Common use of Blended Rates Clause in Contracts

Blended Rates. The Capitation Rates for the LTSS population include blended Capitation Payments for Members who are assigned to a NF or Agency-Based Community Benefit SOC. Rate Cohorts Dual Eligible - NF LOC (Region 1,3,4), Dual Eligible - NF LOC (Region 2), and Dual Eligible - NF LOC (Region 5) represent the blended Rate Cohorts for Dual Eligible Members and Rate Cohorts Medicaid Only - NF LOC (Region 1,3,4), Medicaid Only - NF LOC (Region 2), and Medicaid Only - NF LOC (Region 5) represent the blended Rate Cohorts for Medicaid only Members. The LTSS Capitation Rates outlined in Section 6.4.3.1.1 of this Agreement are developed separately for Members with a NF SOC and Members with an Agency-Based Community Benefit SOC for acute and LTC services outlined in Attachment 1: Turquoise Care Covered Services (Covered Services). On an annual basis HCA shall evaluate the CONTRACTOR’s proportion of enrollment in the NF and Agency-Based Community Benefit settings of care and make a determination of the proportion of NF and Agency-Based Community Benefit Members for the upcoming rating period. This proportion will be used to blend the NF and Agency-Based Community Benefit Capitation Rates to derive the blended Capitation Rates paid by HCA to the CONTRACTOR. HCA, at its discretion, may reevaluate the proportion of the CONTRACTOR’s Members with NF and Agency-Based Community Benefit SOC assumed in the blended Capitation Rates at any time during this Agreement to determine if a revision to the blended Capitation Rates are necessary. The Capitation Rates for the blended LTSS cohorts are “net” of medical care credit. The Capitation Rates used for the NF SOC population are developed on a “gross” basis and reduced for the estimated average monthly amount of medical care credit. The blended Capitation Payments are subject to medical care credit reconciliation outlined in Section 6.7 of this Agreement. HCA may include risk corridor arrangements as deemed appropriate or include an add-on PMPM to the Capitation Rates for services. During the term of this Agreement, HCA reserves the right to modify the structure, type, or number of add-on PMPM rate amounts and shall notify the CONTRACTOR about the change at least thirty (30) days prior to the effective date change.

Blended Rates. The Capitation Rates for the LTSS population include blended Capitation Payments for Members who are assigned to a NF or Agency-Based Community Benefit SOC. Rate Cohorts Dual Eligible - NF LOC (Region 1,3,4), Dual Eligible - NF LOC (Region 2), and Dual Eligible - NF LOC (Region 5) represent the blended Rate Cohorts for Dual Eligible Members and Rate Cohorts Medicaid Only - NF LOC (Region 1,3,4), Medicaid Only - NF LOC (Region 2), and Medicaid Only - NF LOC (Region 5) represent the blended Rate Cohorts for Medicaid only Members. The LTSS Capitation Rates outlined in Section 6.4.3.1.1 of this Agreement are developed separately for Members with a NF SOC and Members with an Agency-Based Community Benefit SOC for acute and LTC services outlined in Attachment 1: Turquoise Care Covered Services (Covered Services). On an annual basis HCA HSD shall evaluate the CONTRACTOR’s proportion of enrollment in the NF and Agency-Based Community Benefit settings of care and make a determination of the proportion of NF and Agency-Based Community Benefit Members for the upcoming rating period. This proportion will be used to blend the NF and Agency-Based Community Benefit Capitation Rates to derive the blended Capitation Rates paid by HCA HSD to the CONTRACTOR. HCAHSD, at its discretion, may reevaluate the proportion of the CONTRACTOR’s Members with NF and Agency-Based Community Benefit SOC assumed in the blended Capitation Rates at any time during this Agreement to determine if a revision to the blended Capitation Rates are necessary. The Capitation Rates for the blended LTSS cohorts are “net” of medical care credit. The Capitation Rates used for the NF SOC population are developed on a “gross” basis and reduced for the estimated average monthly amount of medical care credit. The blended Capitation Payments are subject to medical care credit reconciliation outlined in Section 6.7 of this Agreement. HCA HSD may include risk corridor arrangements as deemed appropriate or include an add-on PMPM to the Capitation Rates for services. During the term of this Agreement, HCA HSD reserves the right to modify the structure, type, or number of add-on PMPM rate amounts and shall notify the CONTRACTOR about the change at least thirty (30) days prior to the effective date change.