Uniform managed care contract terms and conditions
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 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.
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
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).
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
31 Dec 2019 Background a Brief History of Medicaid Managed Care & Payment Reform Services Commission Uniform Managed Care Terms & Conditions.
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
9 Jan 2018 term covers a wide range of conditions, from serious mental impairments Illinois' Medicaid managed care uniform credentialing and re- 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.
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).
and State requirements and provisions of the managed-care contract relating “ Payment Adjustment for Health Care-Acquired Conditions” (Texas Uniform 5 Apr 2019 Provider Contract Checklist is revised to include provisions applicable to Item 50.2, “Nursing Facility Providers – Notice of Adverse Changes in Medical Condition” is added 1 UMCC is the Uniform Managed Care Contract. HHSC amended the Medicaid managed care contracts and the Uniform These changes are included in the Uniform Managed Care Contract (UMCC), STAR+ PLUS Medicaid Rural Service. Area (MRSA) MCO's contract rates and terms. 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 28 Feb 2019 A Medicaid enrollment change is any change in managed care enrollment, The Span of Coverage sections of the Uniform Managed Care Contract, Attachment A, Terms & Conditions, Section 5.06, “Span of Coverage”. 30 Sep 2019 Appendix A. 1115 Waiver Special Terms and Conditions - STC #37.. 45 28 HHSC Uniform Managed Care Contract, sec. 8.1.7.8.2.
The purpose of this Contract is to set forth the terms for the MCO’s participation as a managed care organization in the STAR Kids Program administered by HHSC. Under the terms of this Contract, MCO will provide comprehensive healthcare services to qualified Program recipients through a managed care delivery system. Definition of “Uniform Managed Care Manual” is modified. Section 4.08 is modified to prohibit Medicaid payments to entities located outside the U.S. in conformance with the Affordable Care Act. Section 4.10 is modified to prohibit Medicaid payments to entities located outside the U.S. in conformance with the Affordable Care Act. 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. 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,