CAPITATION. The compensation paid per Member per month (“PMPM”) for each HMO Member who has selected or been assigned to PPG.
CAPITATION. Specific geographic estimates of the maxima for the eligibility classification, age and gender categories are developed based on actual paid claims for a date of service (DOS) period. In order to account for all claims related to the DOS period, historical data are used and inflated forward to the midpoint of the period for which the fee-for-service equivalents are being calculated. The total dollars expended for the DOS period are then aggregated by eligibility classification, age and gender category of the fee-for-service population eligible during the DOS period. (The age cohorts utilized by the Department are listed in Attachment I.) The total dollar amount expended for the DOS period is then divided by the total number of eligible recipient months for the DOS period, resulting in a per member per month fee-for-service equivalent amount, based on the fee levels paid by the Department to Providers, and anticipated levels of service utilization.
CAPITATION. A. Exhibit D (incorporated by reference herein), sets forth the Capitation payments. The applicable Capitation payment for each Member assigned to PARTICIPATING MEDICAL GROUP, shall be paid monthly, prorated in accordance with Member eligibility.
CAPITATION. 2.1 Hospital Capitation Rate (HCR) paid to SCHS: The HCR shall be $107.50 per member, per month (PMPM), which has been calculated for the membership in the month of November 2020, and will fluctuate with membership fluctuations in each Rate Category, consistent with the revenue components listed in Section 1,H above. The HCR and the resulting Hospital Capitation Payment to SCHS may vary as Estimated Earned Net Premium Revenue payments from the state of Oregon to Health Plan increase or decrease, and is a weighted average of the following Central Oregon CCO membership in various benefit categories (which will change each month with membership) and PMPM Capitation Rates specific to each Rate Category as indicated below: Rate Category PMPM Capitation Rate Nov. 2020 Membership Aid to Blind/Disabled & OAA with Medicare $20.12 3,474 Aid to Blind/Disabled & OAA w/o Medicare $389.97 2,132 CAF Children $27.66 820 ACA Ages 19-44 $94.35 15,411 ACA Ages 45-54 $186.29 4,089 ACA Ages 55-64 $209.14 4,183 PLM, TANF and CHIP Children age < 1 $425.93 1,217 PLM, TANF and CHIP Children age 1-5 $26.36 6,333 PLM, TANF and CHIP Children age 6-18 $27.11 14,990 PLM Adults (includes pregnancy) $654.94 420 TANF (Adults only) $170.58 5,042 BCCP $433.42 18 Weighted Average $107.50 Total Average Membership, Central Oregon CCO 58,128 2.2 Hospital Capitation Withhold (HCW): The Hospital Capitation Payment will have an eight percent (8%) Hospital Capitation Withhold.
CAPITATION. 2.1 Hospital Capitation Rate (HCR) paid to SCHS: The HCR shall be negotiated as a variable per member, per month (PMPM) for OHP members with physical health benefits, which has been calculated for the membership in the month of November 2020, and will fluctuate with membership fluctuations in each Rate Category, consistent with the revenue components listed in Section 1,H above. The HCR and the resulting Hospital Capitation Payment to SCHS may vary as Estimated Earned Net Premium Revenue payments from the state of Oregon to Health Plan increase or decrease, and is a weighted average of the following Central Oregon CCO membership in various benefit categories (which will change each month with membership) and PMPM Capitation Rates specific to each Rate Category as indicated below: Rate Category PMPM Capitation Rate Nov. 2020 Membership Aid to Blind/Disabled & OAA with Medicare $20.12 3,474 Aid to Blind/Disabled & OAA w/o Medicare $389.97 2,132 CAF/XXXXXX Children $27.66 820 ACA Ages 19-44 $94.35 15,411 ACA Ages 45-54 $186.29 4,089 ACA Ages 55-64 $209.14 4,183 PLM, TANF and CHIP Children age < 1 $425.93 1,217 PLM, TANF and CHIP Children age 1-5 $26.36 6,333 PLM, TANF and CHIP Children age 6-18 $27.11 14,990 PLM Adults/PWO (includes pregnancy) $654.94 420 TANF/PCR (Adults only) $170.58 5,042 BCCP $433.42 18 Weighted Average Negotiated Total Average Membership, Central Oregon CCO 58,128 2.2 Hospital Capitation Withhold (HCW): The Hospital Capitation Payment will have a eight percent (8%) Hospital Capitation Withhold.
CAPITATION. Except for those Dental Care Services outlined in Subparagraph C below, Dentist agrees to provide all Dental Care Services to Members in consideration of the Capitation payment provided below and will look exclusively to Plan for capitation payment, and agrees to make no further charge to Members. Notwithstanding anything to the contrary, it is agreed and acknowledged that the Capitation payment shall begin and be calculated from and be due Dentist hereunder commencing on a date following the Subscriber's selection of the given Dental Facility (“Selection Date”). An eligibility listing and an accounting of Capitation payments will be sent to the Dentist by Plan at least monthly.
CAPITATION. A. The ability to assign capitation rates structures to specific providers.
CAPITATION. The ability to assign capitation rates structures to specific providers. The ability to process manual adjustments made to capitation pools. The ability to have capitation rates vary by:
CAPITATION. The ability to assign Capitation rates structures to specific providers. The ability to process manual adjustments made to capitation pools. The ability to have capitation rates vary by: Group Plan Rate Code Age/Sex Provider Service Zip Code
CAPITATION. Physicians are paid a fixed amount of money each month to provide specific services to the members they see. This capitation payment may be divided into separate amounts for the services they provide directly to their patients, services provided by referral physicians, and for hospital and other types of services.
