Common use of Requirements for Assignment of Rate Cell Categories for MSC+ Clause in Contracts

Requirements for Assignment of Rate Cell Categories for MSC+. The Rate Cell shall be assigned by the STATE upon receipt of the required information from the MCO as specified in this section. Rate Cells shall be assigned prospectively for the next available month. Changes in Rate Cell due to new living arrangement and/or Elderly Waiver Nursing Facility Certifiable (NHC) status must be entered in MMIS on or before the Capitation Cut-Off Date in order for the MCO to be paid at the rate corresponding to the new Rate Cell for the next available month. When a change to Rate Cell criteria has been entered in MMIS after the enrollment Cut-Off Date, the MCO will be paid at the rate corresponding to the new Rate Cell at the time of the MCO’s next Capitation Payment, unless the requirements provided for in this section are met. Community Non-Elderly Waiver (Community Non-EW) Rate Cell. (a) The Community Non-EW Rate Cell will be assigned to Enrollees who, at capitation for MSC+, are coded in MMIS to be in a community living arrangement and are not enrolled in Elderly Waiver for the 1st of the following month. (b) The Community Non-EW Rate Cell will be assigned based on the Enrollee’s living arrangement in MMIS, and absence of an EW Waiver span in MMIS. Community Elderly Waiver (Community EW) Rate Cell. (a) The Community EW Rate Cell will be assigned to Enrollees who, at capitation for MSC+, are coded in MMIS to be in a community living arrangement and are enrolled in the Elderly Waiver for the 1st of the following month. (b) EW services must be delivered to Enrollees who meet the EW Level of Care criteria based on demonstrated need, and are eligible for payment of LTC services. MCOs are responsible for delivery of EW services even if the EW Rate Cell component was not paid in a given month. Institutionalized Rate Cell. (a) The Institutional Rate Cell will be assigned to Enrollees who, at capitation for MSC+, are coded in MMIS in an Institutionalized living arrangement. (b) MCOs will be required to close waiver spans promptly following placement in a Nursing Facility of greater than thirty (30) days. The STATE reserves the right to retroactively recover overpayments of the EW and NF Add-ons from the MCO that are identified as overpayments due to delays in closing EW spans.