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HomeMy WebLinkAboutAgreements/Contracts - RenewEXHIBIT 1-A Compensation Schedule - Medicaid (Version 2) Health Plan agrees to compensate Provider for Clean Claims for Covered Services rendered to Members, in accordance with Health Plan's programs participation, on a fee -for -services basis, at the lesser of; (i) Provider's allowable charge description master rate, or (ii) the amounts set forth below, less any applicable Member co- payments, deductibles, co-insurance, or amounts paid or to be paid by other liable third parties, if any: Integrated Managed Care ("IMC") Apple Health, IMC Apple Health Adult, IMC Apple Health Blind and Disabled, IMC Apple Health with Premium (collectively referred to as "IMC"), and Behavioral Health Services Only ("BHSO"): Provider agrees to follow Health Plan's IMC Companion Guide, which is intended to supplement the use of the Health Care Authority ("HCA") Integrated Managed Care Service Encounter Reporting Instructions ("SERI"). Health Plan may unilaterally change or modify the IMC Companion Guide from time to time, as updates are made to SERI or Health Plan policies and procedures. Upon written request from Health Plan, Provider shall submit annual independently audited financial statements to Health Plan based upon Provider's prior fiscal year-end financial statements. Provider must accurately and separately track Medicaid and Non -Medicaid funds and report the expenditure of these funds to Health Plan upon its written request. Reimbursement is inclusive and in accordance with HB 1109 Section 215 (23). The following language applies to IMC and BHSO services rendered in THE NORTH CENTRAL REGIONAL SERVICE AREA. The terms below pertaining to IMC and BHSO shall be effective January 1, 2021 through December 31, 2021; thereafter the rates shall automatically renew for successive one (1) year terms, unless otherwise amended upon mutual agreement of the parties. Payment shall be made by Health Plan to the Provider as follows: 1. MENTAL HEALTH AND SUBSTANCE USE DISORDER REIMBURSEMENT 1.1 Health Plan shall make known to Provider by written notice, provided no later than the 15th day of each month, the total North Central Region Medicaid behavioral health premium and General Funds State ("GF -S") dollars received by Health Plan for the current month. Health Plan will provide with monthly accounting statement the total membership by county. North Central Region, for the purpose of this Agreement, is defined as Chelan, Douglas and Grant Counties and excludes Okanogan County. 1.2 From the total funds received by Health Plan identified above, Health Plan shall create withhold accounts or apply deductions as follows (each with the fund types comprising them identified): 1.2.1 Health Plan Administrative costs not to exceed 12.8% of Health Plan's dollars received per section 1.1 above. 1.2.2 Children's Home Society ("CHS") (the amount contracted). These funds will be used to pay CHS' agreement. Payments to CHS shall not exceed: a. For outpatient services: Health Plan's proportionate share of the budget ($100,988.00 per month), which is based on the percentage of Apple Health IMC and BHSO membership in Chelan, Douglas and Grant Counties. Proportionate share will be assessed on a monthly basis. 1.2.3 Columbia Valley Community Health ("CVCH") (the amount contracted). These funds will be used to pay CVCH's agreement. 2022008_IMC.CS MHWAMEND.032022 Page 2 of 11 a. CVCH is reimbursed Fee -For -Service per encounter hour for outpatient mental health services. All claims paid for these services will be deducted on a monthly basis. Payments to CVCH shall not exceed the Health Plan's proportionate share for this budget ($60,000 per month), which shall be based on its percentage of Apple Health IMC and BHSO membership in Chelan, Douglas and Grant Counties. Proportionate share will be assessed on a monthly basis. 1.2.4 The Center for Drug and Alcohol ("CADT") (the amount contracted). These funds will be used to pay CADT's agreement. a. CADT is reimbursed as follows: i. For outpatient substance use disorder services: Health Plan's proportionate share (based on Health Plan's Apple Health IMC and BHSO Member utilization) of the budget ($85,026.00). E.g. 100 IMC/BHSO Members served during the.month; 35 Members are Health Plan's IMC or BHSO Members, so Health Plan is responsible for 35% of that month's Budget Amount). ii. For intensive inpatient residential (including room and board): Health Plan's proportionate share (based on Health Plan's Apple Health IMC and BHSO Member utilization) of twelve (12) beds, to be paid at one hundred percent (100%) of the State of Washington Medicaid Fee -For -Service fee schedule in effect on the date of service. Vacant bed days will be allocated to Health Plan, other health plan(s) and the Behavioral Health Administrative Services Organization ("BH -ASO") based on each party's percentage of utilization for that month (i.e. if Health Plan utilized 50% of the bed days for the month, Health Plan will reimburse Provider for 50% of the vacant bed days). Any utilization above the twelve (12) beds will also be paid via invoice at one hundred percent (100%) of the State of Washington Medicaid Fee -For - Service fee schedule in effect on the date of service. iii. For clinically managed sub -acute withdrawal management beds: Health Plan's proportionate share (based on Health Plan's Apple Health IMC and BHSO Member utilization) of 7 beds, to be paid at one hundred percent (100%) of the State of Washington Medicaid Fee -For -Service fee schedule in effect on the date of service. Vacant bed days will be allocated to Health Plan, other health plan(s) and the Behavioral Health Administrative Services Organization ("BH -ASO") based on each party's percentage of utilization for that month (i.e. if Health Plan utilized 50% of the bed days for the month, Health Plan will reimburse Provider for 50% of the vacant bed days). Any utilization above the 7 beds will also be paid via invoice at one hundred percent (100%) of the State of Washington Medicaid Fee -For -Service fee schedule in effect on the date of service. 1.2.5 Incentive Payment (the amount contracted). These funds will be used to pay all providers' incentive payments per providers' agreements. 1.3 All remaining funds received by Health Plan shall be divided between and paid to Provider and Catholic Family and Children Services ("CFCS") by the 15th of the month as follows: 1.3.1 All remaining North Central Region Medicaid funds received by Health Plan shall be divided between Provider and CFCS according to Health Plan's Medicaid eligible IMC and BHSO population split for Chelan/Douglas and Grant Counties. 1.3.2 From Provider's allocation, the following will be deducted: a. Effective January 1, 2021 and thereafter: A PMPM will be paid to Beacon for crisis services to Members in Grant County. Molina will complete periodic reconciliations on the experience related to the PMPM paid —any excess is paid back to Molina (and passed on to Provider) and any deficit is due to Beacon (paid by Provider). If experience indicates the PMPM should be adjusted, Molina will amend the rate accordingly. 2022008_IMC.CS MHWAMEND.032022 Page 3 of 11 b. Paid state hospitalization penalties, behavioral health inpatient and residential (Effective January 1, 2021: including crisis stabilization/triage) claims for Health Plan's membership assigned to Grant County. Attachment 1 - 2022 North Central Behavioral Health Risk Service Code Set will be utilized to identify eligible claims. Health Plan will provide Provider supporting documentation for state hospitalization penalties and behavioral health inpatient and residential claims paid each month. C. In accordance with Section 3, Performance Measures below 4% of Provider's total Medicaid payment will be withheld each month. 1.3.3 From Provider's allocation, the following will be deducted: GF -S funded services provided to Health Plan's membership assigned to Grant County from out -of -region providers (i.e. room and board claims for residential mental health/substance use disorder treatment). All remaining GF -S funds shall be divided between and paid to Provider and CFCS according to Health Plan's Medicaid eligible IMC and BHSO population split for Chelan/Douglas and Grant Counties. 1.3.4 Health Plan and Provider agree to work together in good faith to achieve a fair and reasonable method of addressing costs as a result of Members accessing care outside their county of residence such that if Provider provides care for Chelan/Douglas County Members or visa versa, those costs will be fairly adjusted and allocated. 1.4 Variability of costs in any one of these withhold accounts will be addressed as follows: 1.4.1 CHS no overspending will be permitted by the agreement between Health Plan and CHS. 1.4.2 CVCH . no overspending will be permitted by the agreement between Health Plan and CVCH. 1.4.3 Inpatient behavioral health (inclusive of behavioral health inpatient and residential claims and state hospitalization penalties) costs for Chelan and Douglas County Members shall be withheld from CFCS and paid directly by Health Plan. 1.5 Upon execution of this Agreement, Provider shall assume the risk for payment of state hospital penalties incurred, billed and paid through the termination of the contact. In the event of the assessment of such state hospital penalty, Provider shall be responsible for the payment of such penalties that result from state hospital census exceeding Health Plan's allocated proportion of state hospital beds for Grant County Members for any given month. Upon execution of this Agreement, Provider shall assume the risk for payment of community hospital claims billed through the termination of the Agreement. Health Plan shall withhold and pay such state hospitalization penalties and behavioral health inpatient and residential claims as provided above. 2. MEDICAID VS. NON -MEDICAID FUNDS 2.1 Provider must accurately and separately track Medicaid and Non -Medicaid funds and report the expenditure of these funds to Health Plan as required. 3. PERFORMANCE MEASURES Provider must meet the following performance measures: 3.1 Provider must render a minimum of 11,000 substance use disorder services and 29,200 mental health services (across all health plans and Behavioral Health Administrative Services Organization ("BH -ASO") on an annual basis; 3.2 Ensure 99% of encounter data submissions are accepted by Health Plan. Any encounter submission errors must be corrected and resubmitted; 3.3 Utilization of Evidence Based Practices ("EBP"). At least 30% of youth mental health consumers receive an EBP as defined in the SERI; 3.4 Maintain a 70% target for Members admitted into treatment within 14 days of first contact as entered into Provider's EHR; and 2022008_IMC.CS MHWAMEND.032022 Page 4 of 11 3.5 Quality Service Clinical Outcomes. To receive incentive payment for the below measures, Provider is expected to support collection of information/data. Baseline data will be collected in year one. 3.5.1 Follow -Up after Hospitalization for Mental Illness ("FUH") 3.5.2 Antidepressant Medication Management ("AMM") 3.5.3 Penetration Rate for behavioral health services 3.5.4 Engagement of Substance Use Disorder ("SUD") treatment — Percent of adult and youth SUD outpatient ("OP") and intensive outpatient ("IOP") service episodes where the member received at least two face-to-face treatment sessions within the 30 days following "initiation" of SUD treatment during an OP/IOP service episode. 3.6 Achievement of any one of the aforementioned performance measures must result in an incentive payment of .5% per measure (3.1 through 3.5 above), up to a maximum of 4% of the total award amount. Total award amount is 4% of Medicaid fund payments each month and will be withheld monthly. 3.7 Compliance with performance standards must be determined semi-annually with any required incentive payment being limited to payments received during the six (6) calendar months preceding the determination. 4. AUDIT 4.1 Provider must obtain an annual independent financial audit or otherwise meet the requirements prescribed by Federal Office of Management. Provider must submit a copy of the independent auditor's report to Health Plan within six (6) months of the close of Provider's fiscal year. 4.2 Provider must submit evidence which documents that the annual audit report has been reviewed by Provider's governing body. 5. Wraparound with Intensive Services (WISe) Program Reimbursement 5.1 The Washington State Health Care Authority has allocated additional funds known as the WISe Case Rate (WCR) to offset costs incurred by Provider and its contractors for WISe services. WISe services in the North Central region shall be reimbursed, for Health Plan's Members, at an amount equal to the current WISe Case Rate (WCR), minus MCO premium tax. 5.2 WISe services will be reimbursed within 30 days of receiving valid WISe encounters for an eligible Health Plan IMC member for a previous month. Attachment 1— 2022 North Central Behavioral Health Risk Service Code Set INSTITUTIONAL (Revenue Codes) Revenue Code Description Notes MH SUD Behavioral Health Accommodations -general 1000 classification X X Behavioral Health Accommodations -residential - 1001 PSYchiatric X Behavioral Health Accommodations -residential - 1002 chemical de endenc X 2022008_IMC.CS MHWAMEND.032022 Page 5 of 11 Revenue Description Notes MH SUD Code Description Notes MH SUD Behavioral Health 1003 Accommodations- supervised livin X X Behavioral Health 1004 Accommodations -halfway house X H0011 Behavioral Health X 1005 Accommodations- rou home X Behavioral Health Accommodations- H0017 Outdoor/Wilderness Behavioral X 1006 Health X Private medical or general - 0114 psychiatric X Private medical or general - 0116 detoxification X Semi -private 2 bed (medical or 0124general) -psychiatric X Semi -private 2 bed (medical or 0126general) -detoxification X Semi -private 3 and 4 beds - 0134 s chiatric X Semi -private 3 and 4 beds - 0136 detoxification X 0144 Private deluxe -psychiatric X 0146 Private deluxe) -detoxification X Room&Board ward (medical or 0154general) -psychiatric X Room&Board ward (medical or 0156general) -detoxification X 0204 Intensive care -psychiatric X PROFESSIONAL (CPT/HCPCS Codes) —STAND ALONE CODES HCPCS/CPT Description Notes MH SUD Alcohol and/or drug services; subacute detoxification (residential H0010 addiction program inpatient) X Alcohol and/or drug services; acute detoxification (residential addiction H0011 program inpatient) X Behavioral health; residential (hospital residential treatment program), without room and board, H0017 per diem X 2022008_IMC.CS MHWAMEND.032022 Page 6 of 11 HCPCS/CPT Description Notes MH SUD Behavioral health; short-term residential (nonhospital residential treatment program), without room MH/SUD Split based on H0018 and board, per diem DX X X Behavioral health; long-term residential (nonmedical, nonacute res treatment program > 30 days), MH/SUD Split based on H0019 w/o R&B, per diem DX X X H2O13 Psych hlth fac svc, per diem X Room and Board _ Molina specific MH/SUD Split based on H2036 Coding DX X X S 948 5 Crisis intervention per diem X Lodging, per diem, not otherwise S9976 classified X X 2022008_IMC.CS MHWAMEND.032022 Page 7 of 11 EXHIBIT 1-B Compensation Schedule - Medicare (version 1) Substance Use Disorder: Health Plan agrees to compensate Provider on a fee-for-service basis for Covered Services provided in accordance with the Medicare Advantage Product, that are determined by Health Plan to be payable and submitted on a Clean Claim, less any applicable Member co -payments, deductibles, co-insurance or amounts paid or to be paid by other liable parties, in any, at the lesser of: (i) Provider's billed charges; or (ii) at an amount equivalent to one hundred percent (100%) of the Medicare Fee -For -Service Program allowable payment rates (adjusted for place of service or geography), as of the date of service. The Medicare Fee -For Service Program allowable rate deducts any cost sharing amounts, including but not limited to co -payments, deductibles, co-insurance, or amount paid or to be paid by other liable third parties that would have been deducted if the Member were enrolled in the Medicare Fee - For -Service Program. 2022008_IMC.CS MHWAMEND.032022 Page 8 of 11 EXHIBIT I -B Compensation Schedule - Medicare (Version 2) Health Plan agrees to compensate Provider on a fee-for-service basis for Covered Services provided in accordance with Medicare, that are determined by Health Plan to be payable and submitted on a Clean Claim, less any applicable Member co -payments, deductibles, co-insurance or amounts paid or to be paid by other liable parties, if any, at the lesser of; (i) Provider's billed charges or (ii) the amounts set forth below. The Medicare Fee -For Service Program allowable rate deducts any cost sharing amounts, including but not limited to co -payments, deductibles, co-insurance, or amount paid or to be paid by other liable third parties that would have been deducted if the Member were enrolled in the Medicare Fee -For -Service Program. I. Mental Health: A. Psychiatrist, Psychologist, Nurse Practitioner: All Medicare Covered Services shall be paid at an amount equivalent to one hundred percent (100%) of the Medicare Fee -For Service Program allowable payment rates (adjusted for place of service or geography) as of the date of service. B. Clinical Social Worker: All Medicare Covered Services shall be paid at an amount equivalent to one hundred percent (100%) of the Medicare Fee -For Service Program allowable payment rates (adjusted for place of service or geography) as of the date of service. (Note: Fees are paid at the level of credentialed licensure, not educational attainment.) 2022008_IMC.CS MHWAMEND.032022 Page 9 of 11 EXHIBIT 1-C Compensation Schedule Molina Marketplace (Version 1) Health Plan agrees to compensate Provider for Clean Claims for Covered Services rendered to Members, in accordance with Health Plan's programs participation, on a fee -for -services basis, at the lesser of; (i) Provider's allowable charge description master rate, or (ii) the amounts set forth below, less any applicable Member co- payments, deductibles, co-insurance, or amounts paid or to be paid by other liable third parties, if any: Substance Use Disorder: Covered Services shall be paid at one hundred ten percent (110%) of the State of Washington Medicaid Fee -For - Service Program fee schedule in effect on the date of service. If there is no payment rate in the State of Washington Medicaid Fee -For -Service Program fee schedule as of the date of service, payment shall be at one hundred percent (100%) of the prevailing local and geographically adjusted Medicare Fee -For -Service Program fee schedule, in effect on the date of service. If there is no payment rate achieved in the above methodologies, reimbursement shall be paid at fifty percent (50%) of billed charges. 2022008_IMC.CS MHWAMEND.032022 Page 10 of 11 EXHIBIT 1-C Compensation Schedule - Molina Marketplace (Version 3) Health Plan agrees to compensate Provider for Clean Claims for Covered Services rendered to Members, in accordance with Health Plan's programs participation, on a fee -for -services basis, at the lesser of; (i) Provider's allowable charge description master rate, or (ii) the amounts set forth below, less any applicable Member co- payments, deductibles, co-insurance, or amounts paid or to be paid by other liable third parties, if any: I. Mental Health: A. Psychiatrist: One hundred thirty-five percent (135%) of the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service. B. Psychologist, Nurse Practitioner: One hundred ten percent (110%) of the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service. C. Master Level Therapist, Clinical Social Worker: One hundred ten percent (110%) of the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service. If there is no payment rate in the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service, payment shall be at one hundred percent (100%) of the prevailing local and geographically adjusted Medicare Fee -For -Service Program fee schedule in effect of the date of service. If there is no payment rate achieved in the above methodologies, reimbursement shall be paid at fifty percent (50%) of billed charges. 2022008_IMC.CS MHWAMEND.032022 Page 11 of 11 AMENDMENT TO THE PROVIDER SERVICES AGREEMENT TRIS AMENDMENT TO THE PROVIDER SERVICES AGREEMENT ("Amendment") is made and entered by and between Molina Healthcare of Washington, Inc. ("Health Plan") and County of Grant ("Provider"). Whereas, Health Plan and Provider entered into a Provider Services Agreement ("Agreement"), January 1, 2021 , as amended. Whereas, Health Plan and Provider hereby agree to amend the Agreement in accordance with the terms and conditions of this Amendment. Now therefore, in consideration of the rights and obligations contained herein, the parties to this Amendment, intending to be legally bound, do hereby agree as follows: 1. Exhibit Is (Compensation Schedule) of the Agreement is amended and attached hereto. 2. Effective Date. This Amendment shall become effective on April 1, 2022 'C, evar-urH-ea-l-n, and renew -with and under the terms of the Agreement. 3. Use of Defined Terms. Terms utilized in this Amendment shall have the same meaning set forth in the definitions to the Agreement. 4. Full Force and Effect. Except as specifically amended by this Amendment, the Agreement shall continue in full force and effect. [Doe # or identifier] MHWAMEND Page 1 of 11 EXHIBIT 1-A Compensation Schedule - Medicaid (Version 2) Health Plan agrees to compensate Provider for Clean Claims for Covered Services rendered to Members, in accordance with Health Plan's programs participation, on a fee -for -services basis, at the lesser of; (i) Provider's allowable charge description master rate, or (ii) the amounts set forth below, less any applicable Member co- payments, deductibles, co-insurance, or amounts paid or to be paid by other liable third parties, if any: Integrated Managed Care ("IMC") Apple Health, IMC Apple Health Adult, IMC Apple Health Blind and Disabled, IMC Apple Health with Premium (collectively referred to as "IMC"), and Behavioral Health Services Only ("BHSO"): Provider agrees to follow Health Plan's IMC Companion Guide, which is intended to supplement the use of the Health Care Authority ("HCA") Integrated Managed Care Service Encounter Reporting Instructions ("SERI"). Health Plan may unilaterally change or modify the IMC Companion Guide from time to time, as updates are made to SERI or Health Plan policies and procedures. Upon written request from Health Plan, Provider shall submit annual independently audited financial statements to Health Plan based upon Provider's prior fiscal year-end financial statements. Provider must accurately and separately track Medicaid and Non -Medicaid funds and report the expenditure of these funds to Health Plan upon its written request. Reimbursement is inclusive and in accordance with HB 1109 Section 215 (23). The following language applies to IMC and BHSO services rendered in THE NORTH CENTRAL REGIONAL SERVICE AREA. The terms below pertaining to IMC and BHSO shall be effective January 1, 2021 through December 31, 2021; thereafter the rates shall automatically renew for successive one (1) year terms, unless otherwise amended upon mutual agreement of the parties. Payment shall be made by Health Plan to the Provider as follows: 1. MENTAL HEALTH AND SUBSTANCE USE DISORDER REIMBURSEMENT 1.1 Health Plan shall make known to Provider by written notice, provided no later than the 15th day of each month, the total North Central Region Medicaid behavioral health premium and General Funds State ("GF -S") dollars received by Health Plan for the current month. Health Plan will provide with monthly accounting statement the total membership by county. North Central Region, for the purpose of this Agreement, is defined as Chelan, Douglas and Grant Counties and excludes Okanogan County. 1.2 From the total funds received by Health Plan identified above, Health Plan shall create withhold accounts or apply deductions as follows (each with the fund types comprising them identified): 1.2.1 Health Plan Administrative costs not to exceed 12.8% of Health Plan's dollars received per section 1.1 above. 1.2.2 Children's Home Society ("CHS") (the amount contracted). These funds will be used to pay CHS' agreement. Payments to CHS shall not exceed: a. For outpatient services: Health Plan's proportionate share of the budget ($100,988.00 per month), which is based on the percentage of Apple Health IMC and BHSO membership in Chelan, Douglas and Grant Counties. Proportionate share will be assessed on a monthly basis. 1.2.3 Columbia Valley Community Health ("CVCH") (the amount contracted). These funds will be used to pay CVCH's agreement. [Doc # or identifier] MHWAMEND Page 2 of 11 a. CVCH is reimbursed Fee -For -Service per encounter hour for outpatient mental health services. All claims paid for these services will be deducted on a monthly basis. Payments to CVCH shall not exceed the Health Plan's proportionate share for this budget ($60,000 per month), which shall be based on its percentage of Apple Health IMC and BHSO membership in Chelan, Douglas and Grant Counties. Proportionate share will be assessed on a monthly basis. 1.2.4 The Center for Drug and Alcohol ("CADT") (the amount contracted). These funds will be used to pay CADT's agreement. a. CADT is reimbursed as follows: i. For outpatient substance use disorder services: Health Plan's proportionate share (based on Health Plan's Apple Health IMC and BHSO Member utilization) of the budget ($85,026.00). E.g. 100 IMC/BHSO Members served during the month; 35 Members are Health Plan's IMC or BHSO Members, so Health Plan is responsible for 35% of that month's Budget Amount). ii. For intensive inpatient residential (including room and board): Health Plan's proportionate share (based on Health Plan's Apple Health IMC and BHSO Member utilization) of twelve (12) beds, to be paid at one hundred percent (100%) of the State of Washington Medicaid Fee -For -Service fee schedule in effect on the date of service. Vacant bed days will be allocated to Health Plan, other health plan(s) and the Behavioral Health Administrative Services Organization ("BH -ASO") based on each party's percentage of utilization for that month (i.e. if Health Plan utilized 50% of the bed days for the month, Health Plan will reimburse Provider for 50% of the vacant bed days). Any utilization above the twelve (12) beds will also be paid via invoice at one hundred percent (100%) of the State of Washington Medicaid Fee -For - Service fee schedule in effect on the date of service. iii. For clinically managed sub -acute withdrawal management beds: Health Plan's proportionate share (based on Health Plan's Apple Health IMC and BHSO Member utilization) of 7 beds, to be paid at one hundred percent (100%) of the State of Washington Medicaid Fee -For -Service fee schedule in effect on the date of service. Vacant bed days will be allocated to Health Plan, other health plan(s) and the Behavioral Health Administrative Services Organization ("BH -ASO") based on each party's percentage of utilization for that month (i.e. if Health Plan utilized 50% of the bed days for the month, Health Plan will reimburse Provider for 50% of the vacant bed days). Any utilization above the 7 beds will also be paid via invoice at one hundred percent (100%) of the State of Washington Medicaid Fee -For -Service fee schedule in effect on the date of service. 1.2.5 Incentive Payment (the amount contracted). These funds will be used to pay all providers' incentive payments per providers' agreements. 1.3 All remaining funds received by Health Plan shall be divided between and paid to Provider and Catholic Family and Children Services ("CFCS") by the 15th of the month as follows: 1.3.1 All remaining North Central Region Medicaid funds received by Health Plan shall be divided between Provider and CFCS according to Health Plan's Medicaid eligible IMC and BHSO population split for Chelan/Douglas and Grant Counties. 1.3.2 From Provider's allocation, the following will be deducted: a. Effective January 1, 2021 and thereafter: A PMPM will be paid to Beacon for crisis services to Members in Grant County. Molina will complete periodic reconciliations on the experience related to the PMPM paid — any excess is paid back to Molina (and passed on to Provider) and any deficit is due to Beacon (paid by Provider). If experience indicates the PMPM should be adjusted, Molina will amend the rate accordingly. [Doc # or identifier] MHWAMEND Page 3 of 11 b. Paid state hospitalization penalties, behavioral health inpatient and residential (Effective January 1, 2021: including crisis stabilization/triage) claims for Health Plan's membership assigned to Grant County. Health Plan will provide Provider supporting documentation for state hospitalization penalties and behavioral health inpatient and residential claims paid each month. C. In accordance with Section 3, Performance Measures below 4% of Provider's total Medicaid payment will be withheld each month. 1.3.3 From Provider's allocation, the following will be deducted: GF -S funded services provided to Health Plan's membership assigned to Grant County from out -of -region providers (i.e. room and board claims for residential mental health/substance use disorder treatment). All remaining GF -S funds shall be divided between and paid to Provider and CFCS according to Health Plan's Medicaid eligible IMC and BHSO population split for Chelan/Douglas and Grant Counties. 1.3.4 Health Plan and Provider agree to work together in good faith to achieve a fair and reasonable method of addressing costs as a result of Members accessing care outside their county of residence such that if Provider provides care for Chelan/Douglas County Members or visa versa, those costs will be fairly adjusted and allocated. 1.4 Variability of costs in any one of these withhold accounts will be addressed as follows: 1.4.1 CHS no overspending will be permitted by the agreement between Health Plan and CHS. 1.4.2 CVCH no overspending will be permitted by the agreement between Health Plan and CVCH. 1.4.3 Inpatient behavioral health (inclusive of behavioral health inpatient and residential claims and state hospitalization penalties) costs for Chelan and Douglas County Members shall be withheld from CFCS and paid directly by Health Plan. 1.5 Upon execution of this Agreement, Provider shall assume the risk for payment of state hospital penalties incurred, billed and paid through the termination of the contact. In the event of the assessment of such state hospital penalty, Provider shall be responsible for the payment of such penalties that result from state hospital census exceeding Health Plan's allocated proportion of state hospital beds for Grant County Members for any given month. Upon execution of this Agreement, Provider shall assume the risk for payment of community hospital claims billed through the termination of the Agreement. Health Plan shall withhold and pay such state hospitalization penalties and behavioral health inpatient and residential claims as provided above. 2. MEDICAID VS. NON -MEDICAID FUNDS 2.1 Provider must accurately and separately track Medicaid and Non -Medicaid funds and report the expenditure of these funds to Health Plan as required. 3. PERFORMANCE MEASURES Provider must meet the following performance measures: 3.1 Provider must render a minimum of 11,000 substance use disorder services and 29,200 mental health services (across all health plans and Behavioral Health Administrative Services Organization ("BH -ASO") on an annual basis; 3.2 Ensure 99% of encounter data submissions are accepted by Health Plan. Any encounter submission errors must be corrected and resubmitted; 3.3 Utilization of Evidence Based Practices ("EBP"). At least 30% of youth mental health consumers receive an EBP as defined in the SERI; 3.4 Maintain a 70% target for Members admitted into treatment within 14 days of first contact as entered into Provider's EHR; and 3.5 Quality Service Clinical Outcomes. To receive incentive payment for the below measures, Provider is expected to support collection of information/data. Baseline data will be collected in year one. 3.5.1 Follow -Up after Hospitalization for Mental Illness ("FUH") [Doe # or identifier] MHWAMEND Page 4 of It 3.5.2 Antidepressant Medication Management ("AMM") 3.5.3 Penetration Rate for behavioral health services 3.5.4 Engagement of Substance Use Disorder ("SUD") treatment — Percent of adult and youth SUD outpatient ("OP") and intensive outpatient ("IOP") service episodes where the member received at least two face-to-face treatment sessions within the 30 days following "initiation" of SUD treatment during an OP/IOP service episode. 3.6 Achievement of any one of the aforementioned performance measures must result in an incentive payment of .5% per measure (3.1 through 3.5 above), up to a maximum of 4% of the total award amount. Total award amount is 4% of Medicaid fund payments each month and will be withheld monthly. 3.7 Compliance with performance standards must be determined semi-annually with any required incentive payment being limited to payments received during the six (6) calendar months preceding the determination. 4. AUDIT 4.1 Provider must obtain an annual independent financial audit or otherwise meet the requirements prescribed by Federal Office of Management. Provider must submit a copy of the independent auditor's report to Health Plan within six (6) months of the close of Provider's fiscal year. 4.2 Provider must submit evidence which documents that the annual audit report has been reviewed by Provider's governing body. INSTITUTIONAL (Revenue Codes) [Doe # or identifier] MHWAMEND Page 5 of 11 Revenue Description Notes MH SUD Code, Description Notes MH SUI) addiction program in-patient) Behavioral Health ni Accommodations -general 1000 classification x x Behavioral Health Accommodations -residential - 1001 psychiatric x Behavioral Health Accommodations -residential - 1002 chemical de -pendency x Behavioral Health 1003 Accommodations -supervised living x Behavioral Health 1004 Accommodations -halfway house x Behavioral Health 1005 Accommodations- roup home x Behavioral Health Accommodations- Outdoor/Wilderness Behavioral 1006 Health x Private medical or general - 0114 psychiatric x Private medical orgeneral- 0116 detoxification x Semi -private 2 bed (medical or 0124 general) -psychiatric x Semi -private 2 bed (medical or 0126 general) -detoxification x Semi -private 3 and 4 beds - 0134 psychiatric x Semi -private 3 and 4 beds - 0136 detoxification x 0144 Private (deluxe) -psychiatric x 0146 Private (deluxe) -detoxification x Room&Board ward (medical or 0154 general) -psychiatric x Room&Board ward (medical or 0156, general) -detoxification x 0204 Intensive care -psychiatric x PROFESSIONAL (CPT/HCPCS Codes) — STAND ALONE CODES, HCPCS/CPT Description Notes MH SUD HOOIO Alcohol and/or drwy, services; subacute detoxification (residential x addiction program in-patient) [Doe # or identifier] MHWAMEND Page 6 of 11 HCPCS/CPT m2ammer—I Descript on Notes NM SUD HOOI I Alcohol and/or drug services; acute x detoxification (residential addiction program inpatient) H0017 Behavioral health; residential (hospital residential treatment -program), without room and boa x per them H0018 Behavioral health; short-term residential (nonhospital residential MH/SUD Split based on DX x x treatment program)., without room and board, per them H0019 Behavioral health; long-term residential (nom-nedical, nonacute NM/SUD Split based on DX x x res treatment program > 30 dam w/o R&B, per them H2013 Psych h1th fac svc, per them x H2036 Room and Board Molina specific Coding MH/SUD Split based on DX x x 59485 Crisis intervention per them x 59976 Lodging, per diem, not otherwise classified X [Doe # or identifier] MHWAMEND Page 7 of 11 EXHIBIT 1-B Compensation Schedule - Medicare (version 1) Substance Use Disorder: Health Plan agrees to compensate Provider on a fee-for-service basis for Covered Services provided in accordance with the Medicare Advantage Product, that are determined by Health Plan to be payable and submitted on a Clean Claim, less any applicable Member co -payments, deductibles, co-insurance or amounts paid or to be paid by other liable parties, in any, at the lesser of: (i) Provider's billed charges; or (ii) at an amount equivalent to one hundred percent (100%) of the Medicare Fee -For -Service Program allowable payment rates (adjusted for place of service or geography), as of the date of service. The Medicare Fee -For Service Program allowable rate deducts any cost sharing amounts, including but not limited to co -payments, deductibles, co-insurance, or amount paid or to be paid by other liable third parties that would have been deducted if the Member were enrolled in the Medicare Fee - For -Service Program. [Doc # or identifier] MHWAMEND Page 8 of 11 EXHIBIT 1-B Compensation Schedule - Medicare (Version 2) Health Plan agrees to compensate Provider on a fee-for-service basis for Covered Services provided in accordance with Medicare, that are determined by Health Plan to be payable and submitted on a Clean Claim, less any applicable Member co -payments, deductibles, co-insurance or amounts paid or to be paid by other liable parties, if any, at the lesser of; (i) Provider's billed charges or (ii) the amounts set forth below. The Medicare Fee -For Service Program allowable rate deducts any cost sharing amounts, including but not limited to co -payments, deductibles, co-insurance, or amount paid or to be paid by other liable third parties that would have been deducted if the Member were enrolled in the Medicare Fee -For -Service Program. I. Mental Health: A. Psychiatrist, Psychologist, Nurse Practitioner: All Medicare Covered Services shall be paid at an amount equivalent to one hundred percent (100%) of the Medicare Fee -For Service Program allowable payment rates (adjusted for place of service or geography) as of the date of service. B. Clinical Social Worker: All Medicare Covered Services shall be paid at an amount equivalent to one hundred percent (100%) of the Medicare Fee -For Service Program allowable payment rates (adjusted for place of service or geography) as of the date of service. (Note: Fees are paid at the level of credentialed licensure, not educational attainment.) [Doc # or identifier] MHWAMEND Page 9 of 11 EXHIBIT 1-C Compensation Schedule - Molina Marketplace (version 1) Health Plan agrees to compensate Provider for Clean Claims for Covered Services rendered to Members, in accordance with Health Plan's programs participation, on a fee -for -services basis, at the lesser of; (i) Provider's allowable charge description master rate, or (ii) the amounts set forth below, less any applicable Member co- payments, deductibles, co-insurance, or amounts paid or to be paid by other liable third parties, if any: Substance Use Disorder: Covered Services shall be paid at one hundred ten percent (110%) of the State of Washington Medicaid Fee -For - Service Program fee schedule in effect on the date of service. If there is no payment rate in the State of Washington Medicaid Fee -For -Service Program fee schedule as of the date of service, payment shall be at one hundred percent (100%) of the prevailing local and geographically adjusted Medicare Fee -For -Service Program fee schedule, in effect on the date of service. If there is no payment rate achieved in the above methodologies, reimbursement shall be paid at fifty percent (50%) of billed charges. [Doc # or identifier] MHWAMEND Page 10 of 11 EXHIBIT 1-C Compensation Schedule - Molina Marketplace (version 3) Health Plan agrees to compensate Provider for Clean Claims for Covered Services rendered to Members, in accordance with Health Plan's programs participation, on a fee -for -services basis, at the lesser of; (i) Provider's allowable charge description master rate, or (ii) the amounts set forth below, less any applicable Member co- payments, deductibles, co-insurance, or amounts paid or to be paid by other liable third parties, if any: I. Mental Health: A. Psychiatrist: One hundred thirty-five percent (135%) of the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service. Be Psychologist, Nurse Practitioner: One hundred ten percent (110%) of the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service. C. Master Level Therapist, Clinical Social Worker: One hundred ten percent (110%) of the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service. If there is no payment rate in the State of Washington Medicaid Fee -For -Service Program fee schedule in effect on the date of service, payment shall be at one hundred percent (100%) of the prevailing local and geographically adjusted Medicare Fee -For -Service Program fee schedule in effect of the date of service. If there is no payment rate achieved in the above methodologies, reimbursement shall be paid at fifty percent (50%) of billed charges. [Doc # or identifier] MHWAMEND Page 11 of 11 • • renew Grant Behavioral Health 6 Wellness 840 E. Plum Street Moses Lake, WA 98837 Phone: (509) 765-9239 Fax: (509) 765-1582 Consent Agenda Week Week of 4/4/2022 Item Amendment to Provider Services Agreement Entity/Contracted Business Molina Healthcare Contract Number n/a Confidential Yes. There is proprietary information in this agreement and should not be posted online. Description This is an amendment to our current Provider Services Agreement with Molina Healthcare. I have attached the draft contract to show the changes in the amendment. Original Needed? No, scanned email will work. Copies Attached One Contact for Questions Dell Anderson., Ext 5472 GR A N T C 0 U�Nl TY C, n ", I Ivi I S S 0 f�i R 3