Common use of Supplemental Payments for Medicaid Wrap-Around Services for Outpatient Drugs and Biological Products Clause in Contracts

Supplemental Payments for Medicaid Wrap-Around Services for Outpatient Drugs and Biological Products. The capitation rates do not include the costs of Medicaid wrap-around services for outpatient drugs and biological products for STAR+PLUS Members, as described in Attachment B-1, Section 8.2.13.1. HHSC will make supplemental payments to the MCO for these Medicaid wrap-around services, based on encounter data received by HHSC’s Administrative Services Contractor during an encounter reporting period. The first supplemental payment will cover encounter data received from March 1, 2012, to February 28, 2013. Thereafter, supplemental payments will cover six-month encounter reporting periods. HHSC will make supplemental payments within a reasonable amount of time after the encounter reporting period, generally no later than 95 calendar days after HHSC’s Administrative Services Contractor has processed the encounter data. Supplemental payments will be limited to the actual amounts paid to pharmacy providers for these Medicaid wrap-around services, as represented in “Net Amount Due” field (Field 281) on the National Council for Prescription Drug Programs (NCPDP) encounter transaction. To be eligible for reimbursement, encounters must contain a Financial Arrangement Code “14” in the “Line of Business” field (Field 270) on the NCPDP encounter transaction.