Common use of Delivery Supplemental Payment Clause in Contracts

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: 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 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: Rate Cell Rate Period 2 Capitation Rates 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.

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 26: 1. STAR+PLUS Service Area: BEXAR 1 Medicaid Only Standard Rate $ 462.72 2. 613.65 $ 618.02 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. 3,453.66 $ 3,536.34 3 Dual Eligible Standard Rate $ 270.37 4. 236.95 $ 236.95 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. 1,469.55 $ 1,480.61 5 Nursing Facility – - Medicaid Only $ 462.72 6. 613.65 $ 618.02 6 Nursing Facility – - Dual Eligible $ 270.37 1. 236.95 $ 236.95 1 Medicaid Only Standard Rate $ 533.57 2. 403.39 $ 408.44 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. 2,069.42 $ 2,095.29 3 Dual Eligible Standard Rate $ 337.13 4. 189.19 $ 189.77 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. 1,250.55 $ 1,254.36 5 Nursing Facility – - Medicaid Only $ 533.57 6. 403.39 $ 408.44 6 Nursing Facility – - Dual Eligible $ 337.13 x 189.19 $ 189.77 1 Medicaid Only Standard Rate $ 611.55 $ 615.67 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,395.03 $ 3,485.14 3 Dual Eligible Standard Rate $ 179.87 $ 179.87 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,710.22 $ 1,724.30 5 Nursing Facility - Medicaid Only $ 611.55 $ 615.67 6 Nursing Facility - Dual Eligible $ 179.87 $ 179.87 þ 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 26: Rate Cell Rate Period 1 < Age 1 $ 216.50 2 Capitation Rates Ages 1 through 5 $ 110.20 3 Ages 6 through 14 $ 78.69 4 Ages 15 through 18 $ 106.54 1 < Age 1 $ 237.92 2 Ages 1 through 5 $ 102.58 3 Ages 6 through 14 $ 74.56 4 Ages 15 through 18 $ 109.03 1 < Age 1 $ 146.81 2 Ages 1 through 5 $ 112.05 3 Ages 6 through 14 $ 65.48 4 Ages 15 through 18 $ 125.81 1 < Age 1 $ 127.64 2 Ages 1 through 5 $ 103.89 3 Ages 6 through 14 $ 69.85 4 Ages 15 through 18 $ 89.50 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.

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 23: 1. Medicaid Only Standard Rate $ 462.72 526.51 $513.06 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 2,748.46 $2,664,76 3. Dual Eligible Standard Rate $ 270.37 287.26 $272.04 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 1,845.00 $1,770.13 5. Nursing Facility – Medicaid Only $ 462.72 526.51 $513.06 6. Nursing Facility – Dual Eligible $ 270.37 287.26 $272.04 7. Bariatric Supplemental Payment $23,000.00 $23,000.00 1. Medicaid Only Standard Rate $ 533.57 614.57 $598.91 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 2,487.20 $2,417.60 3. Dual Eligible Standard Rate $ 337.13 393.22 $374.48 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 1,672.29 $1,610.98 5. Nursing Facility – Medicaid Only $ 533.57 614.57 $598.91 6. Nursing Facility – Dual Eligible $ 337.13 393.22 $374.48 7. Bariatric Supplemental Payment $23,000.00 $23,000.00 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 23: Rate Cell Rate Period 2 3 Capitation Rates 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.

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 23: 1. Medicaid Only Standard Rate $ 462.72 526.51 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 2,748.46 3. Dual Eligible Standard Rate $ 270.37 287.26 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 1,845.00 5. Nursing Facility – Medicaid Only $ 462.72 526.51 6. Nursing Facility – Dual Eligible $ 270.37 287.26 1. Medicaid Only Standard Rate $ 533.57 614.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 2,487.20 3. Dual Eligible Standard Rate $ 337.13 393.22 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 1,672.29 5. Nursing Facility – Medicaid Only $ 533.57 614.57 6. Nursing Facility – Dual Eligible $ 337.13 393.22 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 23: Rate Cell Rate Period 2 3 Capitation Rates 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.

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 þ Medicaid STAR+PLUS HMO 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 and Capitation Rates will apply to Rate Period 2: 1. 1 Medicaid Only Standard Rate $ 462.72 2. *** *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR +PLUS Waiver Rate $ 3,138.64 3. - Above Floor *** *** 3 Medicaid Only HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 4 Dual Eligible Standard Rate $ 270.37 4. *** *** 5 Dual Eligible 1915(C) Nursing Facility HCBS STAR +PLUS Waiver Rate $ 1,931.47 5. - Above Floor *** *** 6 Dual Eligible HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 7 Nursing Facility – Medicaid Only $ 462.72 6. *** *** 8 Nursing Facility – Dual Eligible $ 270.37 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 *** *** o CHIP HMO 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 2: Rate Cell Rate Period 1. 1 < Age 1 2 Capitation Rates Ages 1 through 5 3 Ages 6 through 14 4 Ages 15 through 18 5 Perinate Newborn 0% to 185% 6 Perinate Newborn Above 185% to 200% 7 Perinate 0% to 185% 8 Perinate Above 185% to 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 ProgramProgram and CHIP Perinatal subprogram. The CHIP Delivery Supplemental Payment is $3,100.00 *** for all Service Areas.. Modifications to Part 10 of the HHSC Managed Care Contract document, "Contract Attachments," are italicized below:

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: 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 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: Rate Cell Rate Period 2 Capitation Rates 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. 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. 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. See Contract 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 The STAR Delivery Supplemental Payments for the Service Areas covered by this contract are listed below. þ Medicaid STAR+PLUS HMO 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 and Capitation Rates will apply to Rate Period 2: 1. Cell 1 Medicaid Only Standard Rate $ 462.72 2. *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR+PLUS Waiver Rate $ 3,138.64 3. - Above Floor *** 3 Medicaid Only HCBS STAR+PLUS Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 270.37 4. *** 5 Dual Eligible 1915(C) HCBS STAR+PLUS Waiver Rate- Above Floor *** 6 Dual Eligible HCBS STAR+PLUS Waiver Rate- Below Floor *** 7 Nursing Facility Waiver Rate $ 1,931.47 5. - Medicaid Only *** 8 Nursing Facility – Medicaid Only $ 462.72 6. Nursing Facility – - Dual Eligible $ 270.37 1. *** Rate Cell 1 Medicaid Only Standard Rate $ 533.57 2. *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR+PLUS Waiver Rate $ 3,062.58 3. - Above Floor *** 3 Medicaid Only HCBS STAR+PLUS Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 337.13 4. *** 5 Dual Eligible 1915(C) HCBS STAR+PLUS Waiver Rate- Above Floor *** 6 Dual Eligible HCBS STAR+PLUS Waiver Rate- Below Floor *** 7 Nursing Facility Waiver Rate $ 1,887.61 5. - Medicaid Only *** 8 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: Rate Cell Rate Period 2 Capitation Rates 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.***