Common use of Method of Reimbursement Clause in Contracts

Method of Reimbursement. SCDHHS will pay the Contractor a prospective case management/care coordination fee of Ten Dollars ($10.00) per member per month (PMPM) as payment in full for the services described for the period. Any Care Coordination PMPM fee that the CSO chooses to pay to the participating practices shall be paid from this prospective PMPM. Any merit-based bonuses, not dependent on cost savings that the CSO chooses to pay to the participating practices shall be paid from this prospective PMPM. Any merit bonus or incentive payment made to participating practices must be in accordance/compliance with the requirements set forth in 42CFR §§ 422.208 and 422.210. Detailed information on Physician Incentive Plan requirements may be found in the MHN Policy and Procedure Guide. SCDHHS will share documented cost savings with the Network as an incentive. If the Network fails to achieve cost savings, XXXXXX will impose a penalty and a portion, if not all of the prospective care coordination fee payments must be refunded to the SCDHHS. SCDHHS will conduct periodic cost reconciliation. At a minimum, cost reconciliation shall be conducted semi-annually. A detailed description of the shared savings formula is attached as Appendix B.

Method of Reimbursement. SCDHHS will pay the Contractor a prospective case management/care coordination fee of Ten Dollars ($10.00) per member per month (PMPM) as payment in full for the services described for the period. Any Care Coordination PMPM fee that the CSO chooses to pay to the participating practices shall be paid from this prospective PMPM. Any merit-based bonuses, not dependent on cost savings that the CSO chooses to pay to the participating practices shall be paid from this prospective PMPM. Any merit bonus or incentive payment made to participating practices must be in accordance/compliance with the requirements set forth in 42CFR §§ 422.208 and 422.210. Detailed information on Physician Incentive Plan requirements may be found in the MHN Policy and Procedure Guide. SCDHHS will share documented cost savings with the Network as an incentive. If the Network fails to achieve cost savings, XXXXXX SCDHHS will impose a penalty and a portion, if not all of the prospective care coordination fee payments must be refunded to the SCDHHS. SCDHHS will conduct periodic cost reconciliation. At a minimum, cost reconciliation shall be conducted semi-annually. A detailed description of the shared savings formula is attached as Appendix B.