Acceptance of State. Capitation Payments Contractor shall be capitated for all in-plan services, as described in Section 2.6 of this Agreement, in the amount as specified in Attachment E, and such reimbursement shall be subject to all conditions specified in this Agreement. The monthly capitation rates set forth in Attachment E shall not be subject to change during the effective period therein specified except: (1) by Federal or State law; or (2) to cover additional services not currently included in Attachment A or to reflect a reduction in covered services; or unless such change has been negotiated in accordance with Section 3.3 of this Agreement. Such change in rates shall not be effective until agreed upon in writing by the parties or, in the event of a change due to (1) above, until prior written notice by the State to the Contractor. The State shall make Capitation Payments to Contractor on a monthly basis via electronic funds transfer in the following manner: • For members on or before the last day of every month, Contractor shall receive a roster of individuals projected to be enrolled in or assigned to Contractor for the following month. • For members on or before the fifth (5th) calendar day of every month, Contractor shall receive capitation payments for individuals projected to be enrolled or assigned to Contractor for that month, based on the roster provided at the end of the preceding month (see above). These payments shall reimburse Contractor for services rendered to these individuals during that month. Contractor agrees to accept enrollment information and capitation payments in this manner and shall have written policies and procedures for receiving and processing capitation payments. Notwithstanding any other provision of this agreement, the State shall, beginning the second contract period commencing July 1, 2021 and continuing each contract period thereafter, establish age band specific capitation rates so as to equitably reflect the distribution of enrollees among the RIte Smiles program participating plans. The State will utilize encounter data from the participating plans in the rate setting process.
Acceptance of State and Municipal Department Violations and Orders. The Purchaser accepts the Property subject to all notes or notices of violations, known or unknown, of law or local ordinances, orders, or requirements noted in or issued by any governmental department having authority as to lands, housing, buildings, fire, and health and labor conditions affecting the Property. This provision shall survive the Closing.
Acceptance of State. Capitation Payments is amended by REVISING the following, from “1/301h” to “1/30th.” 105. 2.15.01.01 Fee Schedule Increase and Adoption of Minimum/Maximum Fee Schedule is amended by DELETING the section in its entirety, and REPLACING with section “2.15.01.01 Fee Schedule Increase, Adoption of Minimum/Maximum Fee Schedule and State Directed Payment Requirements, EOHHS may require the MCO to adopt a minimum fee schedule for network providers, provide a uniform dollar or percentage increase for network providers or adopt a max fee schedule so long as MCO retains ability to reasonably manage risk. 42 CFR § 438.6(c) sets forth criteria to receive written approval prior to implementation the arrangement shall be developed as outlined there by submitting a “preprint” to CMS. Per the 2020 Medicaid and CHIP final rule at 42 C.F.R. § 438.6(c)(1)(iii)(A), States no longer need to submit a preprint for prior approval to adopt minimum fee schedules using State plan approved rates as defined in 42 C.F.R. § 438.6(a). Rates for Nursing Facilities, Inpatient Hospitals, and Outpatient Hospital are set annually based on Rhode Island General Law. MCOs must comply with the following State directed payments: Pre-Print Description Pre-Print Payment Requirement Effective Date Hospital Inpatient and Outpatient Rates 2.4% increase over prior year rates 7/1/2021 Nursing Home Rates 2.2% increase over prior year rates 10/1/2021 PCMH PMPM $3.00 PMPM for each member attributed to providers that meet the OHIC definition of PCMH as stated here. 7/1/2021 PCMH quality incentive $0.50 PMPM incentive for each member attributed to providers that meet quality targets on clinical target measures outlined here. 7/1/2021 CTC payment $1.15 PMPM paid to the Care Transformation Collaborative for administration of the program, for each member attributed to providers that meet the OHIC definition of PCMH. Administration includes such activities as: practice facilitation, technical assistance, coaching, and learning collaboratives to support practices in achieving the necessary requirements to become NCQA and OHIC recognized as a PCMH upon completion of the program. 7/1/2021 Level IV Detox $1,617.00 per diem 7/1/2021 • Increase to Pediatricians Rates to ensure access to care: In order to ensure adequate access to primary care for children, EOHHS requires that a minimum fee schedule for participating pediatricians be set at seventy-five percent (75%) of RI Medicare rates for all E&M codes. This increase ...
Acceptance of State. Capitation Payments Contractor shall be capitated for all in-plan services, as described in Section 2.06 in the amount specified in Attachment E, and such reimbursement shall be subject to all conditions specified in this Agreement. The monthly capitation rates set forth in Attachment E shall not be subject to change during the effective period therein specified except: (1) by Federal or State law; or (2) to cover additional services not currently included in Attachment A or to reflect a reduction in covered services; or
