For MSC+ Clause Samples
The 'For MSC+' clause designates specific terms or conditions that apply exclusively to the MSC+ program or offering. In practice, this clause may outline eligibility requirements, special benefits, or obligations that are unique to participants enrolled in MSC+, distinguishing them from standard agreements. Its core function is to clearly separate and define the rights and responsibilities associated with the MSC+ tier, ensuring that all parties understand the distinctions and avoid confusion regarding which provisions apply.
For MSC+. (1) The MSC+ Institutionalized Rate Cell includes the following component, adjusted for age, sex, Medicare status and region or county:
(a) Medicaid Institutional Basic Care payment rate.
(2) The MSC+ Community EW Rate Cell includes the following components, which are adjusted for age, sex, Medicare status and region or county:
(a) Medicaid Community EW Basic Care payment rate.
(b) EW Waiver Add-On.
(c) Medicaid one hundred and eighty (180) day NF Add-On.
(3) The MSC+ Community Non-EW Rate Cell includes the following components, which are adjusted for age, sex, Medicare status and region or county:
(a) Medicaid Community Non-EW Basic Care payment rate.
(b) Medicaid one hundred and eighty (180) day NF Add-On.
For MSC+. When enrollment occurs and has been entered on the state MMIS after the Cut-Off Date, medical coverage shall commence at midnight Minnesota time on the first day of the second month following the month in which enrollment was entered on the state MMIS.
For MSC+. The Institutionalized Rate Cell includes the following component, adjusted for age, sex, Medicare status and region or county:
For MSC+. (A) Categories. The Rate Cell categories shall be assigned by the STATE upon receipt of the required information from the MCO as specified in this section. Rate Cells shall be assigned prospectively for the next available month.
(B) Changes. Changes in Rate Cell due to new living arrangement and/or Elderly Waiver Nursing Facility Certifiable (NHC) status must be entered in MMIS on or before the Capitation Cut-Off Date in order for the MCO to be paid at the rate corresponding to the new Rate Cell for the next available month. When a change to Rate Cell criteria has been entered in MMIS after the enrollment Cut-Off Date, the MCO will be paid at the rate corresponding to the new Rate Cell at the time of the MCO’s next Capitation Payment, unless the requirements provided for in this section are met, and/or the payment is delayed according to section 4.7.1(D)(2) below.
(C) Community Non-Elderly Waiver (Community Non-EW) Rate Cell.
(1) The Community Non-EW Rate Cell will be assigned to those Recipients who, at capitation for MSC+, the time of enrollment in the MCO, are coded in MMIS to be in a community living arrangement and are not enrolled in Elderly Waiver for the 1st of the following month.
(2) The Community Non-EW Rate Cell will be assigned based on the Enrollee’s living arrangement in MMIS, and absence of an EW Waiver span in MMIS.
For MSC+. (1) The MSC+ Institutionalized Rate Cell includes the following component, adjusted for age, sex, Medicare status and region or county:
(a) Medicaid Institutional Basic Care payment rate.
(2) The MSC+ Community EW Rate Cell includes the following components, which are adjusted for age, sex, Medicare status and region or county:
(a) Medicaid Community EW Basic Care payment rate.
(b) EW Waiver Add-On.
(c) Medicaid one hundred and eighty (180) day NF Add-On.