Common use of Federally Qualified Health Centers Clause in Contracts

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP strongly encourages the Contractor to contract with FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality services. The Contractor shall reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any out-of-network Indian healthcare provider (see Section 5.2.11) that is a FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall review and must approve any performance incentives. The Contractor shall report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPP. Annually, OMPP requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall be completed in the form and manner set forth in the Hoosier Healthwise MCE Reporting Manuals, are updated annually. The data shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basis. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall pull the data by NPI or LPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall be available to OMPP upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP FSSA strongly encourages the Contractor to contract with all willing FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality servicescredentialing and service delivery requirements. The Contractor shall must reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In Additionally, in accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any an out-of-of- network Indian healthcare provider (see Section 5.2.116.2.13) that is a an FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- in-network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall FSSA will make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP FSSA requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall FSSA must review and must approve any performance incentives. The Contractor shall must report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim claims reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPPFSSA. Annually, OMPP FSSA requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall must be completed in the form and manner set forth in the Hoosier Healthwise MCE Care Connect Reporting ManualsManual, are updated annually. The data which shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basisprovided following the Contract award date. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall must pull the data by NPI or LPINPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall must be available to OMPP FSSA upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP FSSA requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall must also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP FSSA or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP FSSA and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP FSSA to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP FSSA strongly encourages the Contractor to contract with all willing FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality servicescredentialing and service delivery requirements. The Contractor shall must reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In Additionally, in accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any an out-of-network Indian healthcare provider (see Section 5.2.116.2.13) that is a an FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- in-network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall FSSA will make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP FSSA requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall FSSA must review and must approve any performance incentives. The Contractor shall must report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim claims reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPPFSSA. Annually, OMPP FSSA requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall must be completed in the form and manner set forth in the Hoosier Healthwise MCE Care Connect Reporting ManualsManual, are updated annually. The data which shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basisprovided following the Contract award date. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall must pull the data by NPI or LPINPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall must be available to OMPP FSSA upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP FSSA requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall must also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP FSSA or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP FSSA and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP FSSA to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP strongly encourages the Contractor to contract with FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality services. The Contractor shall reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-non- RHC provider for the same services. In accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any out-of-network Indian healthcare provider (see Section 5.2.11) that is a FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- in-network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall review and must approve any performance incentives. The Contractor shall report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPP. Annually, OMPP requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall be completed in the form and manner set forth in the Hoosier Healthwise MCE Reporting Manuals, are updated annually. The data shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basis. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall pull the data by NPI or LPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall be available to OMPP upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Since Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are essential safety net providers, OMPP strongly encourages the Contractor to contract with FQHCs and RHCs that are willing to contract with the Contractor and meet all of the Contractor’s requirements regarding the ability of these providers to provide quality services. The Contractor shall reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In HIP, Contractors shall make covered services provided by FQHCs and RHCs available to members out-of-network if an FQHC or RHC is not available in the member’s service area within the Contractor’s network. In accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any out-of-network Indian healthcare provider (see Section 5.2.118.2.10) that is a FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- in-network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall review and must approve any performance incentives. The Contractor shall report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise and HIP lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPP. Annually, OMPP requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. A separate report shall be provided for the Contractor’s HIP lines of business. The report shall be completed in the form and manner set forth in the Hoosier Healthwise HIP MCE Reporting Manuals. For HIP, are updated annually. The data shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The the data shall be submitted on a paid claims basis. The submitted FQHC and RHC data must shall be accurate and complete. The Contractor shall pull the data by NPI or LPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall be available to OMPP upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP FSSA strongly encourages the Contractor to contract with all willing FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality servicescredentialing and service delivery requirements. The Contractor shall must reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In Additionally, in accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any an out-of-of- network Indian healthcare provider (see Section 5.2.116.2.13) that is a an FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- in-network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall FSSA will make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP FSSA requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall FSSA must review and must approve any performance incentives. The Contractor shall must report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim claims reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPPFSSA. Annually, OMPP FSSA requires the Contractor to provide the Contractor’s utilization and EXHIBIT 1.M SCOPE OF WORK reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall must be completed in the form and manner set forth in the Hoosier Healthwise MCE Care Connect Reporting ManualsManual, are updated annually. The data which shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basisprovided following the Contract award date. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall must pull the data by NPI or LPINPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall must be available to OMPP FSSA upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP FSSA requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall must also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP FSSA or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP FSSA and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP FSSA to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP FSSA strongly encourages the Contractor to contract with all willing FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality servicescredentialing and service delivery requirements. The Contractor shall must reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In Additionally, in accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any an out-of-of- network Indian healthcare provider (see Section 5.2.116.2.13) that is a an FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- in-network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall FSSA will make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP FSSA requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall FSSA must review and must approve any performance incentives. The Contractor shall must report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim claims reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual reconciliation conducted by OMPPFSSA. Annually, OMPP FSSA requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall be completed in the form and manner set forth in the Hoosier Healthwise MCE Reporting Manuals, are updated annually. The data shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basis. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall pull the data by NPI or LPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall be available to OMPP upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.

Federally Qualified Health Centers. (FQHCs) and Rural Health Clinics (RHCs) Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) are safety net providers, OMPP strongly encourages the Contractor to contract with FQHCs and RHCs that meet all of the Contractor’s requirements regarding the ability of these providers to provide quality services. The Contractor shall reimburse FQHCs and RHCs for services at no less than the level and amount of payment that the Contractor would make to a non-FQHC or non-RHC provider for the same services. In accordance with section 5006(d) of the American Recovery and Reinvestment Act of 2009 (ARRA), the Contractor shall pay any out-of-network Indian healthcare provider (see Section 5.2.11) that is a FQHC for covered services provided to an American Indian/ Alaska Native member at a rate equal to the amount of payment that the Contractor would pay to an in- network FQHC that is not an Indian health care provider for the same services. In accordance with the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 (BIPA), OMPP shall make supplemental payments to FQHCs and RHCs that subcontract (directly or indirectly) with the Contractor. These supplemental payments represent the difference, if any, between the payment to which the FQHC or RHC would be entitled for covered services under the Medicaid provisions of BIPA and the payments made by the Contractor. OMPP requires the Contractor to identify any performance incentives it offers to the FQHC or RHC. OMPP shall review and must approve any performance incentives. The Contractor shall report all such FQHC and RHC incentives which accrue during the Contract period related to the cost of providing FQHC-covered or RHC-covered services to its members along with any fee-for-service and/or capitation payments in the determination of the amount of direct reimbursement paid by the Contractor to the FQHC or RHC. If the incentives vary between the Contractor’s Hoosier Healthwise lines of business, the Contractor shall so specify in its reporting to OMPP. The Contractor shall perform quarterly claim reconciliation with each contracted FQHC or RHC to identify and resolve any billing issues that may impact the clinic’s annual resol reconciliation conducted by OMPP. Annually, OMPP requires the Contractor to provide the Contractor’s utilization and reimbursement data for each FQHC and RHC in each month of the reporting period. The report shall be completed in the form and manner set forth in the Hoosier Healthwise MCE Reporting Manuals, are updated annually. The data shall be submitted on an incurred claims basis, including separate reporting of Package A FFS claims, Package A capitation claims, Package C FFS claims and Package C capitation claims. The data shall be submitted on a paid claims basis. The submitted FQHC and RHC data must be accurate and complete. The Contractor shall pull the data by NPI or LPI, rather than other means, such as a Federal Tax ID number. The Contractor shall establish a process for validating the completeness and accuracy of the data, and a description of this process shall be available to OMPP upon request. The claims files should not omit claims for practitioners rendering services at the clinic nor should the files contain claims for practitioners who did not practice at the clinic. In addition, OMPP requires the FQHC or RHC and the Contractor to maintain and submit records documenting the number and types of valid encounters provided to members each month. Capitated FQHCs and RHCs shall also submit encounter data (e.g., in the form of shadow claims to the Contractor) each month. The number of encounters will be subject to audit by OMPP or its representatives. The Contractor shall work with each FQHC and RHC in assisting OMPP and/or its designee in the resolution of disputes concerning year-end reconciliations between the federally required interim payments (made by OMPP to each FQHC and RHC on the basis of provider reported encounter activity) and the final accounting that is based on the actual encounter data provided by the Contractor.