Basic Care Rates for SNBC Sample Clauses
The 'Basic Care Rates for SNBC' clause establishes the standard payment rates for basic care services provided under the Special Needs BasicCare (SNBC) program. It outlines how these rates are determined, typically referencing state guidelines or negotiated agreements, and specifies which services or populations the rates apply to, such as individuals with disabilities or chronic conditions enrolled in SNBC. By clearly defining the reimbursement structure, this clause ensures transparency in provider payments and helps prevent disputes over compensation for covered services.
Basic Care Rates for SNBC. For the Contract Year, payments for SNBC Enrollees shall be:
4.4.1.1 Monthly payments paid by the STATE to the MCO shall be at 100% of the statewide Base Rate in the Payment Appendix, multiplied by the MCO’s (Plan) risk factor normalized by the overall average rate cell-specific risk scores for all MCOs. The dollar value of the risk adjustment rate is shown in the Payment Appendix.
4.4.1.2 Rates, as reduced by eight percent (8.0%) withhold, plus (if applicable) the NF add-on is the total capitation payment to the MCO.
Basic Care Rates for SNBC. For the Contract Year, payments for SNBC Enrollees shall be:
(A) Monthly payments paid by the STATE to the MCO shall be at 100% of the statewide Base Rate in the Payment Appendix, multiplied by the MCO’s (Plan) risk factor normalized by the overall average rate cell-specific risk scores for all MCOs. The dollar value of risk adjustment rate is shown in the Payment Appendix.
(B) Rates, including the BHH add-on, as reduced by eight percent (8.0%) withhold, plus (if applicable) the NF add-on is the total capitation payment to the MCO.
Basic Care Rates for SNBC. For the Contract Year, payments for SNBC Enrollees shall be: Monthly payments paid by the STATE to the MCO shall be at 100% of the statewide Base Rate in the Payment Appendix, multiplied by the MCO’s (Plan) risk factor normalized by the overall average rate cell-specific risk scores for all MCOs. The dollar value of risk adjustment rate is shown in the Payment Appendix. Rates, including the BHH add-on, as reduced by eight percent (8.0%) withhold, plus (if applicable) the NF add-on is the total capitation payment to the MCO. Add-on Rates for SNBC. A Behavioral Health Home add-on (BHH add-on) is included for all rate cells and subject to the withhold and risk adjustment. A nursing facility add-on (NF Add-on) will be included in the capitation rate for non-institutionalized rate cells. The NF Add-on is not subject to the withhold and is not risk adjusted.