Common use of MCO Programs and Service Areas Clause in Contracts

MCO Programs and Service Areas. This Contract applies to the following HHSC MCO Programs and Service Areas (check all that apply). All references in the Contract Attachments to MCO Programs or Service Areas that are not checked are superfluous and do not apply to the MCO. þ Medicaid STAR MCO Program Service Areas: o Bexar þ Medicaid RSA - Central o Dallas þ Medicaid RSA - Northeast o El Paso þ Medicaid RSA - West x Xxxxxx o Nueces þ Xxxxxxx x Xxxxxxx o Xxxxxxxxx x Xxxxxx o Lubbock See Attachment B-4, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the STAR Service Areas. þ Medicaid STAR+PLUS MCO Program Service Areas: o Bexar o Jefferson o El Paso o Lubbock x Xxxxxx o Nueces þ Xxxxxxx o Travis See Attachment B-4.2, “Map of Counties with STAR+PLUS MCO Program Service Areas,” for listing of counties included within the STAR+PLUS Service Areas. o CHIP MCO Program Service Areas: o Bexar o Lubbock o Dallas o Nueces o El Paso o Tarrant x Xxxxxx o Xxxxxx x Xxxxxxxxx See Attachment B-4.1, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the CHIP Service Areas. Part 9: Payment þ Medicaid STAR 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 Program. The following Rate Cells and Capitation Rates will apply to Rate Period 1: Service Area: Xxxxxxx Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child ≤ 12 months *** *** 8 Federal Mandate Child *** *** 9 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – Central Texas Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – Northeast Texas Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – West Texas Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** ***

MCO Programs and Service Areas. This Contract applies to the following HHSC MCO Programs and Service Areas (check all that apply). All references in the Contract Attachments to MCO Programs or Service Areas that are not checked are superfluous and do not apply to the MCO. þ Medicaid STAR MCO Program Service Areas: þ Bexar o Bexar þ Medicaid RSA - Central o Dallas þ o Medicaid RSA - Northeast o þ El Paso þ o Medicaid RSA - West x Xxxxxx o þ Nueces þ x Xxxxxxx x Xxxxxxx o Xxxxxxxxx x Jefferson þ Xxxxxx o þ Lubbock See Attachment B-4, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the STAR Service Areas. þ Medicaid STAR+PLUS MCO Program Service Areas: o þ Bexar o Jefferson o El Paso o þ Lubbock x Xxxxxx o þ Nueces þ x Xxxxxxx o Travis See Attachment B-4.2, “Map of Counties with STAR+PLUS MCO Program Service Areas,” for listing of counties included within the STAR+PLUS Service Areas. o þ CHIP MCO Program Service Areas: o þ Bexar o þ Lubbock o Dallas o þ Nueces o þ El Paso o Tarrant x Xxxxxx o þ Xxxxxx x Xxxxxxxxx See Attachment B-4.1, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the CHIP Service Areas. Part 9: Payment þ Medicaid STAR 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 Program. The following Rate Cells and Capitation Rates will apply to Rate Period 1: Service Area: Xxxxxxx Bexar Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate Child *** child *** 9 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – Central Texas El Paso Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – Northeast Texas Lubbock Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – West Texas Nueces Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** Service Area: Xxxxxx Rate Cell Rate Period 1 Capitation Rates 1 TANF Child > 12 months *** 2 TANF child ≤ 12 months *** 3 TANF Adult *** 4 Pregnant Woman *** 5 Newborn ≤ 12 months *** 6 Expansion Child > 12 months *** 7 Expansion child ≤ 12 months *** 8 Federal Mandate child *** 9 Delivery Supplemental Payment ***

MCO Programs and Service Areas. This Contract applies to the following HHSC MCO Programs and Service Areas (check all that apply). All references in the Contract Attachments to MCO Programs or Service Areas that are not checked are superfluous and do not apply to the MCO. þ Medicaid STAR MCO Program Service Areas: o Bexar þ Medicaid RSA - Central o Dallas þ Medicaid RSA - Northeast o El Paso þ Medicaid RSA - West x Xxxxxx o Nueces þ Xxxxxxx x Xxxxxxx o Xxxxxxxxx x Xxxxxx o Lubbock See Attachment B-4, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the STAR Service Areas. þ Medicaid STAR+PLUS MCO Program Service Areas: o Bexar o Jefferson o El Paso o Lubbock x Xxxxxx o Nueces þ Xxxxxxx o Travis See Attachment B-4.2, “Map of Counties with STAR+PLUS MCO Program Service Areas,” for listing of counties included within the STAR+PLUS Service Areas. o CHIP MCO Program Service Areas: o Bexar o Lubbock o Dallas o Nueces o El Paso o Tarrant x Xxxxxx o Xxxxxx x Xxxxxxxxx See Attachment B-4.1, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the CHIP Service Areas. Part 9: Payment þ Medicaid STAR 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 Program. The following Rate Cells and Capitation Rates will apply to Rate Period 1: Service Area: Xxxxxxx Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-5/31/13) Rate Period 1 Capitation Rates (6/1/13-8/31/13) 1 TANF Child > 12 months *** *** *** 2 TANF Child ≤ 12 months *** *** *** 3 TANF Adult *** *** *** 4 Pregnant Woman *** *** *** 5 Newborn ≤ 12 months *** *** *** 6 Expansion Child > 12 months *** *** *** 7 Expansion Child ≤ 12 months *** *** *** 8 Federal Mandate Child *** *** *** 9 Delivery Supplemental Payment *** *** *** Service Area: Medicaid Rural Service Area – Central Texas Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-5/31/13) Rate Period 1 Capitation Rates (6/1/13-8/31/13) 1 TANF Child > 12 months *** *** *** 2 TANF Child ≤ 12 months *** *** *** 3 TANF Adult *** *** *** 4 Pregnant Woman *** *** *** 5 Newborn ≤ 12 months *** *** *** 6 Expansion Child > 12 months *** *** *** 7 Expansion Child ≤ 12 months *** *** *** 8 Federal Mandate child *** *** *** 9 SSI - Aged, Blind, & Disabled *** *** *** 10 Delivery Supplemental Payment *** *** *** Service Area: Medicaid Rural Service Area – Northeast Texas Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-5/31/13) Rate Period 1 Capitation Rates (6/1/13-8/31/13) 1 TANF Child > 12 months *** *** *** 2 TANF Child ≤ 12 months *** *** *** 3 TANF Adult *** *** *** 4 Pregnant Woman *** *** *** 5 Newborn ≤ 12 months *** *** *** 6 Expansion Child > 12 months *** *** *** 7 Expansion Child ≤ 12 months *** *** *** 8 Federal Mandate child *** *** *** 9 SSI - Aged, Blind, & Disabled *** *** *** 10 Delivery Supplemental Payment *** *** *** Service Area: Medicaid Rural Service Area – West Texas Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-5/31/13) Rate Period 1 Capitation Rates (6/1/13-8/31/13) 1 TANF Child > 12 months *** *** *** 2 TANF Child ≤ 12 months *** *** *** 3 TANF Adult *** *** *** 4 Pregnant Woman *** *** *** 5 Newborn ≤ 12 months *** *** *** 6 Expansion Child > 12 months *** *** *** 7 Expansion Child ≤ 12 months *** *** *** 8 Federal Mandate child *** *** *** 9 SSI - Aged, Blind, & Disabled *** *** *** 10 Delivery Supplemental Payment *** *** ***

MCO Programs and Service Areas. This Contract applies to the following HHSC MCO Programs and Service Areas (check all that apply). All references in the Contract Attachments to MCO Programs or Service Areas that are not checked are superfluous and do not apply to the MCO. þ Medicaid STAR MCO Program Service Areas: þ Bexar o Bexar þ Medicaid RSA - Central o Dallas þ o Medicaid RSA - Northeast o þ El Paso þ o Medicaid RSA - West x Xxxxxx o þ Nueces þ x Xxxxxxx x Xxxxxxx o Xxxxxxxxx x Jefferson þ Xxxxxx o þ Lubbock See Attachment B-4, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the STAR Service Areas. þ Medicaid STAR+PLUS MCO Program Service Areas: o þ Bexar o Jefferson o El Paso o þ Lubbock x Xxxxxx o þ Nueces þ x Xxxxxxx o Travis See Attachment B-4.2, “Map of Counties with STAR+PLUS MCO Program Service Areas,” for listing of counties included within the STAR+PLUS Service Areas. o þ CHIP MCO Program Service Areas: o þ Bexar o þ Lubbock o Dallas o þ Nueces o þ El Paso o Tarrant x Xxxxxx o þ Xxxxxx x Xxxxxxxxx See Attachment B-4.1, “Map of Counties with MCO Program Service Areas,” for listing of counties included within the CHIP Service Areas. Part 9: Payment þ Medicaid STAR 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 Program. The following Rate Cells and Capitation Rates will apply to Rate Period 1: Service Area: Xxxxxxx Bexar Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate Child child *** *** 9 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – Central Texas El Paso Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – Northeast Texas Lubbock Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled *** *** 10 Delivery Supplemental Payment *** *** Service Area: Medicaid Rural Service Area – West Texas Nueces Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF Child child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion Child child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 SSI - Aged, Blind, & Disabled Delivery Supplemental Payment *** *** 10 Service Area: Xxxxxx Rate Cell Rate Period 1 Capitation Rates (3/1/12-8/31/12) Rate Period 1 Capitation Rates (9/1/12-8/31/13) 1 TANF Child > 12 months *** *** 2 TANF child ≤ 12 months *** *** 3 TANF Adult *** *** 4 Pregnant Woman *** *** 5 Newborn ≤ 12 months *** *** 6 Expansion Child > 12 months *** *** 7 Expansion child ≤ 12 months *** *** 8 Federal Mandate child *** *** 9 Delivery Supplemental Payment *** ***