GENERAL FINANCIAL PROVISIONS. II.14. Eligible costs of the project
GENERAL FINANCIAL PROVISIONS. Capitation
GENERAL FINANCIAL PROVISIONS. Article II.12
GENERAL FINANCIAL PROVISIONS. Capitation Payments CMS and EOHHS will each contribute to the total capitation payment. CMS and EOHHS will each make monthly payments to the Contractor for their portion of the capitated rate, in accordance with the rates of payment and payment provisions set forth herein and subject to all applicable Federal and State laws, regulations, rules, billing instructions, and bulletins, as amended. The Contractor will receive three monthly payments for each Enrollee: one amount from CMS reflecting coverage of Medicare Parts A/B services (Medicare Parts A/B Component), one amount from CMS reflecting coverage Medicare Part D services (Medicare Part D Component), and a third amount from EOHHS reflecting coverage of Medicaid services (MassHealth Component).
GENERAL FINANCIAL PROVISIONS. A. Capitation Payments EOHHS will make monthly capitation payments to the Contractor in accordance with the rates of payment and payment provisions set forth herein for all Covered Services actually and properly delivered to eligible Enrollees in accordance with and subject to all applicable federal and State laws, regulations, rules, billing instructions, and bulletins, as amended. The Contractor will receive two monthly capitation payments for each Dual Eligible Enrollee: one amount from Medicare and a second amount from MassHealth. Medicare and MassHealth each produce different Rate Cells (RCs) according to the individual Enrollee’s clinical and demographic status and setting of care. For those Enrollees who are eligible for MassHealth only, the Contractor will receive one monthly capitation payment from MassHealth.
GENERAL FINANCIAL PROVISIONS. 4.1.1. Capitation
GENERAL FINANCIAL PROVISIONS. Capitation Payments CMS and SCDHHS will each contribute to the total Capitation Payment paid to the CICO. CMS and SCDHHS will each make monthly payments for each Enrollee to the CICO for their portion of the capitated rate, in accordance with the rates of payment and payment provisions set forth herein and subject to all applicable federal and state laws, regulations, rules, billing instructions, and bulletins, as amended. The CICO will receive three (3) monthly payments for each Enrollee: one amount from CMS reflecting coverage of Medicare Parts A/B services (Medicare Parts A/B Component), one amount from CMS reflecting coverage Medicare Part D services (Medicare Part D Component), and a third amount from SCDHHS reflecting coverage of Medicaid services (Medicaid Component). The Medicare Parts A/B payment will be risk adjusted using the Medicare Advantage CMS-HCC Model and the CMS-HCC ESRD Model, except as specified in Section 4.2.4.1. The Medicare Part D payment will be risk adjusted using the Part D RxHCC Model. The Medicaid Component will utilize the rate cell methodology described in Section 4.2. CMS and SCDHHS will provide the CICO with a rate report on an annual basis for the upcoming calendar year. On a regular basis, CMS will provide SCDHHS with the CICO plan-level payment information in the Medicare Plan Payment Report. The use of such information by SCDHHS will be limited to financial monitoring, performing financial audits, and related activities, unless otherwise agreed to by CMS and the CICO. On a regular basis, SCDHHS will also provide to CMS CICO plan-level payment information, including the Medicaid Capitation Payments. Demonstration Year Dates Capitation Rate updates will take place on January 1st of each calendar year or more frequently, as described in this section; however, savings percentages and quality withhold percentages (see Sections 4.2.3. and 4.4.4.) will be applied based on Demonstration Years, as follows: Demonstration Year 1: February 1, 2015-December 31, 2016 Demonstration Year 2: January 1, 2017-December 31, 2017 Demonstration Year 3: January 1, 2018-December 31, 2018 Demonstration Year 4: January 1, 2019 – December 31, 2019 Demonstration Year 5: January 1, 2020 – December 31, 2020 Demonstration Year 6: January 1, 2021 – December 31, 2021 Demonstration Year 7: January 1, 2022 – December 31, 2022 Demonstration Year 8: January 1, 2023 – December 31, 2023 Demonstration Year 9: January 1, 2024 – Decem...
GENERAL FINANCIAL PROVISIONS. Article IV.7 of GA – Eligible costs Principle Maximum grant is based on an estimation of eligible costs prepared by the partners and negotiated with the Joint Undertaking (see Article 5 of GA). Estimation of eligible costs of the beneficiary's participation in the implementation of the project must be shown in detail in the provisional budget included in the Grant Preparation Forms (GPF) and subsequently in the Technical Annex. In order to be considered for reimbursement, costs incurred by the beneficiaries in the course of the project, must satisfy the eligibility criteria laid down by the GA. It must be stressed that subject to these criteria, it is always the Joint Undertaking which takes the final decision on the nature and amount of the costs to be considered eligible, either when analysing proposals for the establishment of the estimated budget to be annexed to the GA or when examining financial statements for the purposes of determining the JU contribution.
GENERAL FINANCIAL PROVISIONS. Notwithstanding paragraph #28 the Agency sole source of revenue is a .005 cents sales tax to be received from within the municipalities contained within the boundaries of the Agency and may issue bonds to finance Projects in accordance with the provisions of the Act.
GENERAL FINANCIAL PROVISIONS. 4.1.1. Capitation Payments
