Requirements for Medicaid Managed Care Partners Sample Clauses

Requirements for Medicaid Managed Care Partners.  Submit to EOHHS a Schedule of Project Based Metrics and Payment for EOHHS Approval o Within 30 days of an AE being certified by EOHHS, the Contractor must submit for approval to EOHHS project-based metrics and associated incentive payment per each AE contract. Evidence of AE attestation must be included with submission. As described in Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners, both the AE and MCOs must agree to a defined set of project-based measures and targets for three AE project as delineated in the AEs HSTP project plan submitted to EOHHS as part of the AEs annual certification. Each project should have at minimum 2 measures per project, one of the three projects shall focus on behavioral health integration and one on social determinants of health. Project- based measure are metrics the AE and MCOs use to track and monitor project implementation and progress. MCO/AE specific performance targets implemented for Performance Year 1 and 2 outcome metrics performance areas can be considered.  Assess AE Performance to Determine Whether Incentive Payments Have Been Earned o Contractor will review and evaluate AE progress in achieving AEIP performance targets and determine whether AE performance warrants incentive payments. o The Contractor must certify that an AE has met its approved metrics as a condition for its release of associated AEIP funds to the AE.  Make payments to the AE’s on a timely basis

Requirements for Medicaid Managed Care Partners. This section is further amended by ADDING a third bullet under the first paragraph as follows, “Provision of Monthly Provider Roster: On a monthly basis, the Contractor will provide EOHHS with electronic list of AE providers, inclusive of identification of additions and deletions.” This section is further amended by DELETING in its entirety the first sentence of the fourth bullet under paragraph one and REPLACING it as follows, “On a monthly basis, Contractor will provide AE with a full claims extract, including member specific utilization and cost data to better enable AEs to examine and understand patterns of utilization by attributed members and develop plans of action.”