Hhsc uniform managed care contract terms and conditions
IPA/ACO contracts with Providers, and Providers must agree to such clauses. A. Definitions for B. General Terms and Conditions. 1. This agreement is Medicaid Managed Care contract between the MCO and DOH as set forth fully herein Contractual Document (CD) Subject: Attachment A – Medicaid and CHIP Managed Care Services RFP, Uniform Managed Care Contract Terms and Conditions Version 2.29 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Definition for “DSM” is modified. Subject: Attachment A – Medicaid and CHIP Managed Care Services RFP, Uniform Managed Care Contract Terms and Conditions Version 2.19 DOCUMENT HISTORY LOG STATUS1 DOCUMENT REVISION2 EFFECTIVE DATE DESCRIPTION3 Baseline n/a September 1, 2011 Initial version of the Attachment A, “Medicaid and CHIP Uniform Managed Care Contract Terms & Texas Medicaid and CHIP - Uniform Managed Care Manual The manual below defines procedures that Managed Care Organizations (MCOs) must follow in order to meet certain requirements in the HHSC managed care contracts, and to provide interpretation on contractual provisions that need clarification. Contract amendment did not revise Attachment A HHSC Uniform Managed Care Terms and Conditions Revision 1.5 January 1, 2007 Revised version of the Uniform Managed Care Contract Terms & Conditions that includes provisions applicable to MCOs participating in the STAR, STAR+PLUS, CHIP, and CHIP Perinatal Programs.
Ambulance providers that participate in Texas Medica id fee-for-service, managed care programs, or the CHIP must, as a condition of emergency medical services (EMS) provider license renewal, obtain a surety bond that complies with 1 TAC §352.15 and su bmit the bond to TMHP according to the require- ments listed above.
Commission’s Uniform Managed Care Contract and Uniform Managed Care Manual, resulting in unallowable and questioned costs in its financial statistical report for fiscal year 2016. Superior included approximately $31.2 million in unallowable costs (including the approximately $29.6 million in bonus and B. MONITORING MANAGED CARE PLANS The Health and Human Services Commission (HHSC) staff evaluates and routinely monitors managed care organizations (MCOs) and dental maintenance organizations (DMOs) performance reported by the MCOs and DMOs and compiled by HHSC. Ambulance providers that participate in Texas Medica id fee-for-service, managed care programs, or the CHIP must, as a condition of emergency medical services (EMS) provider license renewal, obtain a surety bond that complies with 1 TAC §352.15 and su bmit the bond to TMHP according to the require- ments listed above. Part 8 of the HHSC Managed Care Contract document, “Payment,” is modified to add the capitation rates for Rata Period 3. þ Medicaid STAR HMO PROGRAM Capitation : See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR Program. Executive Summary. The purpose of this Enrollment is to improve the Adult Protective Services (APS) Division of DFPS access to professionals to conduct medical and mental health assessments. The goal of the Enrollment is to obtain: (1) medical and mental health assessments to support DFPS staff in making decisions about the presence/absence fails to meet a performance expectation, standard, schedule, or other contract requirement such as the timely submission of deliverables or at the level of quality required, the managed care contracts give HHSC the authority to use a variety of remedies, including:
Part 8 of the HHSC Managed Care Contract document, “Payment,” is modified to add the capitation rates for Rata Period 3. þ Medicaid STAR HMO PROGRAM Capitation : See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR Program.
HHSC Uniform Terms and Conditions Version 2.13 Published and Effective: July 15, 2016 Responsible Office: Chief Counsel Health and Human Services Commission HHSC Uniform Terms and Conditions - Grant Version 2.13. determine compliance with the terms and conditions of this Contract and all state and federal rules, regulations, and statutes. The Health and Human Services Commission's (HHSC) Uniform Managed Care Contract Terms and Conditions, Attachment A, defines a complaint as: "an expression of dissatisfaction expressed by a Complainant, orally or in writing to the managed care organization (MCO), about any matter related to the MCO other than an Action.
1 Mar 2012 Subject: Attachment A -- General Contract Terms & Conditions. Version Section 8.05 Modification of HHSC Uniform Managed Care Manual.
Commission’s Uniform Managed Care Contract and Uniform Managed Care Manual, resulting in unallowable and questioned costs in its financial statistical report for fiscal year 2016. Superior included approximately $31.2 million in unallowable costs (including the approximately $29.6 million in bonus and B. MONITORING MANAGED CARE PLANS The Health and Human Services Commission (HHSC) staff evaluates and routinely monitors managed care organizations (MCOs) and dental maintenance organizations (DMOs) performance reported by the MCOs and DMOs and compiled by HHSC. Ambulance providers that participate in Texas Medica id fee-for-service, managed care programs, or the CHIP must, as a condition of emergency medical services (EMS) provider license renewal, obtain a surety bond that complies with 1 TAC §352.15 and su bmit the bond to TMHP according to the require- ments listed above.
Medicaid Managed Care Program: Behavioral Health Benefits HHSC provides mental health services to the safety-net population through service area contracts with 39 CMHCs Uniform Managed Care Contract Terms and Conditions.
1 Mar 2012 Subject: Attachment A -- General Contract Terms & Conditions. Version Section 8.05 Modification of HHSC Uniform Managed Care Manual. and State requirements and provisions of the managed-care contract relating “ Payment Adjustment for Health Care-Acquired Conditions” (Texas Uniform recoupments from hospital providers by MCOs, under HHSC's Hospital Quality. contracts with managed care organizations (“MCOs”) to furnish services to Medicaid enrollees. standard terms and conditions as a participating provider; or, alternatively,. • Impose an o A uniform definition of a “Clean. Claim” that is HHSC. HHSC will maintain separate. Medicaid and CHIP formularies, and a. Medicaid 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 Acronyms and Terms document that accompanies this webinar to help with the In Medicaid managed care, HHSC pays the MMCO a capitated rate for each Medicaid condition or at the parent's request. encouraged to cite the applicable section of the Uniform Managed Care Contract (UMCC) when educating their. 28 Feb 2019 A Medicaid enrollment change is any change in managed care enrollment, including: The Span of Coverage sections of the Uniform Managed Care Contract, STAR+PLUS Young@hhsc.state.tx.us and copy your MCCO team. Attachment A, Terms & Conditions, Section 5.06, “Span of Coverage”.
Definition of “Post-stabilization Care Services” is modified. Definition of “Texas Health Network” is deleted. 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. Commission’s Uniform Managed Care Contract and Uniform Managed Care Manual, resulting in unallowable and questioned costs in its financial statistical report for fiscal year 2016. Superior included approximately $31.2 million in unallowable costs (including the approximately $29.6 million in bonus and B. MONITORING MANAGED CARE PLANS The Health and Human Services Commission (HHSC) staff evaluates and routinely monitors managed care organizations (MCOs) and dental maintenance organizations (DMOs) performance reported by the MCOs and DMOs and compiled by HHSC. Ambulance providers that participate in Texas Medica id fee-for-service, managed care programs, or the CHIP must, as a condition of emergency medical services (EMS) provider license renewal, obtain a surety bond that complies with 1 TAC §352.15 and su bmit the bond to TMHP according to the require- ments listed above. Part 8 of the HHSC Managed Care Contract document, “Payment,” is modified to add the capitation rates for Rata Period 3. þ Medicaid STAR HMO PROGRAM Capitation : See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the Capitation Rate-setting methodology and the Capitation Payment requirements for the STAR Program. Executive Summary. The purpose of this Enrollment is to improve the Adult Protective Services (APS) Division of DFPS access to professionals to conduct medical and mental health assessments. The goal of the Enrollment is to obtain: (1) medical and mental health assessments to support DFPS staff in making decisions about the presence/absence fails to meet a performance expectation, standard, schedule, or other contract requirement such as the timely submission of deliverables or at the level of quality required, the managed care contracts give HHSC the authority to use a variety of remedies, including: