Provider P4P Program Funding Clause Samples

Provider P4P Program Funding. The Department will make quarterly payments based on a per member per month (PMPM) rate, noted in ▇▇▇▇▇▇▇▇ ▇▇. This payment is separate from the monthly capitation process, as identified in Appendix 3b, and will be made via Gross Adjustment. The Department will process a payment in the second subsequent month following the quarter end. The Department will make these payments only to the extent that adequate funds are included for the purpose of these Exhibit B (3) payments to all PH-MCOs in the Commonwealth’s enacted budget for the capitation appropriation. If this payment is subject to the Gross Receipts Tax (GRT), the payment amount will increase by 6.27%. This increase recognizes the legitimate and marginal administrative cost to the PH-MCO of this tax. If the Department has notified the PH-MCO that the GRT is reduced or ended, upon advance written notice to the PH-MCO, the increase to the Provider P4P payment for GRT will be appropriately reduced or ended. Payments made to the PH-MCO under the Provider P4P program are intended to fund all mandatory measures first prior to funding optional measures and/or Community Based Care Management activities, or as approved by the Department. If the PH-MCO has unspent Provider P4P funds after all final disbursements have been made for the approved QPP above, upon advanced written notice to the PH-MCO, the Department may reduce a future Provider P4P payment by the unspent amount. If at any time the Department determines Provider P4P funds were not disbursed in accordance with the approved QPP above, upon advanced written notice to the PH- MCO, the Department may elect to reduce a future Provider P4P payment by the amount identified.