Reimbursement – General Provisions Sample Clauses

Reimbursement – General Provisions. DHH shall make prospective monthly prepaid risk-adjusted payments for each member enrolled into the CCN. The CCN shall enroll as a Louisiana Medicaid provider (PE 50 – CCN-P) and as per 42 CFR §438.106 (a),(b) and(c), agree to accept, as payment in full, the actuarially sound rate established by DHH pursuant to this agreement, and shall not seek additional payment from a member, or DHH, for any unpaid cost. DHH reserves the right to defer remittance of the PMPM payment for July until the first Medicaid Management Information System (MMIS) payment cycle in July to comply with state fiscal policies and procedures. In the event the federal government lifts any moratorium on supplemental payments to physicians or facilities, PMPM rates in this Provider Agreement may be adjusted accordingly.
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