Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 462.72 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. Dual Eligible Standard Rate $ 270.37 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. Nursing Facility – Medicaid Only $ 462.72 6. Nursing Facility – Dual Eligible $ 270.37 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 533.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. Dual Eligible Standard Rate $ 337.13 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. Nursing Facility – Medicaid Only $ 533.57 6. Nursing Facility – Dual Eligible $ 337.13 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 89.60 2 Ages 1 through 5 $ 93.96 3 Ages 6 through 14 $ 60.55 4 Ages 15 through 18 $ 78.04 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 67.70 2 Ages 1 through 5 $ 67.69 3 Ages 6 through 14 $ 58.59 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 62.31 2 Ages 1 through 5 $ 97.40 3 Ages 6 through 14 $ 84.79 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through 5 $ 99.35 3 Ages 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.
Appears in 2 contracts
Samples: Centene Corp, Centene Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 23: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 3 Capitation Rates 9/1/08-2/28/09 Rate Period 3 Capitation Rates 3/1/09-8/31/09 1. Medicaid Only Standard Rate $ 462.72 526.51 $513.06 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 2,748.46 $2,664,76 3. Dual Eligible Standard Rate $ 270.37 287.26 $272.04 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 1,845.00 $1,770.13 5. Nursing Facility – Medicaid Only $ 462.72 526.51 $513.06 6. Nursing Facility – Dual Eligible $ 270.37 287.26 $272.04 7. Bariatric Supplemental Payment $23,000.00 $23,000.00 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 3 Capitation Rates 9/1/08-2/28/09 Rate Period 3 Capitation Rates 3/1/09-8/31/09 1. Medicaid Only Standard Rate $ 533.57 614.57 $598.91 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 2,487.20 $2,417.60 3. Dual Eligible Standard Rate $ 337.13 393.22 $374.48 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 1,672.29 $1,610.98 5. Nursing Facility – Medicaid Only $ 533.57 614.57 $598.91 6. Nursing Facility – Dual Eligible $ 337.13 393.22 $374.48 7. Bariatric Supplemental Payment $23,000.00 $23,000.00 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 23: Service Area: BEXAR Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 89.60 117.46 2 Ages 1 through 5 $ 93.96 114.44 3 Ages 6 through 14 $ 60.55 77.43 4 Ages 15 through 18 $ 78.04 90.66 Service Area: EL PASO Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 67.70 83.94 2 Ages 1 through 5 $ 67.69 82.60 3 Ages 6 through 14 $ 58.59 64.48 4 Ages 15 through 18 $ 64.24 76.34 Service Area: LUBBOCK Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 80.56 87.45 2 Ages 1 through 5 $ 78.16 84.55 3 Ages 6 through 14 $ 62.30 62.56 4 Ages 15 through 18 $ 89.83 87.06 Service Area: NUECES Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 62.31 125.81 2 Ages 1 through 5 $ 97.40 102.44 3 Ages 6 through 14 $ 84.79 75.46 4 Ages 15 through 18 $ 116.44 94.22 Service Area: XXXXXX Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 129.53 85.36 2 Ages 1 through 5 $ 99.35 107.53 3 Ages 6 through 14 $ 86.64 72.61 4 Ages 15 through 18 $ 117.02 98.21 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.
Appears in 1 contract
Samples: Centene Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x þ Medicaid STAR+PLUS HMO MCO 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: 1. STAR+PLUS Service Area: BEXAR Xxxxxxx Rate Cell Rate Period 2 1 Capitation Rates 1. (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 Medicaid Only Standard Rate $ 462.72 2. *** *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR +PLUS Waiver Rate $ 3,138.64 3. - Above Floor *** *** 3 Medicaid Only HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 4 Dual Eligible Standard Rate $ 270.37 4. *** *** 5 Dual Eligible 1915(C) Nursing Facility HCBS STAR +PLUS Waiver Rate $ 1,931.47 5. - Above Floor *** *** 6 Dual Eligible HCBS STAR +PLUS Waiver Rate - Below Floor *** *** 7 Nursing Facility – Medicaid Only $ 462.72 6. *** *** 8 Nursing Facility – Dual Eligible $ 270.37 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 533.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. Dual Eligible Standard Rate $ 337.13 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. Nursing Facility – Medicaid Only $ 533.57 6. Nursing Facility – Dual Eligible $ 337.13 x *** *** o CHIP HMO MCO 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: 1. Service Area: BEXAR Rate Cell Rate Period 2 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 < Age 1 $ 89.60 2 Ages 1 through 5 $ 93.96 3 Ages 6 through 14 $ 60.55 4 Ages 15 through 18 $ 78.04 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 67.70 2 Ages 1 through 5 $ 67.69 3 Ages Perinate Newborn 0% to 185% 6 through 14 $ 58.59 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 62.31 2 Ages 1 through 5 $ 97.40 3 Ages 6 through 14 $ 84.79 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through 5 $ 99.35 3 Ages 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Perinate Newborn Above 185% to 200% 7 Perinate 0% to 185% 8 Perinate Above 185% to 200% Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP ProgramProgram and CHIP Perinatal subprogram. The CHIP Delivery Supplemental Payment is $3,100.00 *** for all Service Areas.. Part 10: Contract Attachments: Modifications to Part 10 of the HHSC Managed Care Contract document, "Contract Attachments," are italicized below:
Appears in 1 contract
Samples: Centene Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 26: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 6 Capitation Rates 1. 1 Medicaid Only Standard Rate $ 462.72 2. 525.34 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. 2,907.50 3 Dual Eligible Standard Rate $ 270.37 4. 265.80 4 Dual Eligibl 1915(C) Nursing Facility Waiver Rate $ 1,673.44 5 Nursing Facility - Medicaid Only $ 525.34 6 Nursing Facility - Dual Eligible $ 265.80 STAR+PLUS Service Area: XXXXXX Rate Cell Rate Period 6 Capitation Rates 1 Medicaid Only Standard Rate $ 613.65 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,453.66 3 Dual Eligible Standard Rate $ 236.95 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. 1,469.55 5 Nursing Facility – - Medicaid Only $ 462.72 6. 613.65 6 Nursing Facility – - Dual Eligible $ 270.37 236.95 STAR+PLUS Service Area: NUECES JEFFERSON Rate Cell Rate Period 2 6 Capitation Rates 1. 1 Medicaid Only Standard Rate $ 533.57 2. 403.39 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. 2,069.42 3 Dual Eligible Standard Rate $ 337.13 4. 189.19 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. 1,250.55 5 Nursing Facility – - Medicaid Only $ 533.57 6. 403.39 6 Nursing Facility – - Dual Eligible $ 337.13 189.19 STAR+PLUS Service Area: XXXXXX Rate Cell Rate Period 6 Capitation Rates 1 Medicaid Only Standard Rate $ 611.55 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,395.03 3 Dual Eligible Standard Rate $ 179.87 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,710.22 5 Nursing Facility - Medicaid Only $ 611.55 6 Nursing Facility - Dual Eligible $ 179.87 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 26: Service Area: BEXAR DALLAS Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 89.60 216.50 2 Ages 1 through 5 $ 93.96 110.20 3 Ages 6 through 14 $ 60.55 78.69 4 Ages 15 through 18 $ 78.04 106.54 Service Area: EL PASO XXXXXX Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 67.70 237.92 2 Ages 1 through 5 $ 67.69 102.58 3 Ages 6 through 14 $ 58.59 74.56 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 109.03 Service Area: NUECES Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 62.31 146.81 2 Ages 1 through 5 $ 97.40 112.05 3 Ages 6 through 14 $ 84.79 65.48 4 Ages 15 through 18 $ 116.44 125.81 Service Area: XXXXXX TARRANT Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 129.53 127.64 2 Ages 1 through 5 $ 99.35 103.89 3 Ages 6 through 14 $ 86.64 69.85 4 Ages 15 through 18 $ 117.02 89.50 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.
Appears in 1 contract
Samples: Amerigroup Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 462.72 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. Dual Eligible Standard Rate $ 270.37 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. Nursing Facility – Medicaid Only $ 462.72 6. Nursing Facility – Dual Eligible $ 270.37 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 533.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. Dual Eligible Standard Rate $ 337.13 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. Nursing Facility – Medicaid Only $ 533.57 6. Nursing Facility – Dual Eligible $ 337.13 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 89.60 2 Ages 1 through 5 $ 93.96 3 Ages 6 through 14 $ 60.55 4 Ages 15 through 18 $ 78.04 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 67.70 2 Ages 1 through 5 $ 67.69 3 Ages 6 through 14 $ 58.59 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period RatePeriod 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 62.31 2 Ages 1 through 5 $ 97.40 3 Ages 6 through 14 $ 84.79 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through 5 $ 99.35 3 Ages 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas. x CHIP Perinatal 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 CHIP Perinatal Program. Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1 Perinate 0% - 185% $ 539.19 2 Perinate 186% - 200% $ 175.04 3 Perinate Newborn 0% - 185% $ 394.44 4 Perinate Newborn 186% - 200% $ 741.26 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 Perinate 0% - 185% $ 539.19 2 Perinate 186% - 200% $ 175.04 3 Perinate Newborn 0% - 185% $ 323.76 4 Perinate Newborn 186% - 200% $ 608.42 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 Perinate 0% - 185% $ 539.19 2 Perinate 186% - 200% $ 175.04 3 Perinate Newborn 0% - 185% $ 244.43 4 Perinate Newborn 186% - 200% $ 459.35 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 Perinate 0% - 185% $ 539.19 2 Perinate 186% - 200% $ 175.04 3 Perinate Newborn 0% - 185% $ 523.42 4 Perinate Newborn 186% - 200% $ 983.65 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 Perinate 0% - 185% $ 539.19 2 Perinate 186% - 200% $ 175.04 3 Perinate Newborn 0% - 185% $ 434.23 4 Perinate Newborn 186% - 200% $ 816.04 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Perinatal Program. The CHIP Perinatal Delivery Supplemental Payment is $3,100.00 for Perinates between 186% and 200% of the Federal Poverty Level for all Service Areas.
Appears in 1 contract
Samples: Centene Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x þ Medicaid STAR+PLUS HMO MCO 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: 1. STAR+PLUS Service Area: BEXAR Bexar Rate Cell Rate Period 2 1 Capitation Rates 1. 1 Medicaid Only Standard Rate $ 462.72 2. *** 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. - Above Floor *** 3 Medicaid Only 1915(C) Nursing Facility Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 270.37 4. *** 5 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. - Above Floor *** 6 Dual Eligible 1915(C) Nursing Facility Waiver Rate - Below Floor *** 7 Nursing Facility – Medicaid Only $ 462.72 6. *** 8 Nursing Facility – Dual Eligible $ 270.37 *** STAR+PLUS Service Area: NUECES Lubbock Rate Cell Rate Period 2 1 Capitation Rates 1. 1 Medicaid Only Standard Rate $ 533.57 2. *** 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. - Above Floor *** 3 Medicaid Only 1915(C) Nursing Facility Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 337.13 4. *** 5 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. - Above Floor *** 6 Dual Eligible 1915(C) Nursing Facility Waiver Rate - Below Floor *** 7 Nursing Facility – Medicaid Only $ 533.57 6. *** 8 Nursing Facility – Dual Eligible $ 337.13 x *** STAR+PLUS Service Area: Nueces Rate Cell Rate Period 1 Capitation Rates 1 Medicaid Only Standard Rate *** 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate - Above Floor *** 3 Medicaid Only 1915(C) Nursing Facility Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate *** 5 Dual Eligible 1915(C) Nursing Facility Waiver Rate - Above Floor *** 6 Dual Eligible 1915(C) Nursing Facility Waiver Rate - Below Floor *** 7 Nursing Facility – Medicaid Only *** 8 Nursing Facility – Dual Eligible *** þ CHIP HMO MCO 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: 1. Service Area: BEXAR Bexar Rate Cell Rate Period 2 1 Capitation Rates 1 < Age 1 $ 89.60 *** 2 Ages 1 through 5 $ 93.96 *** 3 Ages 6 through 14 $ 60.55 *** 4 Ages 15 through 18 $ 78.04 *** 5 Perinate Newborn 0% to 185% *** 6 Perinate Newborn Above 185% to 200% *** 7 Perinate 0% to 185% *** 8 Perinate Above 185% to 200% *** Service Area: EL PASO El Paso Rate Cell 1 < Age 1 *** 2 Ages 1 through 5 *** 3 Ages 6 through 14 *** 4 Ages 15 through 18 *** 5 Perinate Newborn 0% to 185% *** 6 Perinate Newborn Above 185% to 200% *** 7 Perinate 0% to 185% *** 8 Perinate Above 185% to 200% *** Service Area: Lubbock Rate Cell Rate Period 2 1 Capitation Rates 1 < Age 1 $ 67.70 *** 2 Ages 1 through 5 $ 67.69 *** 3 Ages 6 through 14 $ 58.59 *** 4 Ages 15 through 18 $ 64.24 *** 5 Perinate Newborn 0% to 185% *** 6 Perinate Newborn Above 185% to 200% *** 7 Perinate 0% to 185% *** 8 Perinate Above 185% to 200% *** Service Area: LUBBOCK Nueces Rate Cell Rate Period 2 1 Capitation Rates 1 < Age 1 $ 80.56 *** 2 Ages 1 through 5 $ 78.16 *** 3 Ages 6 through 14 $ 62.30 *** 4 Ages 15 through 18 $ 89.83 *** 5 Perinate Newborn 0% to 185% *** 6 Perinate Newborn Above 185% to 200% *** 7 Perinate 0% to 185% *** 8 Perinate Above 185% to 200% *** Service Area: NUECES Xxxxxx Rate Cell Rate Period 2 1 Capitation Rates 1 < Age 1 $ 62.31 *** 2 Ages 1 through 5 $ 97.40 *** 3 Ages 6 through 14 $ 84.79 *** 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through *** 5 $ 99.35 3 Ages Perinate Newborn 0% to 185% *** 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Perinate Newborn Above 185% to 200% *** 7 Perinate 0% to 185% *** 8 Perinate Above 185% to 200% *** Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP ProgramProgram and CHIP Perinatal subprogram. The CHIP Delivery Supplemental Payment is $3,100.00 *** for all Service Areas.
Appears in 1 contract
Samples: Centene Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 26: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 6 Capitation Rates 1. (9/1/11 -12/31/11) Rate Period 6 Capitation Rates (1/1/12 -2/29/12) 1 Medicard only Standard Rate $ 525.34 $ 531.27 2 Medicard only 1915(C) Nursing Facility Waiver Rate $ 2,907.50 $ 2,984.13 3 Dual Eligible Standard Rate $ 265.80 $ 265.80 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,673.44 $ 1,685.10 5 Nursing Facility - Medicaid Only $ 525.34 $ 531.27 6 Nursing Facility - Dual Eligible $ 265.80 $ 265.80 STAR+PLUS Service Area: XXXXXX Rate Cell Rate Period 6 Capitation Rates (9/1/11 - 12/31/11) Rate Period 6 Capitation Rates (1/1/12 - 2/29/12) 1 Medicaid Only Standard Rate $ 462.72 2. 613.65 $ 618.02 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 3. 3,453.66 $ 3,536.34 3 Dual Eligible Standard Rate $ 270.37 4. 236.95 $ 236.95 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 5. 1,469.55 $ 1,480.61 5 Nursing Facility – - Medicaid Only $ 462.72 6. 613.65 $ 618.02 6 Nursing Facility – - Dual Eligible $ 270.37 236.95 $ 236.95 STAR+PLUS Service Area: NUECES JEFFERSON Rate Cell Rate Period 2 6 Capitation Rates 1. (9/1/11 - 12/31/11) Rate Period 6 Capitation Rates (1/1/12 - 2/29/12) 1 Medicaid Only Standard Rate $ 533.57 2. 403.39 $ 408.44 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. 2,069.42 $ 2,095.29 3 Dual Eligible Standard Rate $ 337.13 4. 189.19 $ 189.77 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. 1,250.55 $ 1,254.36 5 Nursing Facility – - Medicaid Only $ 533.57 6. 403.39 $ 408.44 6 Nursing Facility – - Dual Eligible $ 337.13 x 189.19 $ 189.77 STAR+PLUS Service Area: XXXXXX Rate Cell Rate Period 6 Capitation Rates (9/1/11 - 12/31/11) Rate Period 6 Capitation Rates (1/1/12 - 2/29/12) 1 Medicaid Only Standard Rate $ 611.55 $ 615.67 2 Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,395.03 $ 3,485.14 3 Dual Eligible Standard Rate $ 179.87 $ 179.87 4 Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,710.22 $ 1,724.30 5 Nursing Facility - Medicaid Only $ 611.55 $ 615.67 6 Nursing Facility - Dual Eligible $ 179.87 $ 179.87 þ CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 26: Service Area: BEXAR DALLAS Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 89.60 216.50 2 Ages 1 through 5 $ 93.96 110.20 3 Ages 6 through 14 $ 60.55 78.69 4 Ages 15 through 18 $ 78.04 106.54 Service Area: EL PASO XXXXXX Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 67.70 237.92 2 Ages 1 through 5 $ 67.69 102.58 3 Ages 6 through 14 $ 58.59 74.56 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 109.03 Service Area: NUECES Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 62.31 146.81 2 Ages 1 through 5 $ 97.40 112.05 3 Ages 6 through 14 $ 84.79 65.48 4 Ages 15 through 18 $ 116.44 125.81 Service Area: XXXXXX TARRANT Rate Cell Rate Period 2 6 Capitation Rates 1 < Age 1 $ 129.53 127.64 2 Ages 1 through 5 $ 99.35 103.89 3 Ages 6 through 14 $ 86.64 69.85 4 Ages 15 through 18 $ 117.02 89.50 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.
Appears in 1 contract
Samples: Amerigroup Corp
Delivery Supplemental Payment. See Contract Attachment A, “HHSC "Uniform Managed Care Contract Terms and Conditions,” " Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x The STAR Delivery Supplemental Payments for the Service Areas covered by this contract are listed below. Service Area Delivery Supplemental Payment Xxxxxxx *** Medicaid Rural Service Area - Central Texas *** Medicaid Rural Service Area - Northeast Texas *** Medicaid Rural Service Area - West Texas *** þ Medicaid STAR+PLUS HMO MCO 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1. STAR + PLUS Service Area: Xxxxxxx Rate Cell 1 Medicaid Only Standard Rate $ 462.72 2. *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR+PLUS Waiver Rate $ 3,138.64 3. - Above Floor *** 3 Medicaid Only HCBS STAR+PLUS Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 270.37 4. *** 5 Dual Eligible 1915(C) HCBS STAR+PLUS Waiver Rate- Above Floor *** 6 Dual Eligible HCBS STAR+PLUS Waiver Rate- Below Floor *** 7 Nursing Facility Waiver Rate $ 1,931.47 5. - Medicaid Only *** 8 Nursing Facility – Medicaid Only $ 462.72 6. Nursing Facility – - Dual Eligible $ 270.37 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1. Medicaid Only Standard Rate $ 533.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 3. Dual Eligible Standard Rate $ 337.13 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 5. Nursing Facility – Medicaid Only $ 533.57 6. Nursing Facility – Dual Eligible $ 337.13 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 89.60 2 Ages 1 through 5 $ 93.96 3 Ages 6 through 14 $ 60.55 4 Ages 15 through 18 $ 78.04 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 67.70 2 Ages 1 through 5 $ 67.69 3 Ages 6 through 14 $ 58.59 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 62.31 2 Ages 1 through 5 $ 97.40 3 Ages 6 through 14 $ 84.79 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through 5 $ 99.35 3 Ages 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.***
Appears in 1 contract
Samples: Centene Corp
Delivery Supplemental Payment. See Contract Attachment A, “HHSC "Uniform Managed Care Contract Terms and Conditions,” " Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x The STAR Delivery Supplemental Payments for the Service Areas covered by this contract are listed below. Service Area Delivery Supplemental Payment Xxxxxxx *** Medicaid Rural Service Area - Central Texas *** Medicaid Rural Service Area - Northeast Texas *** Medicaid Rural Service Area - West Texas *** þ Medicaid STAR+PLUS HMO MCO 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1. (9/1/13 - 3/31/14) STAR + PLUS Service Area: Xxxxxxx Rate Cell 1 Medicaid Only Standard Rate $ 462.72 2. *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR+PLUS Waiver Rate $ 3,138.64 3. - Above Floor *** 3 Medicaid Only HCBS STAR+PLUS Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 270.37 4. *** 5 Dual Eligible 1915(C) HCBS STAR+PLUS Waiver Rate- Above Floor *** 6 Dual Eligible HCBS STAR+PLUS Waiver Rate- Below Floor *** 7 Nursing Facility Waiver Rate $ 1,931.47 5. - Medicaid Only *** 8 Nursing Facility – Medicaid Only $ 462.72 6. Nursing Facility – - Dual Eligible $ 270.37 STAR+PLUS Service Area: NUECES Rate Cell *** Rate Period 2 Capitation Rates 1. (4/1/14 - 8/31/14) STAR + PLUS Service Area: Xxxxxxx Rate Cell 1 Medicaid Only Standard Rate $ 533.57 2. *** 2 Medicaid Only 1915(C) Nursing Facility HCBS STAR+PLUS Waiver Rate $ 3,062.58 3. - Above Floor *** 3 Medicaid Only HCBS STAR+PLUS Waiver Rate - Below Floor *** 4 Dual Eligible Standard Rate $ 337.13 4. *** 5 Dual Eligible 1915(C) HCBS STAR+PLUS Waiver Rate- Above Floor *** 6 Dual Eligible HCBS STAR+PLUS Waiver Rate- Below Floor *** 7 Nursing Facility Waiver Rate $ 1,887.61 5. - Medicaid Only *** 8 Nursing Facility – Medicaid Only $ 533.57 6. Nursing Facility – - Dual Eligible $ 337.13 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 2: Service Area: BEXAR Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 89.60 2 Ages 1 through 5 $ 93.96 3 Ages 6 through 14 $ 60.55 4 Ages 15 through 18 $ 78.04 Service Area: EL PASO Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 67.70 2 Ages 1 through 5 $ 67.69 3 Ages 6 through 14 $ 58.59 4 Ages 15 through 18 $ 64.24 Service Area: LUBBOCK Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 80.56 2 Ages 1 through 5 $ 78.16 3 Ages 6 through 14 $ 62.30 4 Ages 15 through 18 $ 89.83 Service Area: NUECES Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 62.31 2 Ages 1 through 5 $ 97.40 3 Ages 6 through 14 $ 84.79 4 Ages 15 through 18 $ 116.44 Service Area: XXXXXX Rate Cell Rate Period 2 Capitation Rates 1 < Age 1 $ 129.53 2 Ages 1 through 5 $ 99.35 3 Ages 6 through 14 $ 86.64 4 Ages 15 through 18 $ 117.02 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.***
Appears in 1 contract
Samples: Centene Corp
Delivery Supplemental Payment. See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the STAR Program. x Medicaid STAR+PLUS 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+PLUS Program. The following Rate Cells and Capitation Rates will apply to Rate Period 23: STAR+PLUS Service Area: BEXAR Rate Cell Rate Period 2 3 Capitation Rates 1. Medicaid Only Standard Rate $ 462.72 526.51 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,138.64 2,748.46 3. Dual Eligible Standard Rate $ 270.37 287.26 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,931.47 1,845.00 5. Nursing Facility – Medicaid Only $ 462.72 526.51 6. Nursing Facility – Dual Eligible $ 270.37 287.26 STAR+PLUS Service Area: NUECES Rate Cell Rate Period 2 3 Capitation Rates 1. Medicaid Only Standard Rate $ 533.57 614.57 2. Medicaid Only 1915(C) Nursing Facility Waiver Rate $ 3,062.58 2,487.20 3. Dual Eligible Standard Rate $ 337.13 393.22 4. Dual Eligible 1915(C) Nursing Facility Waiver Rate $ 1,887.61 1,672.29 5. Nursing Facility – Medicaid Only $ 533.57 614.57 6. Nursing Facility – Dual Eligible $ 337.13 393.22 x CHIP 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 CHIP Program. The following Rate Cells and Capitation Rates will apply to Rate Period 23: Service Area: BEXAR Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 89.60 117.46 2 Ages 1 through 5 $ 93.96 114.44 3 Ages 6 through 14 $ 60.55 77.43 4 Ages 15 through 18 $ 78.04 90.66 Service Area: EL PASO Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 67.70 83.94 2 Ages 1 through 5 $ 67.69 82.60 3 Ages 6 through 14 $ 58.59 64.48 4 Ages 15 through 18 $ 64.24 76.34 Service Area: LUBBOCK Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 80.56 87.45 2 Ages 1 through 5 $ 78.16 84.55 3 Ages 6 through 14 $ 62.30 62.56 4 Ages 15 through 18 $ 89.83 87.06 Service Area: NUECES Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 62.31 125.81 2 Ages 1 through 5 $ 97.40 102.44 3 Ages 6 through 14 $ 84.79 75.46 4 Ages 15 through 18 $ 116.44 94.22 Service Area: XXXXXX Rate Cell Rate Period 2 3 Capitation Rates 1 < Age 1 $ 129.53 85.36 2 Ages 1 through 5 $ 99.35 107.53 3 Ages 6 through 14 $ 86.64 72.61 4 Ages 15 through 18 $ 117.02 98.21 Delivery Supplemental Payment: See Attachment A, “HHSC Uniform Managed Care Contract Terms and Conditions,” Article 10, for a description of the methodology for establishing the Delivery Supplemental Payment for the CHIP Program. The CHIP Delivery Supplemental Payment is $3,100.00 for all Service Areas.
Appears in 1 contract
Samples: Centene Corp
