Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
Regional Generic Provider Agreement - Ohio Department of Job and ...
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Appendix P<br />
Covered Families <strong>and</strong> Children (CFC) population<br />
Page 1<br />
APPENDIX P<br />
MCP TERMINATIONS/NONRENEWALS/AMENDMENTS<br />
CFC ELIGIBLE POPULATION<br />
Upon termination either by the MCP or ODJFS, nonrenewal or denial <strong>of</strong> an MCP’s provider<br />
agreement, all previously collected refundable monetary sanctions will be retained by ODJFS.<br />
MCP-INITIATED TERMINATIONS/NONRENEWALS<br />
If an MCP provides notice <strong>of</strong> the termination/nonrenewal <strong>of</strong> their provider agreement to ODJFS,<br />
pursuant to Article VIII <strong>of</strong> the agreement, the MCP will be required to submit a refundable monetary<br />
assurance. This monetary assurance will be held by ODJFS until such time that the MCP has<br />
submitted all outst<strong>and</strong>ing monies owed <strong>and</strong> reports, including, but not limited to, grievance, appeal,<br />
encounter <strong>and</strong> cost report data related to time periods through the final date <strong>of</strong> service under the<br />
MCP=s provider agreement. The monetary assurance must be in an amount <strong>of</strong> either $50,000 or 5 %<br />
<strong>of</strong> the capitation amount paid by ODJFS in the month the termination/nonrenewal notice is issued,<br />
whichever is greater.<br />
The MCP must also return to ODJFS the at-risk amount paid to the MCP under the current provider<br />
agreement. The amount to be returned will be based on actual MCP membership for preceding<br />
months <strong>and</strong> estimated MCP membership through the end date <strong>of</strong> the contract. MCP membership for<br />
each month between the month the termination/nonrenewal is issued <strong>and</strong> the end date <strong>of</strong> the provider<br />
agreement will be estimated as the MCP membership for the month the termination/nonrenewal is<br />
issued. Any over payment will be determined by comparing actual to estimated MCP membership<br />
<strong>and</strong> will be returned to the MCP following the end date <strong>of</strong> the provider agreement.<br />
The MCP must remit the monetary assurance <strong>and</strong> the at-risk amount in the specified amounts via<br />
separate electronic fund transfers (EFT) payable to Treasurer <strong>of</strong> State, State <strong>of</strong> <strong>Ohio</strong> (ODJFS). The<br />
MCP should contact their Contract Administrator to verify the correct amounts required for the<br />
monetary assurance <strong>and</strong> the at-risk amount <strong>and</strong> obtain an invoice number prior to submitting the<br />
monetary assurance <strong>and</strong> the at-risk amount. Information from the invoices must be included with<br />
each EFT to ensure monies are deposited in the appropriate ODJFS Fund account. In addition, the<br />
MCP must send copies <strong>of</strong> the EFT bank confirmations <strong>and</strong> copies <strong>of</strong> the invoices to their Contract<br />
Administrator.<br />
If the monetary assurance <strong>and</strong> the at-risk amount are not received as specified above, ODJFS will<br />
withhold the MCP’s next month’s capitation payment until such time that ODJFS receives<br />
documentation that the monetary assurance <strong>and</strong> the at-risk amount are received by the Treasurer <strong>of</strong><br />
State. If within one year <strong>of</strong> the date <strong>of</strong> issuance <strong>of</strong> the invoice, an MCP does not submit all<br />
outst<strong>and</strong>ing monies owed <strong>and</strong> required submissions, including, but not limited to, grievance, appeal,<br />
encounter <strong>and</strong> cost report data related to time periods through the final date <strong>of</strong> service under the<br />
MCP’s provider agreement, the monetary assurance will not be refunded to the MCP.