Categories of Payments Sample Clauses
Categories of Payments. The payments made to the PASSE, as well as the conditions under which the payments will be made, are set out in the PASSE Medicaid Provider Manual and the Medicaid Provider-Led Organized Care Act (Act 775 of 2017, Ark. Code ▇▇▇. §20-77-2701 et seq.) For the purposes of this Agreement and applicable only to Phase I, the following payments can or may be made by DHS to the PASSE:
1. Foundation Payment:
a) This payment will be in the amount of $208.00 per PASSE Member;
b) It will be paid only in the first month that a PASSE Member is enrolled in a PASSE;
c) If a PASSE Member transitions to another PASSE, if a PASSE Member leaves the Provider-led program and later returns the Provider-led program for any reason, or under another set of similar conditions, the Foundation payment will not be paid another time; and
2. Care Coordination Payment:
a) This payment will be in the amount of $173.33 Per-Member-Per-Month (PMPM);
b) It will be paid starting in the second month of PASSE enrollment and continuing thereafter so long as the PASSE Member does not enter into a change in status reflected below that results in non-payment, recoupment or other adjustment of the Care Coordination Payment;
c) In order to continue to receive the full Care Coordination PMPM for an attributed PASSE Member, the PASSE must meet the Quality Performance standards set forth herein under Section XXIV and in the PASSE Provider Manual (PASSE Provider Manual §251.000); and
d) If the PASSE fails to meet 2 of the 5 quality metrics for care coordination, DHS may take action to correct the failure or impose penalties on the PASSE, including but not limited to, suspension of PMPM payments for all attributed PASSE Members. (PASSE Provider Manual §252.000). The Phase II Global Payment will replace both of these payments as the functions of the PASSE expand to full-risk care of the PASSE Members. A new Agreement will reflect the terms and conditions applicable thereto.
Categories of Payments