Menu
Home / Advocacy & Policy / Finance & Policy / Medicaid / Medicaid Managed Care Hospital Inpatient Incentive Program

Medicaid Managed Care Hospital Inpatient Incentive Program


Hospitals must execute new amendments to their provider agreements with the Medicaid Managed Care plans prior to receiving payments under the Medicaid Managed Care Hospital Incentive Program for SFY 2014-2015.

The Medicaid Managed Care Hospital Inpatient Incentive Program was created in the SFY 2012-2013 state budget as a mechanism to return additional hospital franchise fee dollars back to hospitals.  The Program was continued for the current state fiscal biennium (SFYs 2014-2015).  Under the Program, OHA acts as the payment agent for the plans to make incentive payments to hospitals.

The first payment under the Program for SFYs 2014-2015 is expected to be made from OHA to hospitals in early December.  As was required for payments made under the Program for SFYs 2012-2013, hospitals are required to execute amendments to their provider agreements with the plans in order to designate OHA as the payment agent for the incentive funds for SFYs 2014-2015. Such amendments are required for all agreements facilities have with the plans in effect on or before October 1, 2013. We have made the terms of these amendments continue until either the hospital’s agreement with a plan terminates or until termination of the Program, whichever occurs first. Accordingly, it is our hope that these will be the last amendments hospitals are required to execute under the Program, assuming it continues into the future in much the same form that it exist today.

Please note that other than date changes and some minor language changes to recognize the ongoing  nature of the Program, the amendments that hospitals must sign are substantively identical to those that were executed for SFY 2012-2013, and the distribution formula for OHA’s payment of funds under the Program also remains unchanged.

Please see below for instructions regarding execution of the required amendments in order to allow payments under the Program to be made by OHA to your facility(ies).

Amendments Pre-Signed by Plans

The amendments for agreements with all of the plans have already been signed by the plans.  Hospitals with contracts with these plans need to do the following:
  1. Download the amendment from the table below;
  2. Execute the amendment;
  3. Keep a copy for your records;
  4. Email the amendment to Rhonda Major-Mack at OHA at rhondam@ohanet.org.  OHA will forward the fully-executed amendment to the plan.

Important Notes

  1. There are separate amendments for privately owned hospitals and for governmental/public hospitals. The only difference between these amendments has to do with paragraph 4 of the amendment. The amendment for private facilities includes indemnification language, while the amendment for governmental/public facilities includes alternative language. This change is necessary because there is a constitutional prohibition against public hospitals indemnifying other parties. A list of governmental/public hospitals in Ohio can be found here.
     2.  A numeric distribution example can be viewed here to assist hospitals in understanding the distribution formula.

Amendment Content

In order to receive payments under the Program, hospitals must execute amendments to all provider contracts with Medicaid Managed Care plans in effect as of October 1, 2013. The amendment, which is the same for all hospitals (other than one difference for governmental/public hospitals, as explained above) and all plans and was agreed to by OHA and each plan, does the following:
  1. authorizes OHA to receive payments from the plans and make those payments to hospitals according to the agreed-upon distribution formula set forth in OHA’s agreement with the plans and in the amendment;
  2. requires the hospital to indemnify and hold harmless the plan from losses incurred as a result of incorrect or non-payments by OHA to the hospital (contingent on the plan’s appropriate payment to OHA), except that for governmental/public hospitals (which cannot by law indemnify) each party agrees to be responsible for their own actions and inactions; and
  3. prohibits both the hospital and plan from using this amendment to open the door for other changes to their agreement.

Private Hospital Amendments
Buckeye Community Health Plan amendment
CareSource amendment
Molina Healthcare of Ohio amendment
Paramount Advantage amendment
United Healthcare Community Plan of Ohio amendment

Governmental/Public Hospital Amendments
Buckeye Community Health Plan amendment
CareSource amendment
Molina Healthcare of Ohio amendment
Paramount Advantage amendment
United Healthcare Community Plan of Ohio amendment


The following is the anticipated schedule of plan reporting dates (i.e. the dates on which plans will report contract status and inpatient claims payments) and dates on which OHA anticipates making payments:

Contract
Reporting Date
Anticipated
Payment Date
11/15/2013 12/6/13
01/15/2014 02/7/2014
03/14/2014 04/7/2014
05/15/2014 06/6/2014
11/14/2014 12/8/2014
01/15/2015 02/6/2015
03/16/2015 04/7/2015
05/15/2015 06/8/2015
06/15/2015 07/7/2015

© 2019 The Ohio Hospital Association. All Rights Reserved.