Common use of HSTP and the Medicaid Infrastructure Incentive Clause in Contracts

HSTP and the Medicaid Infrastructure Incentive. Program As part of XXX 00 XXX 438.6, the State has the authority to implement incentive payments to providers. CMS has approved Rhode Island’s 1115 Demonstration Waiver enabling EOHHS to proceed with the Health System Transformation Project (HSTP). The HSTP includes financial support in the form of incentives for activities attributable to the establishment of Accountable Entities through Medicaid managed care contracts and Health Work Force Development. Such incentive opportunities will be implemented in compliance 42 CFR 438.6. Associated HSTP incentive payments will be made directly by EOHHS to the Contractor based upon EOHHS approval of such arrangements and EOHHS determination of satisfactory compliance with such incentive arrangements. The 1115 waiver provide the financial foundation for the Medicaid Infrastructure Incentive Program (MIIP). Initiation of the MIIP is based upon executed contracts between EOHHS and contracted MCOs and, in turn, upon MCO contracts with EOHHS certified AEs. HSTP and MIIP programs must comply with EOHHS and CMS requirements. The HSTP is intended to be developed in partnership with MCO contractors. The Contractor will have the opportunity to partner with EOHHS Certified Comprehensive AEs for funding to support the design, development, and implementation of AE infrastructure, skills and capacity. Incentive based funding opportunities for AEs through the Contractor can begin upon EOHHS certification and execution of an EOHHS compliant APM contract between the Contractor and an AE. This section of the contract describes the MIIP, its component parts, and requirements for the Contractor. Incentive payments made pursuant to the MIIP are not to be considered part of the medical component of the premium payment made to the MCO. Incentive payments paid to the Contractor inclusive of payments made by the Contractor to AEs will not be included in any risk/gain share calculations between EOHHS and the Contractor or in any APM total cost of care calculations pertaining to arrangements with AEs. Total incentive payments inclusive of MIIP incentives, performance goal and/other provider performance-based payments cannot exceed five percent of capitation. The Contractor will implement the MIIP program in compliance with: EOHHS Medicaid Infrastructure Incentive Program: Requirements for Medicaid Managed Care Organizations and Certified Accountable Entities available at: xxx.xxxxx.xx.xxx. The EOHHS MIIP Incentive Requirements document will be amended annually by EOHHS as program specifications and requirements are refined, as the specific amount of available HSTP funding is determined, as the number of certified AEs and attributable lives becomes more fully known, and in respect to CMS review of HSTP program elements. Structure of the Medicaid Infrastructure Incentive Program

HSTP and the Medicaid Infrastructure Incentive. Program As part of XXX 00 XXX CFR 42 CFR 438.6, the State has the authority to implement incentive payments to providers. CMS has approved Rhode Island’s 1115 Demonstration Waiver enabling EOHHS to proceed with the Health System Transformation Project (HSTP). The HSTP includes financial support in the form of incentives for activities attributable to the establishment of Accountable Entities through Medicaid managed care contracts and Health Work Force Development. Such incentive opportunities will be implemented in compliance 42 CFR 438.6. Associated HSTP incentive payments will be made directly by EOHHS to the Contractor based upon EOHHS approval of such arrangements and EOHHS determination of satisfactory compliance with such incentive arrangements. The 1115 waiver provide the financial foundation for the Medicaid Infrastructure Incentive Program (MIIP). Initiation of the MIIP is based upon executed contracts between EOHHS and contracted MCOs and, in turn, upon MCO contracts with EOHHS certified AEs. HSTP and MIIP programs must comply with EOHHS and CMS requirements. The HSTP is intended to be developed in partnership with MCO contractors. The Contractor will have the opportunity to partner with EOHHS Certified Comprehensive AEs for funding to support the design, development, and implementation of AE infrastructure, skills and capacity. Incentive based funding opportunities for AEs through the Contractor can begin upon EOHHS certification and execution of an EOHHS compliant APM contract between the Contractor and an AE. This section of the contract describes the MIIP, its component parts, and requirements for the Contractor. Incentive payments made pursuant to the MIIP are not to be considered part of the medical component of the premium payment made to the MCO. Incentive payments paid to the Contractor inclusive of payments made by the Contractor to AEs will not be included in any risk/gain share calculations between EOHHS and the Contractor or in any APM total cost of care calculations pertaining to arrangements with AEs. Total incentive payments inclusive of MIIP incentives, performance goal and/other provider performance-based payments cannot exceed five percent of capitation. The Contractor will implement the MIIP program in compliance with: EOHHS Medicaid Infrastructure Incentive Program: Requirements for Medicaid Managed Care Organizations and Certified Accountable Entities available at: xxx.xxxxx.xx.xxx. The EOHHS MIIP Incentive Requirements document will be amended annually by EOHHS as program specifications and requirements are refined, as the specific amount of available HSTP funding is determined, as the number of certified AEs and attributable lives becomes more fully known, and in respect to CMS review of HSTP program elements. Structure of the Medicaid Infrastructure Incentive Program