Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program.
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS HMO Program Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 462.72 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. Dual Eligible Standard Rate $ 270.37 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. Nursing Facility – Medicaid Only $ 462.72 6. Nursing Facility – Dual Eligible $ 270.37 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 533.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. Dual Eligible Standard Rate $ 337.13 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. Nursing Facility – Medicaid Only $ 533.57 6. Nursing Facility – Dual Eligible $ 337.13 x CHIP HMO PROGRAM Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 89.60 2 Ages 1 through 5 $ 93.96 3 Ages 6 through 14 $ 60.55 4 Ages 15 through 18 $ 78.04 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 67.70 2 Ages 1 through 5 $ 67.69 3 Ages 6 through 14 $ 58.59 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 62.31 2 Ages 1 through 5 $ 97.40 3 Ages 6 through 14 $ 84.79 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through 5 $ 99.35 3 Ages 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Con...
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas. xCHIP Perinatal Program Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the CHIP Perinatal Program. ***
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Perinatal Program. The CHIP Perinatal Delivery Supplemental Payment is $3,100.00 for Perinates between 186% and 200% of the Federal Poverty Level for all Service Areas.
Delivery Supplemental Payment. A one-time per pregnancy supplemental payment for each delivery shall be paid to HMO in the following amount: $2.834.10. HMO will receive a DSP for each live or still birth. The one-time payment is made regardless of whether there is a single or multiple births at time of delivery. A delivery is the birth of a liveborn infant, regardless of the duration of the pregnancy, or a stillborn (fetal death) infant of 20 weeks or more gestation. A delivery does not include a spontaneous or induced abortion, regardless of the duration of the pregnancy.
Delivery Supplemental Payment. (DSP). HHSC shall pay to CONTRACTOR a one-time-per-pregnancy Delivery Supplemental Payment (DSP) in the amount of $3,000.00 for each live or still birth delivery. The one-time payment is made regardless of whether there is a single birth or multiple births at the time of delivery. For purposes of this section, a "delivery" is the birth of a live-born infant, regardless of the duration of the pregnancy, or a stillborn (fetal death) infant of 22 weeks or more gestation. CONTRACTOR should make its best effort to report all deliveries to the Administrative Services Contractor within 10 days of the delivery and no later than 45 days from the date of delivery. No DSP will be made for deliveries that are not reported by CONTRACTOR to the Administrative Services Contractor within 120 days from the receipt of claim, or within 60 days from the date of discharge from the hospital for the stay related to the delivery, whichever is later. HHSC reserves the right to audit the claims submitted for DSP to ensure the accuracy of those claims. The DSP will be paid to CONTRACTOR as part of the monthly premium payment after receiving an accurate report from CONTRACTOR.
Delivery Supplemental Payment. See Contract Attachment A, "Uniform Managed Care Contract Terms and Conditions," Article 10, for a description of the Delivery Supplemental Payment for the STAR Program. The STAR Delivery Supplemental Payments for the Service Areas covered by this contract are listed below. Service Area Delivery Supplemental Payment Xxxxxxx $3,409.95 Medicaid Rural Service Area - Central Texas $3,035.27 Medicaid Rural Service Area - Northeast Texas $3,160.40 Medicaid Rural Service Area - West Texas $3,204.07 þ Medicaid STAR+PLUS MCO Program Capitation: See Attachment A, “Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR+PLUS Program. Rate Period 3 Capitation Rates STAR + PLUS Service Area: Xxxxxxx Rate Cell 1 Medicaid Only Standard Rate $1,465.38 2 Medicaid Only HCBS STAR+PLUS Waiver Rate - Above Floor $3,890.75 3 Medicaid Only HCBS STAR+PLUS Waiver Rate - Below Floor $3,890.75 4 Dual Eligible Standard Rate $925.85 5 Dual Eligible HCBS STAR+PLUS Waiver Rate- Above Floor $1,896.11 6 Dual Eligible HCBS STAR+PLUS Waiver Rate- Below Floor $1,896.11 7 Nursing Facility - Medicaid Only $1,465.38 8 Nursing Facility - Dual Eligible $925.85 9 Individuals with Development Disabilities (IDD) - under age 21 $3,167.03 10 Individuals with Development Disabilities (IDD) - age 21 and older $964.64
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. xMedicaid STAR+PLUS HMO Program Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 3: *** xCHIP HMO PROGRAM Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 3: ***
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Delivery Supplemental Payment for the STAR Program. þ Medicaid STAR+PLUS MCO Program Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR+PLUS Program. The following Rate Cells will apply to Rate Period 1. STAR+PLUS Service Area: Bexar Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 Medicaid Only Standard Rate *** *** 2 Medicaid Only HCBS STAR +PLUS Waiver Rate - Above Floor *** *** 3 Medicaid Only HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 4 Dual Eligible Standard Rate *** *** 5 Dual Eligible HCBS STAR +PLUS Waiver Rate - Above Floor *** *** 6 Dual Eligible HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 7 Nursing Facility – Medicaid Only *** *** 8 Nursing Facility – Dual Eligible *** *** STAR+PLUS Service Area: Lubbock Rate Cell Rate Period 1 Capitation Rate(3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 Medicaid Only Standard Rate *** *** 2 Medicaid Only HCBS STAR +PLUS Waiver Rate - Above Floor *** *** 3 Medicaid Only HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 4 Dual Eligible Standard Rate *** *** 5 Dual Eligible HCBS STAR +PLUS Waiver Rate - Above Floor *** *** 6 Dual Eligible HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 7 Nursing Facility – Medicaid Only *** *** 8 Nursing Facility – Dual Eligible *** *** STAR+PLUS Service Area: Nueces Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 Medicaid Only Standard Rate *** *** 2 Medicaid Only HCBS STAR +PLUS Waiver Rate - Above Floor *** *** 3 Medicaid Only HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 4 Dual Eligible Standard Rate *** *** 5 Dual Eligible HCBS STAR +PLUS Waiver Rate - Above Floor *** *** 6 Dual Eligible HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 7 Nursing Facility – Medicaid Only *** *** 8 Nursing Facility – Dual Eligible *** *** þ CHIP MCO PROGRAM Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 1. Service Area:...
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas. Contractual Document (CD) Responsible Office: HHSC Office of General Counsel (OGC) Subject: HHSC Managed Care Contract HHSC Contract No. 529-06-0280-00002-K X CHIP Perinatal Program Capitation: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the CHIP Perinatal Program. Service Area: TARRANT Rate Period 3 Rate Cell Capitation Rates 1 Perinate Newborn 0% — 185% *****************REDACTED************** 2 Perinate Newborn 186% — 200% 3 Perinate 0% — 185% 4 Perinate 186% — 200% Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Perinatal Program. The CHIP Perinatal Delivery Supplemental Payment is $3,100.00 for Perinates between 186% and 200% of the Federal Poverty Level for all Service Areas.
