Sec. 10.67.04.19-3. MCO Rural Access Incentive

A. Eligibility for Rural Access Incentive. During the months specified in §B(1) and (2) of this regulation, the Department shall make an incentive payment to an MCO for any rural county in which the MCO is accepting new members, provided the MCO has a current MCO provider agreement.

B. Payment of Rural Access Incentive.

(1) June Payment. The June payments to MCOs meeting the requirements specified in §A of this regulation from January 1 through June 30 shall be paid prospectively in May based on June enrollment.

(2) December Payment. The December payments to MCOs meeting the requirements specified in §A of this regulation from July 1 through December 31 shall be paid prospectively in November based on December enrollment.

C. Amount of Rural Access Incentive.

(1) The Department shall allocate a maximum of $11,000,000 for each of the payments in §B(1) and (2) of this regulation, among each of the rural counties specified in §D of this regulation, based on the total MCO enrollment in each county.

(2) An eligible MCO shall receive a portion of the funds allocated to the rural county based on the ratio of the eligible MCO’s enrollment to the total enrollment for all eligible MCOs in the county combined with the fund distribution methodology described in §E of this regulation.

(3) Effective January 1, 2017, any outstanding funds not awarded in §C(2) of this regulation shall be distributed to all MCOs in accordance with each MCO’s Statewide enrollment, regardless of participation in a rural area or whether an MCO is accepting new members.

D. Rural Enrollment Counties. For purposes of this regulation, the following are rural counties:

(1) Allegany;

(2) Caroline;

(3) Cecil;

(4) Dorchester;

(5) Frederick;

(6) Garrett;

(7) Kent;

(8) Queen Anne's;

(9) Somerset;

(10) Talbot;

(11) Washington;

(12) Wicomico; and

(13) Worcester.

E. Funds Distribution. A percentage of the funds allocated will be distributed based on the number of MCOs accepting new enrollments in each rural county as follows:

(1) Two MCOs, 50 percent of funds;

(2) Three MCOs, 75 percent of funds; and

(3) Four or more MCOs, 100 percent of funds.