Capitation Agreements Clause Samples
A Capitation Agreement is a contractual arrangement in which a healthcare provider is paid a fixed amount per patient for a specified period, regardless of the actual number or nature of services provided. Typically, these agreements apply to managed care organizations or insurers who pay providers a set monthly fee for each enrolled member, incentivizing cost-effective care management. The core function of a capitation agreement is to control healthcare costs and allocate financial risk to providers, encouraging efficient resource use while maintaining patient care quality.
Capitation Agreements. The Contractor shall notify the Department of any “capitation” agreement with Subcontractors or Providers that includes the assumption of risk by the Subcontractor or Provider. The notification shall include the name of the entity, the scope of the risk, the contracting amount, and how the entity in turn pays its Subcontractors or Providers for providing Covered Services. Contractor shall submit monthly reports of Capitation payments made to Subcontractors, such as a vision or pharmacy benefit manager or Providers such as Primary Care Physicians. The Contractor shall ▇▇▇▇ records it considers proprietary as such and agrees to defend such classification in the event an Open Records request is made concerning the proprietary record.
Capitation Agreements. To the extent that OHMEDA PPD offers capitation arrangements to customers that include the supply of Products and such capitation arrangements are not on a product basis, then the parties shall act in good faith to agree on a methodology to equitably calculate net sales of such Products covered by such capitation arrangements on a different basis than set forth in Section 1.8.