Common use of FQHCs and RHCS Clause in Contracts

FQHCs and RHCS. The MCO will submit a quarterly data report of FQHC or RHC copayments for service dates on or after January 1, 2015 in accordance with section 3.8(C) below. In the event that a FQHC/RHC contacts the MCO or the STATE regarding payments made to the FQHC/RHC prior to January 1, 2015, but not included in any submitted report, the MCO shall review, and if appropriate, must submit the missing data. Within eight (8) business days of receipt of this report, the STATE shall provide the MCO a return file that contains incorrect data lines that cannot be read by the system and loaded. The MCO must review the data lines and correct appropriately. Corrected data lines must be resubmitted within thirty (30) days, and shall be reported separately as a corrected file. The MCO shall not resubmit data already submitted and accepted. Payment for ad hoc Reporting. The STATE may require reimbursement at standard rates for ad hoc reports requested of the STATE. For the purposes of this section, “standard rates” means those listed in the STATE policy “DHS Policies and Procedures for Handling Protected Information: 2.60 Data Requests and Copy Costs” available at xxxx://xxx.xxx.xxxxx.xx.xx/id_017855. Reporting on MSHO Stakeholder Group. For the MCO’s local or regional stakeholder group (as required in section 7.4.4) the MCO will submit to the STATE twice per Contract Year, on or before June 15th and December 15th, documentation in the form of stakeholder meeting agendas and meeting minutes that demonstrate the MCO response to significant concerns raised by stakeholder group participants. The STATE shall provide the MCO with an electronic listing of all enrolled MHCP Providers and their NPI or UMPI numbers on a monthly basis. The MCO must update the Provider identification numbers by submitting, for Providers who are new to the MCO and do not already have a STATE Provider number (UMPI) or NPI, current complete demographic information about the Provider, on a form approved by the STATE. The MCO shall not require Providers to enroll as an MHCP FFS Provider. If a Provider will only be serving MCO Enrollees, the MCO shall follow the process established by the STATE for MCO-only Providers. Payment Review Information. The MCO shall identify aggregate payment information for specific Provider categories and assess the information as to how it compares to FFS payment information. As part of the assessment the MCO will also be expected to provide an explanation of the basis for how the Provider category payment was determined. The STATE will provide the Provider categories and the template for this report sixty (60) days in advance of the report’s due date. The first report will be due March 15, 2017, and thereafter no later than February 1 of the Contract Year.