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

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Appendix M Covered Families and Children (CFC) population Page 10 Action Required for Noncompliance (12-21 year old age group): Beginning SFY 2007, if the standard is not met and the results are below 30% (33% for SFY 2009), the MCP is required to complete a Corrective Action Plan to address the area of noncompliance. If the standard is not met and the results are at or above 30% (33% for SFY 2009), ODJFS will issue a Quality Improvement Directive which will notify the MCP of noncompliance and may outline the steps that the MCP must take to improve the results. 1.c.v. Use of Appropriate Medications for People with Asthma Measure: The percentage of members with persistent asthma who were enrolled for at least 11 months with the plan during the year and who received prescribed medications acceptable as primary therapy for long-term control of asthma. County-Based Statewide Target: At least 95% of the eligible population must receive the recommended medications. County-Based Statewide Minimum Performance Standard: The level of improvement must result in at least a 10% decrease in the difference between the target and the previous year’s results. Regional-Based Statewide Target: TBD Regional-Based Statewide Minimum Performance Standard: TBD Action Required for Noncompliance: Beginning SFY 2007, if the standard is not met and the results are below 83% (84% for SFY 2009), the MCP is required to complete a Corrective Action Plan to address the area of noncompliance. If the standard is not met and the results are at or above 83% (84% for SFY 2009), ODJFS will issue a Quality Improvement Directive which will notify the MCP of noncompliance and may outline the steps that the MCP must take to improve the results. 1.c.vi. Annual Dental Visits Measure: The percentage of enrolled members age 4 through 21 who were enrolled for at least 11 months with the plan during the year and who had at least one dental visit during the year. County-Based Statewide Target: At least 60% of the eligible population receive a dental visit. County-Based Statewide Minimum Performance Standard: The level of improvement must result in at least a 10% decrease in the difference between the target and the previous year’s results. Regional-Based Statewide Target: TBD Regional-Based Statewide Minimum Performance Standard: TBD
Appendix M Covered Families and Children (CFC) population Page 11 Action Required for Noncompliance: Beginning SFY 2007, if the standard is not met and the results are below 40% (42% for SFY 2009), the MCP is required to complete a Corrective Action Plan to address the area of noncompliance. If the standard is not met and the results are at or above 40% (42% for SFY 2009), ODJFS will issue a Quality Improvement Directive which will notify the MCP of noncompliance and may outline the steps that the MCP must take to improve the results. 1.c.vii. Lead Screening Measure: The percentage of one and two year olds who received a blood lead screening by age group. County-Based Statewide Target: At least 80% of the eligible population receive a blood lead screening. County-Based Statewide Minimum Performance Standard for Each of the Age Groups: The level of improvement must result in at least a 10% decrease in the difference between the target and the previous year’s results. Regional-Based Statewide Target: TBD Regional-Based Statewide Minimum Performance Standard for Each of the Age Groups: TBD Action Required for Noncompliance (1 year olds): Beginning SFY 2007, if the standard is not met and the results are below 45% the MCP is required to complete a Corrective Action Plan to address the area of noncompliance. If the standard is not met and the results are at or above 45%, ODJFS will issue a Quality Improvement Directive which will notify the MCP of noncompliance and may outline the steps that the MCP must take to improve the results. Action Required for Noncompliance (2 year olds): Beginning SFY 2007, if the standard is not met and the results are below 28% the MCP is required to complete a Corrective Action Plan to address the area of noncompliance. If the standard is not met and the results are at or above 28%, ODJFS will issue a Quality Improvement Directive which will notify the MCP of noncompliance and may outline the steps that the MCP must take to improve the results. 2. ACCESS Performance in the Access category will be determined by the following measures: Primary Care Provider (PCP) Turnover, Children’s Access to Primary Care, Adults’ Access to Preventive/Ambulatory Health Services, and Members’ Access to Designated PCP. For a comprehensive description of the access performance measures below, see ODJFS Methods for Access Performance Measures for the CFC Managed Care Program. 2.a. PCP Turnover A high PCP turnover rate may affect continuity of care and may signal poor management of providers. However, some turnover may be expected when MCPs end contracts with providers who
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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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Appendix H Covered Families and Chi
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Appendix H Page 10 ensure that the
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General Hospital 1 Hospital System
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Minimum Provider Panel Requirements
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Minimum Provider Panel Requirements
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General Hospital 1 Total Required H
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PCPs Capacity 1 North East Central
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County Capacity 1 Central Region -
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