Capitation Payment Rates Sample Clauses

Capitation Payment Rates. Monthly rates paid to the MCO shall be paid by the STATE according to the methodology specified in Appendix II of this Contract. 4.6.1 For the Contract Year, payments for SNBC Enrollees shall be the sum of payments in (A) and (B) below: (A) Monthly payments paid by the STATE to the MCO shall be at 100% of the statewide Base Rate in Appendix II, Appendix 1B, 1C, column 3, multiplied by the MCO’s risk factor in column 4. The dollar value of risk adjustment rate (column 5) is shown in Appendix 1B and 1C, column 5, and may change on a quarterly basis. (B) The sum of column 5 plus DHU, (column 2) reduced by eight percent (8%) withhold as shown in column 6, plus (if applicable) the NF add-on (column
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Capitation Payment Rates. The Capitation Payment Rate is equal to the Risk Adjusted Rate. The Department will pay the sum of the applicable monthly Capitation Payment Rate plus the ACA Rate Supplement to the PH-MCO for each Member enrolled in the PH-MCO’s program. This amount will be the payment for each month the MCO Plan Factor remains at 0.971. As each recalculation of the MCO Plan Factor occurs, the PH-MCO will be paid a revised Capitation Payment Rate in effect for each month that each TANF Philadelphia Member is enrolled in the PH-MCO’s program. In addition, the Department will, when specified by this Agreement, pay applicable Pay For performance amounts; and the applicable Maternity Care Payments; and any amounts that are owed in accordance with the Risk Sharing provisions as defined in the Home Nursing Risk Sharing Arrangement(s) of this Agreement; and any amounts that are owed in accordance with Appendix 3k, High Cost Risk Pool, of this Agreement.
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Capitation Payment Rates. The Capitation Payment Rate is equal to the Risk Adjusted Rate. The Department will pay the applicable monthly Capitation Payment Rate to the PH-MCO for each Member enrolled in the PH-MCO’s program. Capitation Payment Rate equals the Risk Adjusted Rate of $97.10. This will be paid for each month the MCO Plan Factor of 0.971 is in effect. As each recalculation of the MCO Plan Factor occurs, the PH-MCO will be paid the revised Capitation Payment Rate in effect for each month that each TANF Philadelphia Member is enrolled in the PH-MCO’s program. In addition, the Department will, when specified by this Agreement, pay applicable Pay For performance amounts; and the applicable Maternity Care Payments; and any amounts that are owed in accordance with the Risk Sharing provisions as defined in the Home Nursing Risk Sharing Arrangement(s) of this Agreement; and any amounts that are owed in accordance with Appendix 3k, High Cost Risk Pool, of this Agreement. Federal HC Agreement New West Updated March 26, 2012
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Capitation Payment Rates. 3.3.1 The CONTRACTOR will be paid a base capitation rate for each enrollee based on the enrollee’s rate category. Rate categories are based on various factors, including the enrollee’s enrollment in CHOICES, category of aid, age/sex combination and the Grand Region served by the CONTRACTOR under this Agreement. The rate categories and the specific rates associated with each rate category are specified in Attachment XII. 3.3.2 The major aid categories are as follows: 3.3.2.1 Medicaid; 3.3.2.2 Uninsured/Uninsurable; 3.3.2.3 Disabled — The disabled rate is only for those enrollees who are eligible for Medicaid as a result of a disability; and 3.3.2.4 Duals/Waiver Duals — For the purpose of capitation rates, Duals/Waiver Duals are TennCare Medicaid or TennCare Standard enrollees who have Medicare eligibility. 3.3.3 The CONTRACTOR will also be paid a priority add-on rate for behavioral health services in accordance with the rates specified in Attachment XII for each priority enrollee. The CONTRACTOR will be paid the priority add-on rate for priority enrollees, as defined in this Agreement, who have received behavioral health services as reported pursuant to Section 2.23.4 of this Agreement, within the preceding twelve (12) months from the date of the calculation of the monthly payment, and who have had a valid CRG/TPG assessment within the preceding twelve (12) months from the date of the calculation of the monthly payment. 3.3.4 TENNCARE will determine the appropriate rate category to which each enrollee is assigned for payment purposes under this Agreement. 3.3.5 TENNCARE’s assignment of an enrollee to a rate category is for payment purposes under this Agreement, only, and is not an “adverse action” or determination of the benefits to which an enrollee is entitled under the TennCare program, TennCare rules and regulations, TennCare policies and procedures, the TennCare waiver or relevant court orders or consent decrees.
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Capitation Payment Rates. Payments for all Enrollees, except dual eligible Enrollees 65 and over, shall be the sum of payments under A. and B. below, which have an actuarial basis and which shall not exceed the payments limits set forth in 42 C.F.R. 447.361. Dual eligible Enrollees 65 and over shall be paid under A only, but at 100% instead of 95%. The HEALTH PLAN shall receive for each Enrollee the rate of the county of service. A. Until the date specified in Section 4.1.4., monthly payments paid by the STATE to the HEALTH PLAN shall be paid at 95% of the rates in Appendix A, Column (3), plus the MERC and DPA rates in Appendix A, Columns (4) and (5) ; This amount is shown in Appendix B, Column (1). After the date specified in Section 4.1.4., the amount is shown in Appendix B, Column (2). B. Monthly payments paid by the STATE to the HEALTH PLAN shall be at 5% of the statewide Base Rate in Appendix B, Column (4), multiplied by the HEALTH PLAN’s risk factor for each eligibility group in Appendix B, Column (3). The dollar value of this add-on is shown in Appendix B, Column (5), and will change on a quarterly basis. The sum of (A) and (B) is the total capitation payment to the HEALTH PLAN and is identified in Appendix B, Column (6). Section 4.2.1. Assignment of Rate Cells shall be made based on information on the STATE MMIS and information provided by the HEALTH PLAN to the STATE. Section 4.2.2. The STATE will periodically review information in MMIS related to the assignment of Rate Cells to verify that appropriate rates are being paid. Section 4.2.3. The HEALTH PLAN shall promptly pay all valid claims, whether provided within or outside the Service Area of this Contract consistent with Sections 1816(c)(2) (42 U.S.C. 1395(h)(c)(2)), 1842(c)(2) (42 U.S.C. 1395u(c)(2)) and 1902(a)(37)(a) (42 U.S.C. Section 4.2.4. The prepaid capitation rates for Recipients enrolled in the HEALTH PLAN shall be subject to renegotiation not more than annually unless required by State or federal law or regulation, or necessary due to changes in eligibility and benefits. Section 4.2.5. The capitation rate shall not include payment for recoupment of losses incurred by the HEALTH PLAN from prior years or under previous contracts.
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Capitation Payment Rates. The Capitation Payment Rate is equal to the Risk Adjusted Rate. The Department will pay the sum of the applicable monthly Capitation Payment Rate plus the ACA Rate Supplement to the PH-MCO for each Member enrolled in the PH-MCO’s program. has provided the PH-MCO with a RAR MCO Plan Factor of 0.9710 for TANF Members in Philadelphia. $100.00 multiplied by 0.971 equals $97.10, which is the Risk Adjusted Rate. The Risk Sharing Withhold amount for Home Nursing is $2.41, and the HCRPAA is $1.21, but these amounts are not incorporated in the calculation of the Capitation Payment Rate. The ACA Rate Supplement is $15.00. This rate of $15.00 is added to the Capitation Payment Rate of $97.10 to total $112.10, which is the final capitation payment issued for the TANF member. This amount will be the payment for each month the MCO Plan Factor remains at 0.971. As each recalculation of the MCO Plan Factor occurs, the PH-MCO will be paid a revised Capitation Payment Rate in effect for each month that each TANF Philadelphia Member is enrolled in the PH-MCO’s program. In addition, the Department will, when specified by this Agreement, pay applicable Pay For performance amounts; and the applicable Maternity Care Payments; and any amounts that are owed in accordance with the Risk Sharing provisions as defined in the Home Nursing Risk Sharing Arrangement(s) of this Agreement; and any amounts that are owed in accordance with Appendix 3k, High Cost Risk Pool, of this Agreement. Federal HC Agreement 13-14 Amendment – NW Updated July 18, 2013 This Agreement establishes a risk sharing arrangement (Arrangement) between the Department and the PH-MCO for certain HealthChoices Members who incur significant costs for home nursing services. This Appendix 3c supersedes any previous version to define the Arrangement for the Arrangement Year beginning January 1, 2014 and subsequent Arrangement Years.
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Capitation Payment Rates. 3.3.1 The CONTRACTOR will be paid a base capitation rate for each enrollee based on the enrollee’s category of aid and age/sex combination and the Grand Region served by the CONTRACTOR under this Agreement in accordance with the rates specified in Attachment X. 3.3.2 The major aid categories are as follows: 3.3.2.1 Medicaid; 3.3.2.2 Uninsured/Uninsurable; 3.3.2.3 Disabled — The disabled rate is only for those enrollees who are eligible for Medicaid as a result of a disability;
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Related to Capitation Payment Rates

  • Interest Rates Payments and Calculations (a) Interest Rate. Except as set forth in Section 2.3(b), or as ------------- specified to the contrary in any Loan Document, any Advances under this Exim Agreement shall bear interest, on the average daily balance, at a rate equal to the Prime Rate per annum.

  • Accrual Rates All eligible employees shall accrue vacation pay according to the following rates:

  • Interest Rates; Benchmark Notification The interest rate on a Loan denominated in dollars may be derived from an interest rate benchmark that may be discontinued or is, or may in the future become, the subject of regulatory reform. Upon the occurrence of a Benchmark Transition Event, Section 2.14(b) provides a mechanism for determining an alternative rate of interest. The Administrative Agent does not warrant or accept any responsibility for, and shall not have any liability with respect to, the administration, submission, performance or any other matter related to any interest rate used in this Agreement, or with respect to any alternative or successor rate thereto, or replacement rate thereof, including without limitation, whether the composition or characteristics of any such alternative, successor or replacement reference rate will be similar to, or produce the same value or economic equivalence of, the existing interest rate being replaced or have the same volume or liquidity as did any existing interest rate prior to its discontinuance or unavailability. The Administrative Agent and its affiliates and/or other related entities may engage in transactions that affect the calculation of any interest rate used in this Agreement or any alternative, successor or alternative rate (including any Benchmark Replacement) and/or any relevant adjustments thereto, in each case, in a manner adverse to the Borrower. The Administrative Agent may select information sources or services in its reasonable discretion to ascertain any interest rate used in this Agreement, any component thereof, or rates referenced in the definition thereof, in each case pursuant to the terms of this Agreement, and shall have no liability to the Borrower, any Lender or any other person or entity for damages of any kind, including direct or indirect, special, punitive, incidental or consequential damages, costs, losses or expenses (whether in tort, contract or otherwise and whether at law or in equity), for any error or calculation of any such rate (or component thereof) provided by any such information source or service.

  • Interest on Payments Any payment by the Receiver pursuant to Section 2.6(d) shall be made together with interest on the amount thereof that accrues with effect from five (5) Business Days after the date on which payment was agreed or determined to be due until such amount is paid. The annual interest rate shall be determined by the Receiver based on the coupon equivalent of the three (3)-month U.S. Treasury Xxxx Rate in effect as of the first Business Day of each Calendar Quarter during which such interest accrues as reported in the Federal Reserve Board Statistical Release for Selected Interest Rates H.15 opposite the caption “Treasury bills (secondary market), 3-Month” or, if not so reported for such day, for the next preceding Business Day for which such rate was so reported.

  • Vacation Accrual Rates Laid off employees who are re-employed shall have the vacation accrual rate they held immediately prior to layoff restored.

  • Interest Rates; LIBOR Notification The interest rate on Eurodollar Loans is determined by reference to the LIBO Rate, which is derived from the London interbank offered rate. The London interbank offered rate is intended to represent the rate at which contributing banks may obtain short-term borrowings from each other in the London interbank market. In July 2017, the U.K. Financial Conduct Authority announced that, after the end of 2021, it would no longer persuade or compel contributing banks to make rate submissions to the ICE Benchmark Administration (together with any successor to the ICE Benchmark Administrator, the “IBA”) for purposes of the IBA setting the London interbank offered rate. As a result, it is possible that commencing in 2022, the London interbank offered rate may no longer be available or may no longer be deemed an appropriate reference rate upon which to determine the interest rate on Eurodollar Loans. In light of this eventuality, public and private sector industry initiatives are currently underway to identify new or alternative reference rates to be used in place of the London interbank offered rate. In the event that the London interbank offered rate is no longer available or in certain other circumstances as set forth in Section 2.14(c) of this Agreement, such Section 2.14(c) provides a mechanism for determining an alternative rate of interest. The Administrative Agent will notify the Borrower, pursuant to Section 2.14, in advance of any change to the reference rate upon which the interest rate on Eurodollar Loans is based. However, the Administrative Agent does not warrant or accept any responsibility for, and shall not have any liability with respect to, the administration, submission or any other matter related to the London interbank offered rate or other rates in the definition of “LIBO Rate” or with respect to any alternative or successor rate thereto, or replacement rate thereof, including without limitation, whether the composition or characteristics of any such alternative, successor or replacement reference rate, as it may or may not be adjusted pursuant to Section 2.14(c), will be similar to, or produce the same value or economic equivalence of, the LIBO Rate or have the same volume or liquidity as did the London interbank offered rate prior to its discontinuance or unavailability.

  • Interest Rates and Letter of Credit Fee Rates Payments and Calculations (a) Interest Rates. Except as provided in Section 2.13(c) and Section 2.15(a), all Obligations (except for the undrawn portion of the face amount of Letters of Credit) that have been charged to the Loan Account pursuant to the terms hereof shall bear interest at a per annum rate equal to the lesser of (i) the LIBOR Rate plus the Applicable Margin, or (ii) the maximum rate of interest allowed by applicable laws; provided, that following notice to Borrower in accordance with Section 2.15(a) hereof, all Obligations that have been charged to the Loan Account pursuant to the terms hereof shall bear interest at a per annum rate equal, during the duration of the circumstances described in Section 2.15(a), to the lesser of (A) the Base Rate plus the Applicable Margin as calculated pursuant to Section 2.15(a) or (B) the maximum rate of interest allowable by applicable laws.

  • Applicable Interest Rates (a) U.S.

  • Interest Rates All outstanding Term Loans to the Borrower shall bear interest on the unpaid principal amount thereof (including, to the extent permitted by law, on interest thereon not paid when due) from the date made until paid in full in cash at a rate determined by reference to the Base Rate or Adjusted Term SOFR plus the Applicable Margin, but not to exceed the Maximum Rate. If at any time Term Loans are outstanding with respect to which the Borrower has not delivered to the Agent a notice specifying the basis for determining the interest rate applicable thereto in accordance herewith, those Term Loans shall be treated as Base Rate Loans until notice to the contrary has been given to the Agent in accordance with this Agreement and such notice has become effective. Except as otherwise provided herein, the Term Loans shall bear interest as follows: (i) For all Base Rate Loans, at a fluctuating per annum rate equal to the Base Rate plus the Applicable Margin; and (ii) For all SOFR Rate Loans, at a fluctuating per annum rate equal to Adjusted Term SOFR plus the Applicable Margin. Each change in the Base Rate (or any component thereof) shall be reflected in the interest rate applicable to Base Rate Loans as of the effective date of such change. All computations of interest for Base Rate Loans when the Base Rate is determined by the “prime rate” shall be made on the basis of a year of 365 or 366 days, as the case may be, and actual days elapsed. All other computations of fees and interest shall be made on the basis of a 360-day year and actual days elapsed (which results in more fees or interest, as applicable, being paid than if computed on the basis of a 365-day year). On the last Business Day of each calendar quarter hereafter and on the Termination Date, the Borrower shall pay to the Agent, for the ratable benefit of the Lenders, interest accrued from the last Business Day of the preceding calendar quarter to the last Business Day of such calendar quarter (or accrued to the Termination Date in the case of a payment on the Termination Date) on all Base Rate Loans in arrears. The Borrower shall pay to the Agent, for the ratable benefit of the Lenders, interest on all SOFR Rate Loans in arrears on each SOFR Interest Payment Date.

  • Overhead Rates The Engineer shall use the provisional overhead rate indicated in Attachment E. If a periodic escalation of the provisional overhead rate is specified in Attachment E, the effective date of the revised provisional overhead rate must be included. For lump sum contracts, the overhead rate remains unchanged for the entire contract period.

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