Provider Relief Payments. In accordance with Amended Substitute House Bill 169 as passed by the 134th General Assembly, and upon approval of the state directed payment preprint [OH_Fee_Oth2_New_20220101-20221231] submitted to the Centers for Medicare and Medicaid Services (CMS), the MCOP shall pay providers of community-based Durable Medical Equipment, Community Behavioral Health Services, State Plan Home Health Services, Hospice services and providers of HCBS Waiver services an added payment amount determined by ODM for members receiving these services. The payments will be made based on historic utilization for services provided to MyCare dual enrollees from a timeframe specified by ODM and later adjusted based on actual utilization. The value of provider one-time payments will be equivalent to a 10% increase in a provider’s base rate, based on the total value of claims paid for services rendered during the specified timeframe. The same uniform percentage increase will apply across the eligible class of providers and shall be distributed to providers by the MCOP as a lump sum. If a provider’s calculated amount is less than $100, the minimum payment will be $100. ODM will provide the MCOP a list of the providers receiving these payments and the amounts that should be paid to each provider. The initial payments will be limited to 50% of the amount owed to the provider and ODM will reconcile the 12-month payment amount against current year utilization and adjust the amount owed to the provider and the direct the MCOP to pay the reconciled amount at a later date. The sanctions for non-compliance with requirements in this appendix are listed in Appendix N of this Agreement. The following are the Ohio Department of Medicaid (ODM) responsibilities not otherwise stated in Ohio Administrative Code (OAC) Chapters 5160-26, 5160-58 or elsewhere in the Agreement.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
Provider Relief Payments. In accordance with Amended Substitute House Bill 169 as passed by the 134th General Assembly, and upon approval of the state directed payment preprint [OH_Fee_Oth2_New_20220101-20221231] submitted to the Centers for Medicare and Medicaid Services (CMS), the MCOP shall pay providers of community-based Durable Medical Equipment, Community Behavioral Health Services, State Plan Home Health Services, Hospice services and providers of HCBS Waiver services an added payment amount determined by ODM for members receiving these services. The payments will be made based on historic utilization for services provided to MyCare dual enrollees from a timeframe specified by ODM and later adjusted based on actual utilization. The value of provider one-time payments will be equivalent to a 10% increase in a provider’s base rate, based on the total value of claims paid for services rendered during the specified timeframe. The same uniform percentage increase will apply across the eligible class of providers and shall be distributed to providers by the MCOP as a lump sum. If a provider’s calculated amount is less than $100, the minimum payment will be $100. ODM will provide the MCOP a list of the providers receiving these payments and the amounts that should be paid to each provider. The initial payments will be limited to 50% of the amount owed to the provider and ODM will reconcile the 12-month payment amount against current year utilization and adjust the amount owed to the provider and the direct the MCOP to pay the reconciled amount at a later date. The sanctions for non-compliance with requirements in this appendix are listed in Appendix N of this Agreement. The following are the Ohio Department of Medicaid (ODM) responsibilities not otherwise stated in Ohio Administrative Code (OAC) Chapters 5160-26, 5160-58 or elsewhere in the Agreement.
1. ODM will provide the MCOP with an opportunity to review and comment on the rate-setting timeline, proposed rates, proposed changes to the OAC program rules and the amended provider agreement.
2. ODM will notify the MCOP of managed care program policy and procedural changes and, whenever possible, offer sufficient time for comment and implementation.
3. ODM will provide regular opportunities for the MCOP to receive program updates and discuss program issues with ODM staff.
4. ODM will provide technical assistance sessions where MCOP attendance and participation is required. ODM will also provide optional technical assistance sessions to the MCOP.
5. ODM will provide the MCOP with linkages to organizations that can provide guidance on the development of effective strategies to eliminate health disparities.
6. ODM will conduct an annual analysis of Medicaid eligible individuals to identify whether there are prevalent common primary languages other than English in the MCOP’s service area. ODM will notify the MCOP of any languages identified as prevalent for the purpose of translating marketing and member materials outlined in Appendix F.
7. ODM will provide the MCOP with an annual MCOP Calendar of Submissions outlining major submissions and due dates.
8. ODM will identify contact staff, including the Contract Administrator (CA), selected for the MCOP.
9. ODM will provide the MCOP with an electronic Provider Master File containing all Ohio Medicaid fee-for-service (FFS) providers, which includes their Medicaid Provider Numbers, for current encounter data purposes. This file will also include NPI information when available.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
