Common use of PCMP CO-PAYMENT VOUCHERS Clause in Contracts

PCMP CO-PAYMENT VOUCHERS. 6.5.1. The Contractor may propose a co-payment voucher plan (plan) to the Department to issue vouchers for primary care visits to Members attributed to the Contractor. The goal(s) of the plan may include, but are not limited to: 6.5.1.1. Reducing the inappropriate utilization of emergency rooms. 6.5.1.2. Reinforcing utilization of primary care and preventative care. 6.5.1.3. Encouraging member connection to a medical home. 6.5.1.4. Supporting members upon determination of financial need. 6.5.1.5. Other goal(s), as proposed in the plan, if approved by the Department. 6.5.2. The Contractor shall submit a plan proposal to the Department for approval. The plan shall contain the following elements: 6.5.2.1. A description of the plan, including plan goals, timeline for implementation, process for evaluating effectiveness of the plan and all of the following: 6.5.2.1.1. The approximate number of PCMP co-payment vouchers to be issued on a per-month or annual basis. 6.5.2.1.2. The criteria by which Members will be selected to receive PCMP co-payment vouchers. 6.5.2.1.3. The format of the PCMP co-payment voucher and the method by which the voucher will be distributed to Members. 6.5.2.1.4. The process whereby PCMPs will be reimbursed or compensated for the full amount of cost sharing waived. 6.5.2.1.5. The process whereby the Contractor will resolve complaints that arise from Members not receiving co-pay vouchers, or complaints from ACC non-contracted Providers unable to accept vouchers. 6.5.2.1.6. The process for tracking the number of vouchers used by Members and where the vouchers are redeemed. 6.5.2.1.7. An attestation that PCMPs and the Contractor have agreed to the manner and frequency of reimbursement. 6.5.3. In the event of a plan's approval, the Contractor shall pay for a Member's portion of primary care cost-sharing whenever a voucher is redeemed at a contracted PCMP. The Department shall not be liable for the Member's portion of cost-sharing. 6.5.4. To preserve Member choice, primary care co-payment vouchers or coupons must be redeemable at any ACC-contracted PCMP and must contain language to that effect. Irrespective of other arrangements with non-contracted primary care providers, the language printed on, or transmitted with, the voucher shall indicate that the voucher may only be used at a contracted PCMP. 6.5.5. The Contractor shall not specify a particular PCMP at which the voucher must be used. Language printed on, or transmitted with, the voucher or coupon shall not specify a particular PCMP by name.

PCMP CO-PAYMENT VOUCHERS. 6.5.1. The Contractor may propose a co-payment voucher plan (plan) to the Department to issue vouchers for primary care visits to Members attributed to the Contractor. The goal(s) of the plan may include, but are not limited to: 6.5.1.1. Reducing the inappropriate utilization of emergency rooms. 6.5.1.2. Reinforcing utilization of primary care and preventative care. 6.5.1.3. Encouraging member connection to a medical home. 6.5.1.4. Supporting members Members upon determination of financial need. 6.5.1.5. Other goal(s), as proposed in the plan, if approved by the Department. 6.5.2. The Contractor shall submit a plan proposal to the Department for approval. The plan shall contain the following elements: 6.5.2.1. A description of the plan, including plan goals, timeline for implementation, process for evaluating effectiveness of the plan and all of the following: 6.5.2.1.1. The approximate number of PCMP co-payment vouchers to be issued on a per-per- month or annual basis. 6.5.2.1.2. The criteria by which Members will be selected to receive PCMP co-payment vouchers. 6.5.2.1.3. The format of the PCMP co-payment voucher and the method by which the voucher will be distributed to Members. 6.5.2.1.4. The process whereby PCMPs will be reimbursed or compensated for the full amount of cost sharing waived. 6.5.2.1.5. The process whereby the Contractor will resolve complaints that arise from Members not receiving co-pay vouchers, or complaints from ACC non-non- contracted Providers unable to accept vouchers. 6.5.2.1.6. The process for tracking the number of vouchers used by Members and where the vouchers are redeemed. 6.5.2.1.7. An attestation that PCMPs and the Contractor have agreed to the manner and frequency of reimbursement. 6.5.3. In the event of a plan's approval, the Contractor shall pay for a Member's portion of primary care cost-sharing whenever a voucher is redeemed at a contracted PCMP. The Department shall not be liable for the Member's portion of cost-sharing. 6.5.4. To preserve Member choice, primary care co-payment vouchers or coupons must be redeemable at any ACC-contracted PCMP and must contain language to that effect. Irrespective of other arrangements with non-contracted primary care providers, the language printed on, or transmitted with, the voucher shall indicate that the voucher may only be used at a contracted PCMP. 6.5.5. The Contractor shall not specify a particular PCMP at which the voucher must be used. Language printed on, or transmitted with, the voucher or coupon shall not specify a particular PCMP by name.