Article VI, K – Critical Access Hospital (CAH) Access Payment Sample Clauses

Article VI, K – Critical Access Hospital (CAH) Access Payment. Amend to read:K. Critical Access Hospital (CAH) Access Payment Within the limits of the budgeted allocation from the Critical Access Hospital (CAH) assessment fund, the Department will pay the HMO a monthly CAH inpatient access payment and a monthly CAH outpatient access payment. The Department’s monthly CAH access payments to the HMOs are made as prospective “per member per month” payments, unadjusted for CDPS. The HMO shall make payments to eligible CAHs based on the number of qualifying inpatient discharges and outpatient claims in the previous month. Payments must be sent to the CAH within 15 calendar days after the HMO receives the monthly amounts from the Department. These payments are in addition to any amount the HMO is required by agreement to pay the CAH for provision of services to HMO members. An “eligible CAH” means a Wisconsin CAH that is not an acute care hospital, an institution for mental disease, or a general psychiatric hospital for which the Department has issued a certificate of approval that applies only to the psychiatric hospital and that is not a satellite of an acute care hospital. A list of qualifying CAH is available from the Department upon request.