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

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Appendix O Covered Families and Children (CFC) population Page 1 APPENDIX O PAY-FOR PERFORMANCE (P4P) CFC ELIGIBLE POPULATION This Appendix establishes P4P for managed care plans (MCPs) to improve performance in specific areas important to the Medicaid MCP members. P4P include the at-risk amount included with the monthly premium payments (see Appendix F, Rate Chart), and possible additional monetary rewards up to $250,000. To qualify for consideration of any P4P, MCPs must meet minimum performance standards established in Appendix M, Performance Evaluation on selected measures, and achieve P4P standards established for selected Clinical Performance Measures. For qualifying MCPs, higher performance standards for three measures must be reached to be awarded a portion of the at-risk amount and any additional P4P (see Sections 1 and 2). An excellent and superior standard is set in this Appendix for each of the three measures. Qualifying MCPs will be awarded a portion of the at-risk amount for each excellent standard met. If an MCP meets all three excellent and superior standards, they may be awarded additional P4P (see Section 3). Prior to the transition to a regional-based statewide P4P system (SFY 2006 through SFY 2009), the county-based statewide P4P system (sections 1 and 2 of this Appendix) will apply to MCPs with membership as of February 1, 2006. Only counties with membership as of February 1, 2006 will be used to calculate performance levels for the county-based statewide P4P system. 1. SFY 2007 P4P 1.a. Qualifying Performance Levels To qualify for consideration of the SFY 2007 P4P, an MCP’s performance level must: 1) Meet the minimum performance standards set in Appendix M, Performance Evaluation, for the measures listed below; and 2) Meet the P4P standards established for the Emergency Department Diversion and Clinical Performance Measures below. A detailed description of the methodologies for each measure can be found on the BMHC page of the ODJFS website. Measures for which the minimum performance standard for SFY 2007 established in Appendix M, Performance Evaluation, must be met to qualify for consideration of P4P are as follows: 1. PCP Turnover (Appendix M, Section 2.a.) Report Period: CY 2006
Appendix O Covered Families and Children (CFC) population Page 2 2. Children’s Access to Primary Care (Appendix M, Section 2.b.) Report Period: CY 2006 3. Adults’ Access to Preventive/Ambulatory Health Services (Appendix M, Section 2.c.) Report Period: CY 2006 4. Overall Satisfaction with MCP (Appendix M, Section 3.) Report Period: The most recent consumer satisfaction survey completed prior to the end of the SFY 2007 contract period. For the EDD performance measure, the MCP must meet the P4P standard for the report period of July - December, 2006 to be considered for SFY 2007 P4P. The MCP meets the P4P standard if one of two criteria are met. The P4P standard is a performance level of either: 1) The minimum performance standard established in Appendix M, Section 4.b.; or 2) The Medicaid benchmark of a performance level at or below 1.1%. For each clinical performance measure listed below, the MCP must meet the P4P standard to be considered for SFY 2007 P4P. The MCP meets the P4P standard if one of two criteria are met. The P4P standard is a performance level of either: 1) The minimum performance standard established in Appendix M, Performance Evaluation, for seven of the nine clinical performance measures listed below; or 2) The Medicaid benchmarks for seven of the nine clinical performance measures listed below. The Medicaid benchmarks are subject to change based on the revision or update of applicable national standards, methods or benchmarks. Clinical Performance Measure Medicaid Benchmark 1. Perinatal Care - Frequency of Ongoing Prenatal Care 42% 2. Perinatal Care - Initiation of Prenatal Care 71% 3. Perinatal Care - Postpartum Care 48% 4. Well-Child Visits – Children who turn 15 months old 34% 5. Well-Child Visits - 3, 4, 5, or 6, years old 6. Well-Child Visits - 12 through 21 years old 7. Use of Appropriate Medications for People with Asthma 8. Annual Dental Visits 9. Blood Lead – 1 year olds 50% 30% 83% 40% 45%
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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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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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PCPs Capacity 1 Total Required Adam
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County Capacity 1 North West Region
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Provider Types Pediatricians 4 Nort
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Provider Types Pediatricians 4 Tota
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Provider Types Pediatricians 4 Sout
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Provider Types Pediatricians 4 Nort
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Appendix I Covered Families and Chi
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Appendix I Covered Families and Chi
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Appendix J Page 2 h. Prompt Pay Rep
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Appendix J Page 4 If the financial
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Regional Generic Provider Agreement - Ohio Department of Job and ...

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