Common use of Medicaid Sub-Capitation Funding Methodology and Payments Clause in Contracts

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.

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» 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. The Payor shall provide both the federal and State shares of Medicaid funds, as sub- sub-capitation funding to the Provider for the Medicaid eligibles within the County of «County» Ionia in the PIHP Medicaid specialty service area, for all Medicaid program services and non- 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- 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.