Common use of Calculation of monthly Capitation Payment Clause in Contracts

Calculation of monthly Capitation Payment. (a) This is a Risk-based contract. For each applicable MCO Program, HHSC will pay the MCO fixed monthly Capitation Payments based on the number of eligible and enrolled Members. HHSC will calculate the monthly Capitation Payments by multiplying the number of Members by each applicable Member Rate Cell. In consideration of the Monthly Capitation Payments, the MCO agrees to provide the Services and Deliverables described in this Contract. (b) MCO will be required to provide timely financial and statistical information necessary in the Capitation Rate determination process. Encounter Data provided by MCO must conform to all HHSC requirements. Encounter Data containing non-compliant information, including, but not limited to, inaccurate Member identification numbers, inaccurate provider identification numbers, or diagnosis or procedures codes insufficient to adequately describe the diagnosis or medical procedure performed, will not be considered in the MCO’s experience for rate-setting purposes. (c) Information or data, including complete and accurate Encounter Data, as requested by HHSC for rate-setting purposes, must be provided to HHSC: (1) within 30 days of receipt of the letter from HHSC requesting the information or data; and (2) no later than March 31st of each year. (d) The fixed monthly Capitation Rate consists of the following components: (1) an amount for Health Care Services performed during the month; (2) an amount for administering the MCO Program, and (3) an amount for the MCO’s Risk margin. Capitation Rates for each MCO Program may vary by Service Area and MCO. HHSC will employ or retain qualified actuaries to perform data analysis and calculate the Capitation Rates for each Rate Period. (e) MCO understands and expressly assumes the risks associated with the performance of the duties and responsibilities under this Contract, including the failure, termination or suspension of funding to HHSC, delays or denials of required approvals, and cost overruns not reasonably attributable to HHSC.

Calculation of monthly Capitation Payment. (a) This is a Risk-based contract. For each applicable MCO HMO Program, HHSC will pay the MCO HMO fixed monthly Capitation Payments based on the number of eligible and enrolled Members. HHSC will calculate the monthly Capitation Payments by multiplying the number of Members by each applicable Member Rate Cell. In consideration of the Monthly Capitation PaymentsPayment(s), the MCO HMO agrees to provide the Services and Deliverables described in this Contract. (b) MCO HMO will be required to provide timely financial and statistical information necessary in the Capitation Rate determination process. Encounter Data provided by MCO HMO must conform to all HHSC requirements. Encounter Data containing non-compliant non­compliant information, including, but not limited to, inaccurate Member client or member identification numbers, inaccurate provider identification numbers, or diagnosis or procedures codes insufficient to adequately describe the diagnosis or medical procedure performed, will not be considered in the MCOHMO’s experience for rate-setting purposes. (c) Information or data, including complete and accurate Encounter Data, as requested by HHSC for rate-setting purposes, must be provided to HHSC: (1) within 30 thirty (30) days of receipt of the letter from HHSC requesting the information or data; and (2) no later than March 31st of each year. (d) The fixed monthly Capitation Rate consists of the following components: (1) an amount for Health Care Services performed during the month;Services (2) an amount for administering the MCO Program, andprogram, (3) an amount for the MCOHMO’s Risk margin, and (4) with respect to the Medicaid program, pass through funds for high-volume providers. Capitation Rates for each MCO HMO Program may vary by Service Area and MCO. HHSC will employ or retain qualified actuaries to perform data analysis and calculate the Capitation Rates for each Rate Period. (e) MCO HMO understands and expressly assumes the risks associated with the performance of the duties and responsibilities under this Contract, including the failure, termination or suspension of funding to HHSC, delays or denials of required approvals, and cost overruns not reasonably attributable to HHSC.

Calculation of monthly Capitation Payment. (a) This is a Risk-based contract. For each applicable MCO Program, HHSC will pay the MCO fixed monthly Capitation Payments based on the number of eligible and enrolled Members. HHSC will calculate the monthly Capitation Payments by multiplying the number of Members in each Rate Cell category by the Capitation Rate for each applicable Member Rate Cell. In consideration of the Monthly Capitation Payments, the MCO agrees to provide the Services and Deliverables described in this Contract. (b) MCO will be required to provide timely financial and statistical information necessary in the Capitation Rate determination process. Encounter Data provided by MCO must conform to all HHSC requirements. Encounter Data containing non-compliant information, including, but not limited to, inaccurate Member identification numbers, inaccurate provider identification numbers, or diagnosis or procedures codes insufficient to adequately describe the diagnosis or medical procedure performed, will not be considered in the MCO’s experience for rate-setting purposes. (c) Information or data, including complete and accurate Encounter Data, as requested by HHSC for rate-setting purposes, must be provided to HHSC: (1) within 30 days of receipt of the letter from HHSC requesting the information or data; and (2) no later than March 31st of each year. (d) The fixed monthly Capitation Rate consists of the following components: (1) an amount for Health Care Services performed during the month; (2) an amount for administering the MCO Program, and (3) an amount for the MCO’s Risk margin. Capitation Rates for each MCO Program may vary by Service Area and MCO. HHSC will employ or retain qualified actuaries to perform data analysis and calculate the Capitation Rates for each Rate Period. (e) MCO understands and expressly assumes the risks associated with the performance of the duties and responsibilities under this Contract, including the failure, termination or suspension of funding to HHSC, delays or denials of required approvals, and cost overruns not reasonably attributable to HHSC.

Calculation of monthly Capitation Payment. (a) This is a Risk-based contract. For each applicable MCO HMO Program, HHSC will pay the MCO HMO fixed monthly Capitation Payments based on the number of eligible and enrolled Members. HHSC will calculate the monthly Capitation Payments by multiplying the number of Members by each applicable Member Rate Cell. In consideration of the Monthly Capitation PaymentsPayment(s), the MCO HMO agrees to provide the Services and Deliverables described in this Contract. (b) MCO HMO will be required to provide timely financial and statistical information necessary in the Capitation Rate determination process. Encounter Data provided by MCO HMO must conform to all HHSC requirements. Encounter Data containing non-compliant non­compliant information, including, but not limited to, inaccurate Member client or member identification numbers, inaccurate provider identification numbers, or diagnosis or procedures codes insufficient to adequately describe the diagnosis or medical procedure performed, will not be considered in the MCOHMO’s experience for rate-setting purposes. (c) Information or data, including complete and accurate Encounter Data, as requested by HHSC for rate-setting purposes, must be provided to HHSC: (1) within 30 thirty (30) days of receipt of the letter from HHSC requesting the information or data; and (2) no later than March 31st of each year. (d) The fixed monthly Capitation Rate consists of the following components: (1) an amount for Health Care Services performed during the month;Services (2) an amount for administering the MCO Program, andprogram, (3) an amount for the MCOHMO’s Risk margin. Capitation Rates for each MCO Program may vary by Service Area and MCO. HHSC will employ or retain qualified actuaries to perform data analysis and calculate the Capitation Rates for each Rate Period., and (e) MCO HMO understands and expressly assumes the risks associated with the performance of the duties and responsibilities under this Contract, including the failure, termination or suspension of funding to HHSC, delays or denials of required approvals, and cost overruns not reasonably attributable to HHSC.

Calculation of monthly Capitation Payment. (a) This is a Risk-based contract. For each applicable MCO HMO Program, HHSC will pay the MCO HMO fixed monthly Capitation Payments based on the number of eligible and enrolled Members. HHSC will calculate the monthly Capitation Payments by multiplying the number of Members by each applicable Member Rate Cell. In consideration of the Monthly Capitation PaymentsPayment(s), the MCO HMO agrees to provide the Services and Deliverables described in this Contract. (b) MCO HMO will be required to provide timely financial and statistical information necessary in the Capitation Rate determination process. Encounter Data provided by MCO HMO must conform to all HHSC requirements. Encounter Data containing non-compliant information, including, but not limited to, inaccurate Member client or member identification numbers, inaccurate provider identification numbers, or diagnosis or procedures codes insufficient to adequately describe the diagnosis or medical procedure performed, will not be considered in the MCOHMO’s experience for rate-setting purposes. (c) Information or data, including complete and accurate Encounter Data, as requested by HHSC for rate-setting purposes, must be provided to HHSC: (1) within 30 thirty (30) days of receipt of the letter from HHSC requesting the information or data; and (2) no later than March 31st of each year. (d) The fixed monthly Capitation Rate consists of the following components: (1) an amount for Health Care Services performed during the month; (2) an amount for administering the MCO Program, andprogram, (3) an amount for the MCOHMO’s Risk margin, and (4) with respect to the Medicaid program, pass through funds for high-volume providers. Capitation Rates for each MCO HMO Program may vary by Service Area and MCO. HHSC will employ or retain qualified actuaries to perform data analysis and calculate the Capitation Rates for each Rate Period. (e) MCO HMO understands and expressly assumes the risks associated with the performance of the duties and responsibilities under this Contract, including the failure, termination or suspension of funding to HHSC, delays or denials of required approvals, and cost overruns not reasonably attributable to HHSC.

Calculation of monthly Capitation Payment. (a) This is a Risk-based contract. For each applicable MCO HMO Program, HHSC will pay the MCO HMO fixed monthly Capitation Payments based on the number of eligible and enrolled Members. HHSC will calculate the monthly Capitation Payments by multiplying the number of Members by each applicable Member Rate Cell. In consideration of the Monthly Capitation PaymentsPayment(s), the MCO HMO agrees to provide the Services and Deliverables described in this Contract. (b) MCO HMO will be required to provide timely financial and statistical information necessary in the Capitation Rate determination process. Encounter Data provided by MCO HMO must conform to all HHSC requirements. Encounter Data containing non-compliant information, including, but not limited to, inaccurate Member client or member identification numbers, inaccurate provider identification numbers, or diagnosis or procedures codes insufficient to adequately describe the diagnosis or medical procedure performed, will not be considered in the MCOHMO’s experience for rate-setting purposes. (c) Information or data, including complete and accurate Encounter Data, as requested by HHSC for rate-setting purposes, must be provided to HHSC: (1) within 30 thirty (30) days of receipt of the letter from HHSC requesting the information or data; and (2) no later than March 31st of each year. (d) The fixed monthly Capitation Rate consists of the following components: (1) an amount for Health Care Services performed during the month; (2) an amount for administering the MCO Programprogram, and (3) an amount for the MCOHMO’s Risk margin. Capitation Rates for each MCO HMO Program may vary by Service Area and MCO. HHSC will employ or retain qualified actuaries to perform data analysis and calculate the Capitation Rates for each Rate Period. (e) MCO HMO understands and expressly assumes the risks associated with the performance of the duties and responsibilities under this Contract, including the failure, termination or suspension of funding to HHSC, delays or denials of required approvals, and cost overruns not reasonably attributable to HHSC.