Common use of Capitation Payment Rates Clause in Contracts

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. Illustrative Example of Rate Calculation, with Risk Adjusted Rates: The Base Capitation Rate for TANF in Philadelphia is $100.00. The Department 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.

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. Illustrative Example of Rate Calculation, with Risk Adjusted Rates: The Base Capitation Rate for TANF in Philadelphia is $100.00. The Department 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 3b-2 Capitation Payment Rate equals the Risk Adjusted Rate of $97.10 to total $112.10, which is the final capitation payment issued for the TANF member97.10. This amount will be the payment paid for each month the MCO Plan Factor remains at 0.971of 0.971 is in effect. As each recalculation of the MCO Plan Factor occurs, the PH-MCO will be paid a 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 APPENDIX 3c

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. Illustrative Example of Rate Calculation, with Risk Adjusted Rates: The Base Capitation Rate for TANF in Philadelphia is $100.00. The Department 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 APPENDIX 3c HOME NURSING RISK SHARING ARRANGEMENT 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.