Alternative Payment Methodologies Clause Samples
The Alternative Payment Methodologies clause establishes the use of non-traditional or flexible payment structures in a contract, rather than relying solely on standard fee-for-service or lump-sum payments. This clause may outline arrangements such as value-based payments, bundled payments, or performance-based compensation, specifying how and when payments are calculated and disbursed based on agreed metrics or outcomes. Its core function is to provide adaptable financial arrangements that can better align incentives, manage costs, or encourage desired performance, thereby addressing the limitations of conventional payment models.
Alternative Payment Methodologies. As a core objective of this Agreement EOHHS seeks to significantly reduce the use of fee-for- service payment as a payment methodology and to replace fee-for-service payment with Alternative Payment Methodologies that provide incentives for better quality, outcomes and more efficient delivery of health services EOHHS requires that the Contractor progressively incorporate value based Alternative Payment Methodologies into their contracts with providers. Within this framework primary emphasis is given to total cost of care arrangements with EOHHS certified Accountable Entities. EOHHS is committed to development of partnerships between health plans and provider based organizations using accountable care delivery models that integrate medical care, behavioral health, substance use disorders, community health, public health, social determinants, related social services, and LTSS, supported by innovative payment and care delivery models that establish shared financial accountability across all partners, with a demonstrated approach to continue to grow and develop the model of integration and accountability. For each contract period, the Contractor will meet or exceed the requirements set forth Transitioning to Alternative Payment Methodologies: Requirements for Medicaid Managed Care Partners for the percent of their total payments made to providers using EOHHS approved alternative payment methods. APM contracts may not include the delegation of network contracting, provider payment, and/or claims processes, member services, or grievance and appeals functions without the express written consent of EOHHS. For any other function (e.g. care management) that is delegated, the Contractor must have an established process for assessing the capability of the subcontractor to assume responsibility for the delegated function(s) and have an established policy and procedure for overseeing performance of such function(s). The Contractor must have a written plan for its monitoring and oversight of the performance of all contracts with providers using APMs. Such oversight will include ensuring compliance with all requirements pertaining to marketing, member communications, and member choice. Upon request by EOHHS, the Contractor will submit an electronic copy of its written plan for monitoring and oversight of all APM subcontractors. The Contractor is required to develop and implement subcontracts with providers including Alternative Payment Methodologies as set forth in Transi...
Alternative Payment Methodologies. As further specified by EOHHS, methods of payment, not based on traditional fee-for-service methodologies, that compensate providers for the provision of health care or support services and tie payments to providers to quality of care and outcomes. These include, but are not limited to, shared savings and shared risk arrangements, bundled payments for acute care episodes, bundled payments for chronic diseases, and global payments. Payments based on traditional fee-for-service methodologies shall not be considered Alternative Payment Methodologies.
Alternative Payment Methodologies. Payment methods used by a payer to reimburse heath care providers that are not solely based on the fee-for-service (FFS) basis.