Specific Terms of the Contract Sample Clauses

Specific Terms of the Contract. Amend #7 to read: The Department shall make case mix adjusted based on rate development methodology to the HMO for BadgerCare Plus – Standard and Benchmark Plan members using the prospective Chronic Illness and Disability Payment System (CDPS) based adjustment method. The payment rates for members will be adjusted based upon the prospective CDPS scores applied prospectively to the rate schedule in the attached Exhibits. The adjustment will be budget neutral to the Department and any excess or deficient funding being divided proportionately amongst the effected HMO(s).

Specific Terms of the Contract. The specific terms of the Medicaid/BadgerCare HMO Contract to which the HMO agrees are set forth in this Contract. The capitation rates to which the HMO agrees are indicated by the Department in a completed Addendum III, Actuarial Basis of the Medicaid and BadgerCare HMO Contract. Except as stated below, the specific terms in the HMO’s completed application for certification are incorporated into this Contract, including whether dental services and chiropractic services will be provided by the HMO. Notwithstanding the certification application, the HMO’s service area and maximum enrollment are specified in Addendum X. In WITNESS WHEREOF, the State of Wisconsin has executed this agreement: Official Signature /s/ Xxxxxxxx X. Xxxxxxxx Official Signature /s/ Xxxx X. Xxxxx Title President and CEO Title Date April 27, 2004 Note: The following subcontract with the Department for Chiropractic Services is not effective unless signed below. A. THIS AGREEMENT is made and entered into by and between the HMO and the Department of Health and Family Services. The parties agree as follows: 1. The Department agrees to be at risk for and pay claims for chiropractic services covered under this Contract. 2. The HMO agrees to a deduction from the capitation rate of an amount of money based on the cost of chiropractic services. This deduction is reflected in the Contract that is being signed on the same date. B. This is the only subcontract for services that the Department is entering into with the HMO. C. The provisions of the Contract regarding subcontracts, in Addendum I, do not apply to this subcontract.

Specific Terms of the Contract. The specific terms of the Medicaid/BadgerCare HMO Contract to which the HMO agrees are set forth in this Contract. The capitation rates to which the HMO agrees are indicated by the Department in a completed Addendum III, Actuarial Basis of the Medicaid and BadgerCare HMO Contract. Except as stated below, the specific terms in the HMO’s completed application for certification are incorporated into this Contract, including whether dental services and chiropractic services will be provided by the HMO. For each rate period in this Contract, the HMO agrees not to reduce its service area that was in effect at the time of acceptance of the rates. The HMO’s service area and maximum enrollment are specified in its certification application.

Specific Terms of the Contract a. The specific terms in the HMO’s completed application for certification are incorporated into this Contract, including whether dental services and chiropractic services will be provided by the HMO. b. For each rate period in this Contract, the HMO agrees, at minimum, to maintain the service area that was in effect at the time the HMO accepted the rates. This provision does not prevent the HMO from expanding to new service areas as approved by the Department. c. The HMO’s service area and maximum enrollment are specified in its certification application. d. Rates are determined for county(ies) in which enrollment is accepted. e. Adjusted rates - Rates may be changed to reflect legislative changes in BadgerCare Plus and/or Medicaid SSI reimbursement or changes in approved services. Rate changes may occur during the rate year or in rare instances, retroactively. f. The Department shall calculate chronicity or risk adjustment scores as part of the rate development methodology depending on the availability of data. The risk adjustment scores will be applied prospectively to the rate schedule in the rate exhibits provided by the Department. The Department may adjust the HMO prospective risk score if a significant variance in chronicity occurs from the risk adjustment score that was used to adjust the base rates. Any such adjustment will take effect no sooner than 45 days after calculating the variance. Any risk score changes applied to a given HMO will also impact other HMO risk scores due to budget neutrality requirements. g. An annual risk adjustment reconciliation will be calculated based on actual enrollment. This may result in additional payments to or recoupments from the HMO. The adjustments will be budget neutral to the Department.

Specific Terms of the Contract. Schedule of Works Schedule of Charges