Medicaid Capitation Rates Sample Clauses

Medicaid Capitation Rates. In full consideration of services in the Medicaid benefit package rendered by the MCO for each enrolled member, the Department agrees to pay the MCO a monthly capitation rate. The capitation rates shall be based on an actuarially sound methodology as required by federal regulations. The capitation rates shall include funding to support relocation of members from institutional settings into the most integrated community setting. The capitation rate shall not include any amount for recoupment of losses incurred by the MCO under previous contracts nor does it include services that are not covered under the State Plan. When the rate cell used to process a member’s capitation payment changes in the middle of a month, the Department will use a daily rate to calculate the capitation payment for the member. This daily rate is based on the annualized monthly capitation rate (i.e. monthly capitation rate times twelve months) divided by the number of days in the contracted calendar year and rounded to the fourth digit to the right of the decimal. Payment of the rate is based on the daily rate multiplied by the number of days the member was enrolled for the month and rounded to the nearest cent. Examples of mid- month changes that would require the use of a daily rate to calculate the capitation rate include enrollment and disenrollments between programs or MCOs, changes in the nursing home level of care for PACE/Partnership members, and changes between a nursing home level of care and a non-nursing home level of care for Family Care members.
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Related to Medicaid Capitation Rates

  • Medicaid Enrollment Treatment Grantees shall enroll as a provider with Texas Medicaid and Healthcare Partnership (TMHP) and all Medicaid Managed Care organizations in Grantee’s service region within the first quarter of this procurement term and maintain through the procurement term.

  • Medicaid If and when the Resident’s assets/funds have fallen below the Medicaid eligibility levels, and the Resident otherwise satisfies the Medicaid eligibility requirements and is not entitled to any other third party coverage, the Resident may be eligible for Medicaid (often referred to as the “payor of last resort”). THE RESIDENT, RESIDENT REPRESENTATIVE AND SPONSOR AGREE TO NOTIFY THE FACILITY AT LEAST THREE (3) MONTHS PRIOR TO THE EXHAUSTION OF THE RESIDENT’S FUNDS (APPROXIMATELY $50,000) AND/OR INSURANCE COVERAGE TO CONFIRM THAT A MEDICAID APPLICATION HAS OR WILL BE SUBMITTED TIMELY AND ENSURE THAT ALL ELIGIBILITY REQUIREMENTS HAVE BEEN MET. THE RESIDENT, RESIDENT REPRESENTATIVE AND/OR SPONSOR AGREE TO PREPARE AND FILE AN APPLICATION FOR MEDICAID BENEFITS PRIOR TO THE

  • Medicare Parts A and B of the health care program for the aged and disabled provided by Title XVIII of the United States Social Security Act, as amended from time to time. [MEMBER]. An eligible person who is covered under this Contract (includes Covered Employee[ and covered Dependents, if any)].

  • Long Term Cost Evaluation Criterion # 4 READ CAREFULLY and see in the RFP document under "Proposal Scoring and Evaluation". Points will be assigned to this criterion based on your answer to this Attribute. Points are awarded if you agree not i ncrease your catalog prices (as defined herein) more than X% annually over the previous year for years two and thr ee and potentially year four, unless an exigent circumstance exists in the marketplace and the excess price increase which exceeds X% annually is supported by documentation provided by you and your suppliers and shared with TIP S, if requested. If you agree NOT to increase prices more than 5%, except when justified by supporting documentati on, you are awarded 10 points; if 6% to 14%, except when justified by supporting documentation, you receive 1 to 9 points incrementally. Price increases 14% or greater, except when justified by supporting documentation, receive 0 points. increases will be 5% or less annually per question Required Confidentiality Claim Form This completed form is required by TIPS. By submitting a response to this solicitation you agree to download from th e “Attachments” section, complete according to the instructions on the form, then uploading the completed form, wit h any confidential attachments, if applicable, to the “Response Attachments” section titled “Confidentiality Form” in order to provide to TIPS the completed form titled, “CONFIDENTIALITY CLAIM FORM”. By completing this process, you provide us with the information we require to comply with the open record laws of the State of Texas as they ma y apply to your proposal submission. If you do not provide the form with your proposal, an award will not be made if your proposal is qualified for an award, until TIPS has an accurate, completed form from you. Read the form carefully before completing and if you have any questions, email Xxxx Xxxxxx at TIPS at xxxx.xxxxxx@t xxx-xxx.xxx

  • EMPLOYEE EVALUATION A. Formal evaluation of employees shall be in writing and shall be for the purpose of establishing a record of the employee’s work performance. The evaluation may include but is not limited to: establishing performance standards and outcome measures, recognition of an employee’s efforts, as well as planning for improvement. Issues of attendance and punctuality may be addressed if they have previously been discussed with the employee. The employee’s job description shall be a basis for the evaluation. B. The evaluator shall review the written evaluation with the employee and provide the employee with a copy. The employee shall sign the evaluation acknowledging receipt. If the employee has objections to the evaluation, s/he, may within twenty (20) working days following receipt of the evaluation put such objections in writing and have them attached to the evaluation report and placed in his/her personnel file. C. The frequency of evaluations shall be determined by the District and generally occur every other year by April 1st for bargaining unit employees. If the District chooses to do so, it may conduct formal evaluations on an annual basis. An employee may request to receive one (1) annual evaluation. Such request shall be in writing to the employee’s supervisor with a copy to the Human Resources Department. D. The Human Resources Department will consult with the Federation in developing an outline of best practices to be used in conducting employee evaluations. E. When the District determines that an employee’s work performance is unsatisfactory, it shall inform the employee in writing of any deficiency and the improvement expected and provide the employee with the opportunity to correct the unsatisfactory performance within a reasonable time period established by the District. F. The judgment of an employee’s work performance by an evaluating supervisor shall not be the subject of a grievance. A grievance concerning an evaluation shall be limited to an allegation that the evaluation was done in bad faith or clearly untrue. The burden of proof shall rest with the grievant. Such grievance shall be filed at the next administrative level above that of the evaluator and that administrator shall provide a written decision within ten (10) working days of any hearing. If the grievance is not resolved, it may be appealed by submitting a written statement to the Human Resources Department within ten (10) working days following receipt of the administrative written decision. The written statement must clearly set forth why the previous decision is in error regarding the allegation of bad faith or being clearly untrue. The Director of Labor Relations, or designee, may review the record of the grievance and/or conduct a hearing and shall issue a written decision within ten (10) working days following such review or hearing. Such decision shall be final. G. Effective July 1, 2013, Sign Language Interpreters will be evaluated using the Educational Interpreter Performance Assessment (EIPA) pursuant to OAR 581-015-2035 and/or the District’s evaluation form.

  • EMPLOYEE EVALUATIONS 6.1 Administrators will meet with new employees to discuss their job description within one (1) month of hire. The Administrator and new employee will sign off on the job description and it will be forwarded to the Human Resources Department for inclusion in the employee‘s personnel file. The Human Resources Department will compile and distribute a list showing each employee‘s evaluator prior to November 1st of each year. Bargaining unit job descriptions will be made available via the District‘s web site. 6.2 Evaluations will transpire as follows for employees that are receiving satisfactory ratings: a. New hires—regular part-time (school year employees) will be evaluated at three (3) and six (6) working months. b. New hires—full time (12 month employees) will be evaluated at three (3), six (6) and twelve (12) months. c. After the initial year of employment, each employee shall be evaluated at least once annually by March 31st. 6.3 Criteria for evaluating bargaining unit members will be based on the performance categories outlined on the evaluation form as related to the job description of their specific position assignment. 6.4 Evaluation reports shall include feedback regarding strengths and weaknesses (if any) demonstrated by the employee. Prior to an employee receiving a rating less than “Meets Expectations,” the employee shall be advised of the performance concern and provided with a clear statement of any deficiency and a statement defining acceptable performance. This shall occur within a reasonable time prior to the final evaluation to allow the employee a chance to demonstrate improvement. 6.5 In the event an employee is evaluated overall as “Does Not Meet Expectations,” the district, in consultation with the employee and the Association, will provide the employee a written plan of improvement (See Employee Plan of Improvement form in Appendix). The plan shall clearly define all areas of deficiency, provide clear and attainable performance goals, and outline supports (if any) to be given, including any necessary training at the District’s expense. The employee will be given a reasonable amount of time, not to exceed sixty (60) working days, to meet job performance expectations. During the improvement period, feedback will be provided through a minimum of three scheduled meetings. Following the completion of the plan, the supervisor shall notify the employee in writing of the outcome. Failure to demonstrate satisfactory improvement may constitute grounds for termination. 6.6 The bargaining unit member shall be given a copy of their evaluation, and any data collection sheets (with the submitters name excluded) used in the evaluation. 6.7 Under the law there is no right to Association Representation at evaluation conferences. 6.8 Any information shared with the evaluating administrator for the evaluation process shall be recorded on Data Collection Sheet(s), with the exception of those unit members that have supervising teachers. Supervising teachers will work directly with the evaluating administrator to share performance information for inclusion in the unit member‘s evaluation. 6.9 Employees shall have the right to respond to evaluations in writing. Such written response shall be attached to the evaluation if received within 5 days. 6.10 No bargaining unit member shall be required to sign a blank or incomplete evaluation form.

  • Long Term Cost Evaluation Criterion 4. READ CAREFULLY and see in the RFP document under "Proposal Scoring and Evaluation". Points will be assigned to this criterion based on your answer to this Attribute. Points are awarded if you agree not increase your catalog prices (as defined herein) more than X% annually over the previous year for the life of the contract, unless an exigent circumstance exists in the marketplace and the excess price increase which exceeds X% annually is supported by documentation provided by you and your suppliers and shared with TIPS, if requested. If you agree NOT to increase prices more than 5%, except when justified by supporting documentation, you are awarded 10 points; if 6% to 14%, except when justified by supporting documentation, you receive 1 to 9 points incrementally. Price increases 14% or greater, except when justified by supporting documentation, receive 0 points. increases will be 5% or less annually per question Required Confidentiality Claim Form This completed form is required by TIPS. By submitting a response to this solicitation you agree to download from the “Attachments” section, complete according to the instructions on the form, then uploading the completed form, with any confidential attachments, if applicable, to the “Response Attachments” section titled “Confidentiality Form” in order to provide to TIPS the completed form titled, “CONFIDENTIALITY CLAIM FORM”. By completing this process, you provide us with the information we require to comply with the open record laws of the State of Texas as they may apply to your proposal submission. If you do not provide the form with your proposal, an award will not be made if your proposal is qualified for an award, until TIPS has an accurate, completed form from you. Read the form carefully before completing and if you have any questions, email Xxxx Xxxxxx at TIPS at xxxx.xxxxxx@xxxx-xxx.xxx If the vendor is awarded a contract with TIPS under this solicitation, the vendor agrees to make any Choice of Law clauses in any contract or agreement entered into between the awarded vendor and with a TIPS member entity to read as follows: "Choice of law shall be the laws of the state where the customer resides" or words to that effect.

  • SALARY RATES Section 12.1 The following shall apply to full-time employees including so called TPL A and B: A. Effective the first full pay period of July 2017, employees who meet the eligibility criteria provided in Section 2 of this Article shall receive a one percent (1%) increase in salary rate. B. Effective the first full pay period of July, 2017, employees who meet the eligibility criteria provided in Section 2 of this Article shall receive an additional one percent (1%) increase in salary rate due to the realization of the FY’18 tax revenue trigger threshold. C. Effective the first pay period of July, 2018, employees who meet the eligibility criteria in Section 2 of this Article shall receive a two percent (2%) increase in salary rate. D. Effective the first pay period of July, 2019, employees who meet the eligibility criteria in Section 2 of this Article shall receive a two percent (2%) increase in salary rate. Section 12.2 Employees who receive a "Below" rating on their annual EPRS evaluation shall not be eligible to receive the salary increases provided in Section 1 of this Article, nor any step increases. Employees who receive a "Below" rating will have their performance reviewed on a monthly basis in accordance with Article 24A of this Agreement and will become eligible for the salary and step rate increase previously denied effective upon the date of receiving a "Meets" or "Exceeds" rating. Section 12.3 The salary rate for new employees hired, reinstated or re-employed on or after July 1, 1990 shall be Step 1 for the job group of his/her position except in cases where a new employee is hired by a Department/Agency at a salary rate, approved by the Chief Human Resources Officer, above Step 1. A. Under the terms of this Agreement, an employee shall advance to the next higher salary step in his/her job group until the maximum salary rate is reached, unless he/she is denied such step rate by his/her Appointing Authority. An employee shall progress from one step to the next higher step after each fifty-two (52) weeks of creditable service in a step commencing from the first day of the payroll period immediately following his/her anniversary date. B. In the event an employee is denied a step rate increase by his/her Appointing Authority, he/she shall be given a written statement of reasons therefore not later than five (5) days preceding the date when the increase would otherwise have taken effect. Time off the payroll is not creditable service for the purpose of step rate increases. Section 12.5 Whenever an employee paid in accordance with the salary schedules provided in Appendix A of this Agreement receives a promotion to a higher job group, the employee's new salary rate shall be calculated as follows: 1. For employees who are below the maximum step within their current job: a. Determine the employee’s current salary rate and step within his/her current job group; then b. Find the salary rate of the next higher step within the employee’s current job group; and c. Multiply the employee’s current salary rate by one and three one- hundredths (1.03); then d. Compare the higher of the resultant amounts from b) or c) above to the salary rates for the higher job group into which the employee is being promoted. e. The employee’s salary rate shall be the first rate in the higher job group that at least equals the higher of the resultant amounts from d) above. f. In the event the application of the above formula results in a salary that is less than the amount the employee would receive had he/she been promoted to the next lower grade, the employee’s salary upon promotion shall be increased to the next higher step in the grade the employee is being promoted into. 2. For employees who are at the maximum step within their current job: a. Determine the employee’s current salary rate and step within his/her current job group; then, b. Multiply the employee’s current salary rate by one and three one- hundredths (1.03); then, c. Compare the resultant amount from b) above to the salary rates for the higher job group into which the employee is being promoted. d. The employee’s salary rate shall be the first rate in the higher job group that at least equals the resultant amount from c) above. A. Salary rates of full time employees are set forth in Appendix A of this Agreement, which is attached hereto and is hereby made a part of this Agreement. B. The salary rates set forth in Appendix A shall remain in effect during the term of this agreement. Salary rates shall not be increased or decreased except in accordance with the provisions of this Agreement. C. Employees shall be compensated on the basis of the salary rate for their official job classification. Section 12.7 A regular part-time employee shall be entitled to the provisions of this Article in the proportion that his/her service bears to full-time service. A. An employee entering a position within a bargaining unit covered by this Agreement from a position in an equivalent salary grade in a bargaining unit not covered by this Agreement shall be placed at the first step-in-grade up to the maximum of the grade, which at least equals the rate of compensation received immediately prior to his/her entry into the bargaining unit.

  • Extended Child Care Leave Upon written notification, no later than four weeks prior to the expiration of the aggregate leave taken pursuant to Clauses 21.1 (Maternity Leave) and 21.2 (Parental Leave), an employee will be granted a further unpaid leave of absence not to exceed one year. An employee wishing continued coverage under any applicable benefit plans will pay the total premium costs while on extended child care leave. An employee on extended child care leave will provide the Employer with at least one month's written notice of return from such leave. Upon return from extended child care leave, an employee will be placed in their former position.

  • Population The Population shall be defined as all Paid Claims during the 12-month period covered by the Claims Review.

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