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

More documents

Recommendations

Info

Appendix O Covered Families and Children (CFC) population Page 5 Medicaid Clinical Performance Measure 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 2.b. Excellent and Superior Performance Levels 50% 30% 83% 40% 45% For qualifying MCPs as determined by Section 2.a., performance will be evaluated on the measures below to determine the status of the at-risk amount or any additional P4P that may be awarded. Excellent and Superior standards are set for the three measures described below. The standards are subject to change based on the revision or update of applicable national standards, methods or benchmarks. A brief description of these measures is provided in Appendix M, Performance Evaluation. A detailed description of the methodologies for each measure can be found on the BMHC page of the ODJFS website. 1. Case Management of Children (Appendix M, Section 1.b.i.) Report Period: April - June 2008 Excellent Standard: 5.5% Superior Standard: 6.5% 2. Use of Appropriate Medications for People with Asthma (Appendix M, Section 1.c.v.) Report Period: CY 2007 Excellent Standard: 86% Superior Standard: 88% 3. Adults’ Access to Preventive/Ambulatory Health Services (Appendix M, Section 2.c.) Report Period: CY 2007 Excellent Standard: 76%
Appendix O Covered Families and Children (CFC) population Page 6 Superior Standard: 84% 2.c. Determining SFY 2008 P4P MCP’s reaching the minimum performance standards described in Section 2.a. herein, will be considered for P4P including retention of the at-risk amount and any additional P4P. For each Excellent standard established in Section 2.b. herein, that an MCP meets, one-third of the at-risk amount may be retained. For MCPs meeting all of the Excellent and Superior standards established in Section 2.b. herein, additional P4P may be awarded. For MCPs receiving additional P4P, the amount in the P4P fund (see Section 3.) will be divided equally, up to the maximum additional amount, among all MCPs’ ABD and/or CFC programs receiving additional P4P. The maximum additional amount to be awarded per plan, per program, per contract year is $250,000. An MCP may receive up to $500,000 should both of the MCP’s ABD and CFC programs achieve the Superior Performance Levels. 3. NOTES 3.a. Transition from a county-based statewide to a regional-based statewide P4P system. The current county-based statewide P4P system will transition to a regional-based statewide system as managed care expands statewide. The regional-based statewide approach will be fully phased in no later than SFY 2010. The regional-based statewide P4P system will be modeled after the county-based statewide system with adjustments to performance standards where appropriate. 3.a.i. County-based statewide P4P system For MCPs in their first twenty-four months of Ohio Medicaid CFC Managed Care Program participation, the status of the at-risk amount will not be determined because compliance with many of the standards cannot be determined in an MCP’s first two contract years (see Appendix F., Rate Chart). In addition, MCPs in their first two contract years are not eligible for the additional P4P amount awarded for superior performance. Starting with the twenty-fifth month of participation in the program, a new MCP’s at-risk amount will be included in the P4P system. The determination of the status of this at-risk amount will be after at least three full calendar years of membership as many of the performance standards require three full calendar years to determine an MCP’s performance level. Because of this requirement, more than 12 months of at-risk dollars may be included in an MCP’s first atrisk status determination depending on when an MCP starts with the program relative to the calendar year. During the transition to a regional-based statewide system (SFY 2006 through SFY 2009), MCPs with membership as of February 1, 2006 will continue in the county-based statewide P4P system until the transition is complete. These MCPs will be put at-risk for a portion of the premiums received for members in counties they are serving as of February 1, 2006.
Page 1 and 2:
Baseline Covered Families and Child
Page 3 and 4:
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
APPENDIX A OAC RULES 5101:3-26 The
Page 15 and 16:
Appendix C Covered Families and Chi
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Appendix D Covered Families and Chi
Page 43 and 44:
Appendix D Covered Families and Chi
Page 45:
APPENDIX E RATE METHODOLOGY CFC ELI
Page 75 and 76:
APPENDIX F REGIONAL RATES 2. AT-RIS
Page 77 and 78:
Appendix G Covered Families and Chi
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Appendix H Covered Families and Chi
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Appendix H Page 10 ensure that the
Page 103 and 104:
General Hospital 1 Hospital System
Page 105 and 106:
Minimum Provider Panel Requirements
Page 107 and 108:
Minimum Provider Panel Requirements
Page 109 and 110:
General Hospital 1 Total Required H
Page 111 and 112:
PCPs Capacity 1 North East Central
Page 113 and 114:
County Capacity 1 Central Region -
Page 115 and 116:
PCPs Capacity 1 Total Required Adam
Page 117 and 118:
County Capacity 1 North West Region
Page 119 and 120:
Provider Types Pediatricians 4 Nort
Page 121 and 122:
Provider Types Pediatricians 4 Tota
Page 123 and 124:
Provider Types Pediatricians 4 Sout
Page 125 and 126:
Provider Types Pediatricians 4 Nort
Page 127 and 128:
Appendix I Covered Families and Chi
Page 129 and 130:
Appendix I Covered Families and Chi
Page 131 and 132:
Appendix J Page 2 h. Prompt Pay Rep
Page 133 and 134:
Appendix J Page 4 If the financial
Page 135 and 136:
Appendix J Page 6 Penalty for nonco
Page 137 and 138:
Appendix J Page 8 6. NOTIFICATION O
Page 139 and 140: Appendix K Covered Families and Chi
Page 141 and 142: Appendix L Covered Families and Chi
Page 157 and 158: Appendix M Covered Families and Chi
Page 177 and 178: Appendix N Covered Families and Chi
Page 187 and 188: Appendix O Covered Families and Chi
Page 189: Appendix O Covered Families and Chi
Page 193 and 194: Appendix P Covered Families and Chi
Page 195: Appendix P Covered Families and Chi
show all

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

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?