Medicaid Rate Setting and Fee Schedules Sample Clauses

Medicaid Rate Setting and Fee Schedules. Contractor shall assist in rate setting and deliver rates, fee schedules, and related documents to the State in preparation for Vermont’s Medicaid’s annual update changes that are effective January 1st and October 1st. Contractor will provide these rates, fee schedules, and related documents to the State as specified prior to the Vermont annual effective date or as prior approved by the State due to unforeseen difficulties. a. Inpatient Prospective Payment System (IPPS) I. Contractor shall provide payment modeling and rate setting related to the Vermont Medicaid IPPS: collect and analyze claims information, model payment scenarios, and advise the State of updates or changes resulting from Medicare’s IPPS Final Rule. II. Contractor shall assist the State in updating the hospital-specific cost-to-charge ratios (CCRs), inpatient fixed outlier threshold, outlier payment percentage, inpatient base rates, inpatient psych base rate and additive factors, as well as identify Diagnosis Related Grouper additions or deletions. III. All inpatient rates, updates, and related documents are due to the state two weeks prior to Vermont’s annual effective date of October 1st. The Contractor may submit the rates, fee schedules, and related documents in a shorter period of time due to unforeseen difficulties, with prior written approval by the State. b. Outpatient Prospective Payment System (OPPS) I. Contractor provide payment modeling and rate setting related to the Vermont Medicaid OPPS: collect and analyze claims information, model payment scenarios, and advise the State of any updates or changes resulting from Medicare’s OPPS Final Rule. II. Contractor shall assist the State in updating the status indicators, Ambulatory Payment Classifications, packaged revenue code list, composite pricing methodology, outpatient fixed outlier threshold, outpatient outlier payment percentages, and the hospital standard discount and adjusters. III. Contractor shall supply the State with a memorandum summarizing all updates and changes made to the OPPS methodology. IV. All OPPS rates, updates, and related documents are due to the state two weeks prior to Vermont’s annual effective date of January 1st. The Contractor may submit the rates, fee schedules, and related documents in a shorter period of time due to unforeseen difficulties, with written approval by the State. c. Resource Based Relative Value Scale (RBRVS) I. Contractor will be responsible for payment modeling and rate setting relate...
Sample 1
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Medicaid Rate Setting and Fee Schedules. Contractor shall provide analytic support and reimbursement subject matter expertise to State in rate setting and shall deliver rates, fee schedules, and related documents to State in preparation for Vermont Medicaid’s annual rate updates that are effective January 1st, April 1st and October 1st, or other dates as specified by State. Contractor will provide these rates, fee schedules, fiscal impact, and related documents to State at least six (6) weeks prior to the applicable Vermont annual effective date. 1.1. Inpatient Prospective Payment System (IPPS) 1.1.1. Contractor shall provide payment modeling and rate setting related to the Vermont Medicaid IPPS. This includes but is not limited to collecting and analyzing claims information, modeling payment scenarios, and advising State of updates or changes resulting from Medicare’s IPPS Final Rule. 1.1.2. Contractor shall provide analytic support and reimbursement subject matter expertise to State in updating the hospital-specific cost-to-charge ratios (CCRs), inpatient fixed outlier threshold, outlier payment percentage, inpatient base rates, inpatient psychiatric base rate and additive factors, as well as identify Diagnosis Related Grouper additions or deletions. 1.1.3. All inpatient rates, updates, fiscal impact, and related documents are due to State at least six (6) weeks prior to Vermont’s annual effective date of October 1st or other date as specified by State. 1.2. Outpatient Prospective Payment System (OPPS) 1.2.1. Contractor shall provide payment modeling and rate setting related to the Vermont Medicaid OPPS. This includes but is not limited to collecting and analyzing claims information, modeling payment scenarios, and advising State of any updates or changes resulting from Medicare’s OPPS Final Rule. 1.2.2. Contractor shall provide analytic support and reimbursement subject matter expertise to State in updating the status indicators, Ambulatory Payment Classifications, packaged revenue code list, composite pricing methodology, outpatient fixed outlier threshold, outpatient outlier payment percentages, and the hospital standard discount and adjusters. 1.2.3. Contractor shall supply State with a memorandum summarizing all updates and changes made to the OPPS methodology. 1.2.4. All OPPS rates, updates, fiscal impact, and related documents are due to State at least six (6) weeks prior to Vermont’s annual effective date of January 1st or other date as specified by State.
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