Sec. 10.09.33.09. Payment Procedures

A. The Department shall reimburse the health home according to the requirements in this chapter and the rate established in §C of this regulation.

B. Request for Payment.

(1) The health home provider is authorized to bill for the intake and ongoing PMPM rate for a participant when:

(a) The participant is receiving PRP, MTS, or OTP services; and

(b) The intake portion of the participant’s eMedicaid file has been submitted and initial services have been delivered.

(2) After completing the required health home service provision reporting in eMedicaid, the health home provider shall, within 30 days from the end of the month during which health home services were provided, submit a request for payment for all participants who received two health home services during that month.

(3) A health home provider shall bill the Department for the appropriate rate specified in §C of this regulation.

C. Payment shall be made:

(1) To the health home provider for covered services rendered to a participant; and

(2) Effective July 1, 2019, at a monthly rate per participant of $110.19, on the condition that the requirements of this chapter are met.