Medicaid Sub-Capitation Funding Methodology and Payments. Given the requirements and limitations of the MDHHS/PIHP Master Contract, the Payor has elected under this Agreement to subcontract the actual provision of mental health specialty supports and services to the Provider, as a CMHSP, for the Medicaid eligibles within the County of
(1.) For the purposes of Medicaid payments from the Payor to the Provider, the prepaid sub-capitation funding methodology under this Agreement is as follows: MSHN will use the MDHHS PEPM rates, net of any required taxes and fees that must be paid to the State of Michigan, paid to this PIHP as the basis for the payment to each CMHSP. The only additional modification to this rate will be the application of a PIHP indirect administration cost adjustment, on a projected cost basis.
(2.) The MDHHS/PIHP Master Contract, requires that contracts include a description of the method of payment for Medicaid funds to be used by the PIHP and assumptions used that such payments to a Provider are at a level that will meet the needs of beneficiaries residing in that county(ies) of that CMHSP. Thereto, for the purposes of Medicaid payments from the Payor to the Provider, the prepaid sub-capitation funding methodology under this Agreement is as follows:
Medicaid Sub-Capitation Funding Methodology and Payments. Given the requirements and limitations of the MDHHS/PIHP Master Contract, the Payor has elected under this Agreement to subcontract the actual provision of mental health specialty supports and services to the Provider, as a CMHSP, for the Medicaid eligibles within the County of Ionia in the PIHP Medicaid specialty service area on the reimbursement basis of a prepaid sub-capitation funding methodology subject to net cost settlement with the return of unspent Medicaid funds to the Payor per fiscal year.
(1.) For the purposes of Medicaid payments from the Payor to the Provider, the prepaid sub-capitation funding methodology under this Agreement is as follows: MSHN will use the MDHHS PEPM rates, net of any required taxes and fees that must be paid to the State of Michigan, paid to this PIHP as the basis for the payment to each CMHSP. The only additional modification to this rate will be the application of a PIHP indirect administration cost adjustment, on a projected cost basis.
(2.) The MDHHS/PIHP Master Contract, requires that contracts include a description of the method of payment for Medicaid funds to be used by the PIHP and assumptions used that such payments to a Provider are at a level that will meet the needs of beneficiaries residing in that county(ies) of that CMHSP. Thereto, for the purposes of Medicaid payments from the Payor to the Provider, the prepaid sub- capitation funding methodology under this Agreement is as follows:
Medicaid Sub-Capitation Funding Methodology and Payments. Given the requirements and limitations of the MDHHS/PIHP Master Contract, the Payor has elected under this Agreement to subcontract the actual provision of mental health specialty supports and services to the Provider, as a CMHSP, for the Medicaid eligibles within the County of «County» in the PIHP Medicaid specialty service area on the reimbursement basis of a prepaid sub-capitation funding methodology subject to net cost settlement with the return of unspent Medicaid funds to the Payor per fiscal year. The Payor shall provide both the federal and State shares of Medicaid funds, as sub- capitation funding to the Provider for the Medicaid eligibles within the County of «County» in the PIHP Medicaid specialty service area, for all Medicaid program services and non- retained and/or delegated PIHP Medicaid administrative services and costs thereto of the Provider pursuant to this Agreement based upon the Per Eligible Per Month (PEPM) sub- capitation methodology as negotiated by the parties and set forth in this Agreement. Consistent with the MDHHS/PIHP Master Contract, certain groups of Medicaid eligibles are excluded from the sub-capitation methodology/payments under this Agreement. These are the eligibles enrolled in various State Waiver Programs.
(1.) For the purposes of Medicaid payments from the Payor to the Provider, the prepaid sub-capitation funding methodology under this Agreement is as follows: MSHN will use the MDHHS PEPM rates, net of any required taxes and fees that must be paid to the State of Michigan, paid to this PIHP as the basis for the payment to each CMHSP. The only additional modification to this rate will be the application of a PIHP indirect administration cost adjustment, on a projected cost basis.
(2.) The MDHHS/PIHP Master Contract, requires that contracts include a description of the method of payment for Medicaid funds to be used by the PIHP and assumptions used that such payments to a Provider are at a level that will meet the needs of beneficiaries residing in that county(ies) of that CMHSP. Thereto, for the purposes of Medicaid payments from the Payor to the Provider, the prepaid sub-capitation funding methodology under this Agreement is as follows: Payor will use the aforementioned MDHHS PEPM net capitation rates paid to this PIHP as the basis for the payment to each CMHSP. The only modifications to this rate will be the application of a PIHP indirect administration cost adjustment, on a projected cost basis. In addition to th...
