18 Feb 2019 those necessary to allow the use of Managed Care in the Medicaid Program. surgery, acute medical conditions or injuries (usually for a short-term illness or represent a uniform, international classification system of coding 6 Mar 2012 Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment A – Uniform Managed Care Contract Terms and Conditions. Health Care Needs in Medicaid Managed Care: Targeted Contract Language Health Policy (NASHP) has organized these contract provisions by aligning 31 Dec 2019 Background a Brief History of Medicaid Managed Care & Payment Reform Services Commission Uniform Managed Care Terms & Conditions. 2 Jan 2020 Kentucky to rebid Medicaid Managed Care contracts to address concerns of providers and advocates accepted uniform standards for credentialing all health professionals Louisville Future Terms and Conditions.
contracts with managed care organizations (“MCOs”) to furnish services to Medicaid enrollees. to accept an MCO's standard terms and conditions as a participating provider; or, alternatively, o A uniform definition of a “Clean. Claim ” that is
Subject: Attachment A -- General Contract Terms & Conditions Version 1.5 Texas Health & Human Services Commission General Contract Terms & Conditions . Contractual Document (CD) Definition of “Uniform Managed Care Manual” is modified. Section 4.08 is modified to prohibit Medicaid payments to managed care recipients, and WHEREAS, the Managed Care Organization (MCO) has demonstrated the ability to provide risk-based comprehensive health services in compliance with the program terms and requirements, and WHEREAS, the Department has approved the MCO to provide risk-based comprehensive health services to West Virginia Medicaid managed care recipients, members, care providers and state partners with high value and quality services in a manner that delivers the right service at the lowest cost available in the market place. Today, Texas Medicaid, which is administered by Texas HHSC, operates Medicaid managed care under the authority of federal waivers and state plan amendments that were approved 2016, the managed care contract(s) and rate certification(s) for a rating period 9 States may not require health plans to make pass-through payments other than those permitted to network Managed Care Contract HCA Contract Number: Resulting from Solicitation Number (If applicable): THIS AMENDMENT is between the Washington State Health Care Authority, hereinafter referred to as "HCA," and the party whose name appears below, hereinafter referred to as the "Contractor." CONTRACTOR NAME CONTRACTOR ADDRESS WASHINGTON UNIFORM
The Department and Contractor enter into this Contract in order to deliver integrated and quality managed care to Enrollees, supporting Seniors, Persons with a Disability, Families and Children, Special Needs Children, and adults qualifying for the HFS Medical Program under the Affordable Care Act (ACA Adults).
1 Dec 2018 CONTRACT TO PROVIDE MANAGED CARE SERVICES. FOR THE Uniform Data Specifications for Encounter . Terms and Conditions . significantly strengthen existing Medicaid managed care rules. The rule conditions federal matching funds for payments to MCOs, while CHIP managed care contracts, including capitation rates, are subject to or provide a uniform dollar or percentage increase for network providers that provide a particular service. Any. 1 Apr 2019 244. 44. TERM OF CONTRACT AND OPTION TO RENEW . sudden onset of an emergency medical condition as defined above. AHCCCS for members not enrolled with a managed care Dental Services: The Contractor shall adhere to the Dental Uniform Prior Authorization List (List) and the Uniform Medicaid Managed Care Program: Behavioral Health Benefits. D.15. Medicaid Uniform Managed Care Contract Terms and Conditions. Retrieved April 8 28 Jul 2017 An Individual Service Plan (ISP) identifying short and long-term goals, service along with mitigating and exacerbating conditions, and contract terms and Contract (UMCC) and the Uniform Managed Care Manual (UMCM).
UNIFORM TERMS AND CONDITIONS CONTRACT NO: ADHS13-043918 4. Facilities Inspection and Materials Testing. The Contractor agrees to permit access to its facilities, subcontractor facilities and the Contractor‘s processes or services, at reasonable times for inspection of the facilities or materials covered under this Contract.
members, care providers and state partners with high value and quality services in a manner that delivers the right service at the lowest cost available in the market place. Today, Texas Medicaid, which is administered by Texas HHSC, operates Medicaid managed care under the authority of federal waivers and state plan amendments that were approved 2016, the managed care contract(s) and rate certification(s) for a rating period 9 States may not require health plans to make pass-through payments other than those permitted to network Managed Care Contract HCA Contract Number: Resulting from Solicitation Number (If applicable): THIS AMENDMENT is between the Washington State Health Care Authority, hereinafter referred to as "HCA," and the party whose name appears below, hereinafter referred to as the "Contractor." CONTRACTOR NAME CONTRACTOR ADDRESS WASHINGTON UNIFORM Contract. Both care management and healthcare quality initiatives, of the Contract. shall be considered part of the Administrative Allowance for rating purposes. Admission, Discharge, and Transfer (ADT) System means a system that holds Enrollee information and shares it with healthcare Providers, facilities, and systems to which it is connected. The ACA created the first federal uniform minimum MLR standard, which requires most insurance companies that cover individuals and small businesses to spend at least 80 percent of their premium income on health care claims and quality improvement, leaving the remaining 20 percent for administration, marketing, and profit.
Managed Care Operations Memos (MC OPS Memos).. HealthChoices Physical Health Agreement effective January 1, 2019. 1 PH-MCO Responsibility for Reportable Conditions. are inconsistent with the terms of the RFP, the terms of this develop uniform coordination agreements to promote consistency in.
significantly strengthen existing Medicaid managed care rules. The rule conditions federal matching funds for payments to MCOs, while CHIP managed care contracts, including capitation rates, are subject to or provide a uniform dollar or percentage increase for network providers that provide a particular service. Any. 1 Apr 2019 244. 44. TERM OF CONTRACT AND OPTION TO RENEW . sudden onset of an emergency medical condition as defined above. AHCCCS for members not enrolled with a managed care Dental Services: The Contractor shall adhere to the Dental Uniform Prior Authorization List (List) and the Uniform Medicaid Managed Care Program: Behavioral Health Benefits. D.15. Medicaid Uniform Managed Care Contract Terms and Conditions. Retrieved April 8 28 Jul 2017 An Individual Service Plan (ISP) identifying short and long-term goals, service along with mitigating and exacerbating conditions, and contract terms and Contract (UMCC) and the Uniform Managed Care Manual (UMCM). Managed Care Contracts - Key Provisions for Providers. an MCO before considering the specific terms and conditions of the contract will provide a framework “Uniform Managed Care Contract Terms and Conditions.” Revision 2.6 September 1, 2013 Definition for CAHPS is modified to correct the name to which the acronym refers. Definition for “Community Health Worker” is added. Definition for “Court-Ordered Commitment” is modified. Definition for Default Enrollment is modified to add