№ files_lp_4_process_3_071878
Comprehensive government and organizational contract outlining responsibilities, service coverage, payment structures, and administrative obligations for managing a capitated healthcare model.
Year: 2015
Region / City: United States, Massachusetts
Subject: Health Care Contracting, Capitated Payment Model
Document Type: Contract
Organizations: US Department of Health and Human Services, Centers for Medicare & Medicaid Services, Commonwealth of Massachusetts, Commonwealth Care Alliance, Inc., Tufts Health Public Plans, Inc.
Author: Contracting Parties
Effective Period: From December 28, 2015 until termination or renewal per contract terms
Key Provisions: Contractor responsibilities, enrollee services, provider network, quality improvement, financial requirements, payment terms, risk management, confidentiality, termination clauses
Issuance Date: December 28, 2015
Payment Model: Capitation
Enrollee Population: Medicare and MassHealth beneficiaries
Healthcare Services: Primary care, behavioral health, long-term services and supports, health promotion, care coordination
Reporting Requirements: Data submissions, encounter reporting, financial reconciliations
Legal Framework: US federal and Massachusetts state laws, Social Security Act § 1115A(b)(3)(B)
Administrative Terms: Record retention, audits, confidentiality, order of precedence, contract management
Price: 8 / 10 USD
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