Capitation Withhold and Adjusting Payments. Effective July 1, 2018 EOHHS will withhold 0.5% of monthly capitation amounts. EOHHS will consider the withhold, for the prorated period of July 1, 2018 through December 31, 2018, as earned due to the Contractor’s efforts in advancing the development of APMs. The withheld amounts will be repaid as quarterly adjusting payments subject to the Contractor’s demonstration that it has achieved the threshold values in APM payments for the reporting period as set forth in Section 0.00.00.00.00 (Alternative Payment Methodology for Each Contract Period). Such demonstration will be on the basis of quarterly submissions of the “Alternative Payment Methodology Reporting Template for Managed Care Organizations” (included as ATTACHMENT D to Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners and EOHHS review of the submitted report. If the Contractor does not achieve the threshold value within the prescribed period, EOHHS will consider the amount forfeited and retained accordingly. Quarterly submissions and adjusting payments will be based on cumulative performance for the Contract Period. The Contractor submissions to EOHHS for “Alternative Payment Methodology Reporting Template for Managed Care Organizations” will be done in accordance with timeline on Reporting Calendar. EOHHS will review the report within thirty (30) days of receipt of the report. Based on review by EOHHS of the completeness and accuracy of the report adjusting payments to the Contractor within forty-five (45) days of receipt of the report.
Capitation Withhold and Adjusting Payments. Effective July 1, 2018 EOHHS will withhold 0.5% of monthly capitation amounts. EOHHS will consider the withhold, for the prorated period of July 1, 2018 through December 31, 2018, as earned due to the Contractor’s efforts in advancing the development of APMs. The withheld amounts will be repaid as quarterly adjusting payments subject to the Contractor’s demonstration that it has achieved the threshold values in APM payments for the reporting period as set forth in Section 0.00.00.
