong>of</strong><br />
SFY 2007, a case management rate <strong>of</strong> 5.0%. For the first <strong>and</strong> second quarters <strong>of</strong> SFY 2008, a case<br />
management rate <strong>of</strong> 5.0%.<br />
Penalty for Noncompliance: The first time an MCP is noncompliant with a st<strong>and</strong>ard for this<br />
measure, ODJFS will issue a Sanction Advisory informing the MCP that any future noncompliance<br />
instances with the st<strong>and</strong>ard for this measure will result in ODJFS imposing a monetary sanction.<br />
Upon all subsequent measurements <strong>of</strong> performance, if an MCP is again determined to be<br />
noncompliant with the st<strong>and</strong>ard, ODJFS will impose a monetary sanction (see Section 5) <strong>of</strong> two<br />
percent <strong>of</strong> the current month’s premium payment. Monetary sanctions will not be levied for<br />
consecutive quarters that an MCP is determined to be noncompliant. If an MCP is noncompliant for<br />
a subsequent quarter, new member selection freezes or a reduction <strong>of</strong> assignments will occur as<br />
outlined in Appendix N <strong>of</strong> the <strong>Provider</strong> <strong>Agreement</strong>. Once the MCP is determined to be compliant<br />
with the st<strong>and</strong>ard <strong>and</strong> the violations/deficiencies are resolved to the satisfaction <strong>of</strong> ODJFS, the<br />
penalties will be lifted, if applicable, <strong>and</strong> monetary sanctions will be returned.<br />
1.b.ii.Case Management <strong>of</strong> Children (applicable to performance evaluation as <strong>of</strong> January, 2008)<br />
Measure: The average monthly case management rate for children under 21 years <strong>of</strong> age.<br />
Report Period: For the SFY 2008 contract period, January – March 2008, <strong>and</strong> April – June 2008<br />
report periods. For the SFY 2009 contract period, July – September 2008, October – December<br />
2008, January – March 2009, <strong>and</strong> April – June 2009 report periods.<br />
<strong>Regional</strong>-Based Statewide Approach: Performance will be evaluated using a regional-based<br />
statewide approach for all active regions <strong>and</strong> counties (Mahoning <strong>and</strong> Trumbull) in which the MCP<br />
has membership.<br />
<strong>Regional</strong>-Based Statewide Target: For the third <strong>and</strong> fourth quarters <strong>of</strong> SFY 2008, a case<br />
management rate <strong>of</strong> 5.0%. For SFY 2009, a case management rate <strong>of</strong> 5.0%.<br />
<strong>Regional</strong>-Based Statewide Minimum Performance St<strong>and</strong>ard: The level <strong>of</strong> improvement must result<br />
in at least a 20% decrease in the difference between the target <strong>and</strong> the previous report period’s<br />
results.<br />
Penalty for Noncompliance: The first time an MCP is noncompliant with a st<strong>and</strong>ard for this<br />
measure, ODJFS will issue a Sanction Advisory informing the MCP that any future noncompliance<br />
instances with the st<strong>and</strong>ard for this measure will result in ODJFS imposing a monetary sanction.<br />
Upon all subsequent measurements <strong>of</strong> performance, if an MCP is again determined to be<br />
noncompliant with the st<strong>and</strong>ard, ODJFS will impose a monetary sanction (see Section 5) <strong>of</strong> two<br />
percent <strong>of</strong> the current month’s premium payment. Monetary sanctions will not be levied for<br />
consecutive quarters that an MCP is determined to be noncompliant. If an MCP is noncompliant for