Attribution Methodology Clause Samples

Attribution Methodology. 1.1 Attribution Overview 1.1.1 Introduction Attribution will be prospectively conducted for the VMNG Program by DVHA for Members who are enrolled in Medicaid as of November 1st of the year preceding the Performance Year. These Members will be attributed to either the Traditional Attribution Cohort or Expanded Attribution Cohort as follows: a. Attribute Members based on past primary care utilization with Participating Providers to the Traditional Attribution Cohort, as described in Section 1.2. b. Attribute Members not in the Traditional Attribution Cohort who do not have past primary care utilization with health care providers who are not Participating Providers to the Expanded Attribution Cohort described in Section 1.3. 1.1.2 Monthly eligibility checks of Members during the Performance Year On a monthly basis, Fiscal Agent will determine which, if any, Members in the Traditional Attribution Cohort and Expanded Attribution Cohort became ineligible for VMNG Program participation in the previous month due to one of the criteria stated in Section 1.2 or 1.3 as applicable, or as a result of the death of the Member or loss of Medicaid eligibility. An Attributed Member who was previously determined to be ineligible in any given month may regain eligibility in a future month if eligibility criteria are met.
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Attribution Methodology. The State or its designee will conduct attribution monthly. The details of the attribution reports are described in the Data Use Standards, Attachment A, Exhibit 1, Section VIII (B) of this Agreement. 1. Attribution Step 1: Determine all Medicaid beneficiaries who were enrolled for at least 10 months in the study year across any of the four enrollment categories. Assign the beneficiary to the enrollment category where he/she appeared last in the study year. 2. Attribution Step 2: Claims for eligible members are identified for the presence of qualifying CPT Codes (refer to Attachment I) in the calendar year for primary care providers enrolled with Medicaid. The provider specialty must be internal medicine, general medicine, geriatric medicine, family medicine, pediatrics, or naturopathic medicine. In addition to physicians, the primary care provider may be a nurse practitioner, physician assistant, or a provider in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC). 3. Attribution Step 3: For eligible beneficiaries not attributed in Step 2, assign the beneficiary to his/her primary care provider that he/she selected or was auto-assigned to in the study year. If the beneficiary changed primary care provider selection during the year, then the beneficiary is assigned to the primary care provider which he/she was assigned to last in the year. 4. Attribution is done at the rendering provider level; any ACO Participant that includes at least one ACO Provider/Supplier with Attributed Lives must have an exclusive Participant relationship with one ACO. ACO Participants who do not have lives attributed, can participate in multiple ACOs.
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Attribution Methodology. The attribution methodology for PASSE Member enrollment is set forth in the PASSE Medicaid Provider Manual. On a periodic basis, as Medicaid Enrollees receive an Independent Assessment, DHS will attribute Medicaid Enrollees for enrollment in a PASSE as a PASSE Member.
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Related to Attribution Methodology

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