e that Every o Use! Opportunities: Connecting the Dots for 2021 Key Elements for Contract Considerations Payment Rates: For palliative care services, there is no current Medicare baseline. For hospice, Medicare FFS rate will serve as baseline. Alternative arrangements may include case-rates, episode rate, PMPM, shared savings and pay for quality Performance Requirements: Contracts will outline the plan's expectations, such as the amount of time it takes for a provider to see an enrollee following a service authorization. Providers should ensure they are comfortable with these requirements Utilization Management: Contracts may refer to plan policies and procedures as opposed to including language in the contract. Providers should request and review these materials before agreeing to the terms Claims and Billing: Requirements for claims and billing should be detailed and clearly defined. Providers should pay special attention to timely payment and "clean claims" language to ensure it is specific Insurance and Liability: Most contracts will require liability insurance. Providers should pay attention to how each party identifies and manages risks and how risks may be transferred between the plan and the provider Dispute Resolution: Contract terms should address as many potential disputes as possible, including coverage/authorization of services and payment. Note that most contracts indicate that disputes will be handled through arbitration This information prepared by Health Management Association expressly for NHPCO. Newsline / Spring 2020 29