Medicaid Health Plan Contract & Report Guide Versions Pre-2012

Health Plan Contract History:

May 1, 2011 Health Plan Contract

The draft health plan contract combines the May 1, 2010 Health Plan Contract and the Agency’s Fine-Tuning 2 General Amendment executed by health plans in April - May 2011 and the Non-Reform PSN Behavioral Health Amendment executed in January – April 2011. These consolidated contract documents are used for both Reform and non-Reform HMO and PSN contracts.

Attachment I Scope of Services Capitated Health Plans Clean Draft [465 KB, PDF] 5/1/2011
Attachment I Scope of Services Fee-For-Service Provider Service Networks Clean Draft [286 KB, PDF] 5/1/2011
Attachment II – Core Contract Provisions Clean Draft [1.37 MB, PDF] 5/1/2011 (reposted 12-27-11)
Attachment II - Exhibits Clean Draft [798 KB, PDF] 5/1/2011
Attachment II – Core Contract Provisions Clean Draft [1.53 MB, PDF] (reposted 12/27/11)

May 1, 2010 Health Plan Contract

The draft health plan contract combines the December 31, 2009 Health Plan Contract and the Agency’s Performance Measures Amendment executed by health plans in May 2010. These consolidated contract documents are used for both Reform and non-Reform HMO and PSN contracts.  The track-changes versions show the revisions due to the May 1, 2010 Performance Measures Amendment.  The Attachment I for the FFS PSNs did not change.  That remains as the December 2009 version.  For a track-changes version of the Attachment I for FFS PSNs, see history page for the December 2009 Health Plan Contract documents.

Attachment I Scope of Services Capitated Health Plans Clean Draft [471 KB, PDF]
Attachment I Scope of Services Fee-For-Service Provider Service Networks Clean Draft [271 KB, PDF]
Attachment II – Core Contract Provisions Clean Draft [1.37 MB, PDF]
Attachment II - Exhibits Clean Draft [725 KB, PDF]

December 31, 2009 Health Plan Contract

Replaced by May 1, 2010 Draft Version

The draft December 31, 2010 Health Plan Contract documents for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs are located below.  The draft health plan contract combines the September 1, 2009 Health Plan Contract and the Agency’s Fine-Tuning Amendment executed by health plans in December 2009.  These consolidated contract documents are used for both Reform and non-Reform HMO and PSN contracts.  The track-changes versions show the revisions due to the Fine-Tuning Amendment.

Attachment I Scope of Services Capitated Health Plans - Clean Draft [471 KB, PDF]
Attachment I Scope of Services Fee-For-Service Provider Service Networks - Clean Draft [271 KB, PDF]
Attachment II – Core Contract Provisions - Clean Draft [1299 KB, PDF]
Attachment II - Exhibits - Clean Draft [721 KB, PDF]
Attachment I Scope of Services Capitated Health Plans - Track Changes [479 KB, PDF]
Attachment I Scope of Services Fee-For-Service Provider Service Networks - Track Changes [276 KB, PDF]
Attachment II – Core Contract Provisions - Track Changes [1.37MB, PDF]
Attachment II - Exhibits - Track Changes [758 KB, PDF]

September 1, 2009 Health Plan Contract

Replaced by December 31, 2009 Draft Version

The draft September 1, 2009 Health Plan Contract for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.  This draft health plan contract streamlined the HMO and PSN Reform and Non-Reform contracts into one comprehensive Medicaid health plan contract with plan-type and population specific exhibits. This consolidated contract replaced the Attachment I and II documents for both the HMO and PSN Reform and non-Reform health plan contracts.

Attachment I Scope of Services Capitated Health Plans - Final Draft [470 KB, PDF]
Attachment I Scope of Services Fee-For-Service Provider Service Networks - Final Draft [271 KB, PDF]
Attachment II – Core Contract Provisions - Final Draft [1302 KB, PDF]
Attachment II - Exhibits - Final Draft  [724 KB, PDF]
Attachment I Scope of Services Capitated Health Plans (track changes) [459 KB, PDF]
Attachment I Scope of Services Fee-For-Service Provider Service Networks (track changes) [283 KB, PDF]
Attachment II – Core Contract Provisions (track changes) [1410 KB, PDF]
Attachment II - Exhibits (track changes) [836 KB, PDF]

Report Guide History:

July 1, 2012 Report Guide

Replaced by the October 1, 2012 Draft Version

The July 1, 2012 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below. The July 1, 2012 Report Guide will be posted here when the Draft October 1, 2012 version becomes effective.

Report Guide [2.05 MB, PDF] Effective 7/1/2012
Report Guide Revisions Table [307 KB, PDF] Effective 7/1/2012
Report Guide Transmittal [45 KB, PDF] Effective 4/2/2012

April 1, 2012 Report Guide

Replaced by July 1, 2012 Draft Version

The April 1, 2012 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below. The April 1, 2012 Report Guide will be posted here when the Draft July 1, 2012 version becomes effective.

Report Guide [1.72 MB, PDF] Effective 4/1/2012
Report Guide Revisions Table [253 KB, PDF] Effective 4/1/2012
Report Guide Transmittal [41 KB, PDF] Effective 4/1/2012

January 1, 2012 Report Guide

Replaced by April 1, 2012 Draft Version

The January 1, 2012 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below. The January 1, 2012 Report Guide will be posted here when the Draft April 1, 2012 version becomes effective.

Report Guide [2.00 MB, PDF] Effective 1/1/2012
Report Guide Revisions Table [264 KB, PDF] Effective 1/1/2012
Report Guide Transmittal [41 KB, PDF] Effective 1/1/2012

October 1, 2011 Report Guide

Replaced by January 1, 2012 Draft Version

The October 1, 2011 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.

Report Guide [2 MB, PDF] Effective 10/1/2011
Report Guide Transmittal [274 KB, PDF] Effective 10/1/2011
Report Guide Revisions List [299 KB, DOC] Effective 10/1/2011

July 1, 2011 Report Guide

Replaced by October 1, 2011 Draft Version

The July 1, 2011 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.

Report Guide [1.67 MB, PDF] Effective 7/1/2011
Report Guide Transmittal and Revisions [105 KB, PDF]
Report Guide Revisions List [50 KB, DOC] Effective 7/1/2011

April 1, 2011 Report Guide

Replaced by July 1, 2011 Draft Version

The April 1, 2011 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.

Report Guide [2 MB, PDF] Effective 4/1/2011
Report Guide Transmittal and Revisions [92 KB, PDF] Effective 4/1/2011

January 1, 2010 Report Guide

Replaced by April 1, 2011 Draft Version

The January 1, 2010 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.  

Report Guide [1785 KB, PDF] Effective 1/1/2011
Report Guide Transmittal and Revisions [377 KB, PDF] Effective 1/1/2011

October 1, 2010 Report Guide

Replaced by January 1, 2011 Draft Version

The October 1, 2010 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.  

Report Guide [1470 KB, PDF] Effective 10/1/2010
Report Guide Transmittal and Revisions [377 KB, PDF] Effective 10/1/2010

July 1, 2010 Report Guide

Replaced by October 1, 2010 Draft Version

The July 1, 2010 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.  

Report Guide [1.73MKB, PDF] Effective 7/1/2010
Report Guide Revision Transmittal [45 KB, PDF] Effective 7/1/2010
Report Guide REDLINE Final Revised [1.75MB, PDF] Effective 7/1/2010
Report Guide Revisions - Final Revised [369 KB, PDF] Effective 7/1/2010

April 1, 2010 Report Guide

Replaced by July 1, 2010 Draft Version

The April 1, 2010 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.

Report Guide Final Version - effective 04/01/2010 [1.74MB, PDF]
Report Guide Revised - effective 04/01/2010 [1788 KB, PDF]
Report Guide Revised Redline - effective 04/01/2010 [1817 KB, PDF]
Report Guide Revisions Transmittal - 01/01/2010 [43 KB, PDF]
Report Guide Revisions - effective 04/01/2010 [430 KB, PDF]

September 1, 2009 Report Guide

Replaced by April 1, 2010 Draft Version

The September 1, 2009 Report Guide for the Medicaid Reform and non-Reform HMOs, Capitated PSNs and FFS PSNs is located below.  

2009-2012 Report Guide [1690 KB, PDF] Final Draft effective 9/1/09

Discontinued/Prior Templates:

Performance Measures [52 KB, XLS] 7/1/2009
Complaints, Grievances, and Appeals Report [516 KB, XLS]
MPI Annual Fraud and Abuse Activity Report 10/22/10 [857 KB, XLSX]
MPI Annual Fraud and Abuse Activity Report 9-28-10 [857 KB, XLSX]
Minority Participation Report [32 KB, XLS] Discontinued effective 6/17/2010
Customized Benefit Notifications Report [37 KB, XLS] 07/01/2010 Report Guide
Naming Convention for Navigator [36 KB, PDF] 07/01/2010 Report Guide
Performance Measures [52 KB, XLS] 07/01/2010 Report Guide
MCO Subcontractors and Affiliates Report [643 KB, XLSX] 07/01/2012 Report Guide
Benefit Maximum Report [30 KB, XLS]
Catastrophic Component Threshold Report [30 KB, XLS]

Prior 2009-2012 Medicaid Managed Care Contract Versions

Top