INSERT NEW SECTION H. 14.2 The Contractor shall provide language in all of their provider's contracts and subcontracts that preclude balance billing, except for any outstanding co-payments. Medicaid payment is "payment in full". The contractor's contract shall preclude their providers from sending individual Medicaid recipient's bills to collections agencies. -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- POHC-2002-D-0003 PAGE 21 OF 23 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- CONTRACT MODIFICATION - M0001 DCHFP SUMMARY SHEET -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- CONTRACT SECTION CHANGED FROM CHANGED TO -------------------------------------------------------------------------------- Protection of enrollees against balance billing through subcontractors (Amends SSA 1128B (d)(1) --BBA 4704(b) Section 1128b(d)(1) of the Act authorizes criminal penalties to providers in the case of services provided to an individual enrolled with a managed care organization under contract under section 1903(m) of the Act which are charged at a rate in excess of the rate permitted under the organization's contract. Section 1128B(d)(1) of the Act states that whoever knowingly and willfully charges, for any service provided to a patient under a State plan approved under Title XIX or under a managed care organization contract under 1903(m) of the Act, money or other consideration at a rate in excess of the rates established by the State or contract shall be guilty of a felony and upon conviction shall be fined no more than $25,000 or imprisoned for no more than five years, or both. --------------------------------------------------------------------------------
INSERT NEW SECTION H. 1.1.2.7 If more than one MCO is claiming payment for a newborn, MAA will only pay the MCO that demonstrates services rendered to the newborn. The MCO must submit written notification to MAA of the following information: . Newborn's name; . Newborn's Medicaid number; . Newborn's Date of birth; . Date of service; . Diagnosis treatment; . Provider of service; and . Provider's address and telephone number.
