PAYMENT FOR CERTAIN BLOOD CLOTTING FACTORS Sample Clauses

PAYMENT FOR CERTAIN BLOOD CLOTTING FACTORS. The contractor shall be paid separately for factor VIII and IX blood clotting factors. Payment will be made by DMAHS to the contractor based on: 1) submission of appropriate encounter data; and 2) notification from the contractor to DMAHS within 12 months of the date of service of identification of individuals with factor VIII or IX hemophilia. Payment for these products will be the lesser of: 1) Average Wholesale Price (AWP) minus 15% and 2) rates paid by the contractor.
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PAYMENT FOR CERTAIN BLOOD CLOTTING FACTORS. The contractor shall be paid separately for factor VIII and IX blood clotting factors. Payment will be made by DMAHS to the contractor based on: 1) submission of appropriate encounter data; and 2) notification from the contractor to DMAHS within 12 months of the date of service of identification of individuals with factor VIII or IX and greater dispersion around the average than other DMAHS populations. The contractor shall be reimbursed not only on the basis of the demographic cells into which individuals fall, but also on the basis of individual health status. The Chronic Disability Payment System (CDPS) (University of California, San Diego) is the HBPS or the system of Risk Adjustment that shall be used in this contract. The methodology for CDPS specific to New Jersey is provided in the Actuarial Certification Letter for Risk Adjustment issued separately to the contractor. Two-A base capitation rates and a DDD mental health/substance abuse add-on are developed for this population. These are: • ABD without Medicare, • ABD — DDD without Medicare, Mental Health/Substance Abuse add-on-component The Risk adjustment process has four major components. • Development of the base rates for the risk adjusted populations. • Development of algebraic expressions that relate demographic and clinical characteristics of beneficiaries to their expected, prospective covered health care costs, relative to the cost of the average person in the populations. This measure of cost relative to the average cost is known as the individual case score. By definition, the average cost beneficiary will have a case score of 1.0, others with more or less costly conditions and demographic characteristics will have scores that are greater or less than 1.0. • Compilation of case scores for each beneficiary for whom requisite data are available and establishment of criteria to assign case scores to those without claims and eligibility data. • Calculation of an average case mix for each participating contractor. This average case mix is normalized and used in conjunction with the base capitation rate to determine the actual reimbursement to the contractor for the risk-adjusted population, contemporaneous. with the monthly remittance.
PAYMENT FOR CERTAIN BLOOD CLOTTING FACTORS 

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