Capitation Rate Payments Sample Clauses

Capitation Rate Payments. 1. The Agency’s capitation rate payments shall meet the following requirements: a. Medicaid Reform capitation rates will begin with the September 1, 2009, capitation rate payments. (1) For SSI Medicare Part B-only enrollees and SSI Medicare Parts A and B enrollees, the capitation rates are based on non-Reform capitation rate methodology for the age groups listed in Attachment I. (2) The capitation rates for all other enrollees are fully risk-adjusted. (a) The Agency will pay the Health Plan the HIV/AIDS capitation rate only for those enrollees who have been identified and verified as having an HIV/AIDS diagnosis. The HIV/AIDS capitation rate is provided in Attachment I. (i) The Agency will pay the HIV/AIDS capitation rate for those enrollees who have been identified as having an HIV/AIDS diagnosis, regardless of whether or not the Health Plan is a specialty plan. (ii) Enrollees with an HIV/AIDS diagnosis may be identified by either the Agency or the Health Plan. For the Health Plan to identify that an enrollee has an HIV/AIDS diagnosis, the Health Plan must have completed lab testing as interpreted by a licensed physician prior to reporting the enrollee to the Agency as an identified enrollee with an HIV/AIDS diagnosis. The Health Plan shall provide the Agency with such enrollee’s test results upon request. (iii) The Health Plan shall submit enrollees identified with an HIV/AIDS diagnosis to BMHC in a format and transmittal method approved by the Agency as specified in the Agency’s Report Guide. See Attachment II, Section XII, Reporting Requirements, of this Contract. (iv) The Agency shall not pay the HIV/AIDS capitation rate for any enrollee who was not identified as HIV/AIDS prior to enrollment processing for the month for which the capitation payment is made, nor shall the Agency make a retroactive capitation payment at the HIV/AIDS capitation rate if the enrollee was identified as HIV/AIDS after enrollment processing. (b) The Agency will pay the Health Plan the capitation rate for children with chronic conditions only if the enrollee meets the requirements for children with chronic conditions, as identified by the Agency, and the enrollee is enrolled in a specialty plan for children with chronic conditions based on the rates specified in Attachment I. b. For each eligibility category indicated, and for each age group indicated, the Agency will make a capitation payment for enrollees as provided for in the capitation rate tables in Attachment I as follo...
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Capitation Rate Payments. The Agency will pay the Contractor on a monthly basis using the capitation payment methodology for enrollees assigned to Contractor. Capitation rates applicable to each Contract term are set forth in the Capitation Rates table in the Special Contract Attachment section 3. 1. The capitation payment will constitute payment in full for the Contractor’s coverage of the enrollees assigned to Contractor as listed in the monthly HIPAA 820 capitation file. Retroactive adjustments to reflect the actual cost of covered services are prohibited. The Agency will pay any Contractor health insurer fee that may be owed pursuant to Section 9010 of the Affordable Care Act on a retrospective basis upon receipt of information regarding the amount of the fee paid by the Contractor for the premium earned under the terms of this Contract. The retrospective payment will include an adjustment for related income taxes and other adjustments, including tax credits. The Contractor shall submit any requested documentation to the Agency regarding the amount of the fee. A corporate officer for the Contractor shall attest to the accuracy of the documentation. Contractor shall on a monthly basis reconcile the monthly HIPAA 820 capitation file with the Contractor’s enrollment records. Any discrepancies found between the monthly HIPAA 820 capitation file and the Contractor’s enrollment records shall be reported to the Agency within sixty (60) calendar days from the end of the quarter. No adjustment to the capitation payment shall be made for any discrepancies reported after the sixty (60) calendar day period other than as required to avoid Contractor retention of payment in excess of those permitted under Section 1.3(D). The monthly capitation rate shall be subject to review annually during the Contract term or whenever the scope of services may be changed. At least 75 calendar days prior to the earlier of (1) the end of the then current Contract year, or (2) the effective date of the change of the scope of services, the parties will commence negotiating in good faith regarding a change to the capitation rate. The Agency will establish a new capitation rate at least 45 calendar days prior to the earlier of the effective date of the end of the Contract year or the change in scope. At that time the Agency will provide written notice of the proposed rates to Contractor. Contractor shall have 30 days after receiving such notice of the new capitation rates to either (1) sign a Contract amendment ...
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Related to Capitation Rate Payments

  • Interest Rate Payments Subject to Holder's right to charge the Default Rate (as hereinafter defined) pursuant to Section 4 hereof, this Note shall bear interest, and Maker shall make payments as follows: (a) Interest shall accrue on the unpaid principal balance of this Note at the Interest Rate (as defined in Exhibit A). For purposes of computing interest on the debt evidenced hereby, interest shall be calculated on the basis of a twelve (12) month calendar year applied to the actual number of months funds are outstanding. Payments (or prepayments) made on account hereof shall be applied first to the payment of late charges or other fees and costs owed to Holder (if any), next to the payment of accrued and unpaid interest, and then to principal, or, during the continuance of an Event of Default (as hereinafter defined), in such other order or proportion as Holder, in its sole discretion, may elect from time to time. (b) Interest and principal over the term of the Note shall be due and payable monthly in accordance with the Payment Schedule set forth in Exhibit F. Maker may at any time or from time to time make a voluntary prepayment, whether in whole or in part, of this Note, without premium or penalty. (c) The entire outstanding Obligations (as hereinafter defined) shall be due and payable in full on the Maturity Date (as defined in Exhibit A) or such earlier date resulting from acceleration by Holder of the Obligations due hereunder following an Event of Default (the “Maturity Date”).

  • Fixed Rate Payer The Trust.

  • Interest on Late Payments a. State Agencies The payment of interest on certain payments due and owed by Agency may be made in accordance with Article 11-A of the State Finance Law (SFL §179-d et. Seq.) and Title 2 of the New York Code of Rules and Regulations, Part 18 (Implementation of Prompt Payment Legislation -2 NYCRR §18.1 et seq.).

  • Separate Payments Each installment payment required under this Agreement shall be considered a separate payment for purposes of Section 409A.

  • Late Payments Except as expressly provided to the contrary in this Agreement or in any Ancillary Agreement, any amount not paid when due pursuant to this Agreement or any Ancillary Agreement (and any amounts billed or otherwise invoiced or demanded and properly payable that are not paid within thirty (30) days of such xxxx, invoice or other demand) shall accrue interest at a rate per annum equal to Prime Rate plus two (2%) percent.

  • 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.

  • Interest on late payment Subject to clause 9.7, the Trader or the Distributor (as the case may be) must pay any Tax Invoice issued under this clause 9. If any part of a Tax Invoice that is properly due in accordance with this Agreement is not paid by the due date, Default Interest may be charged on the outstanding amount for the period that the Tax Invoice remains unpaid.

  • Additional Fee on Late Payments For any payments thirty (30) calendar days or more overdue under this Agreement, Registry Operator shall pay an additional fee on late payments at the rate of 1.5% per month or, if less, the maximum rate permitted by applicable law.

  • Note Payments The Company agrees that, so long as any Purchaser shall hold any Note, it will make payments of principal of, interest on, and any Yield-Maintenance Amount payable with respect to, such Note, which comply with the terms of this Agreement, by wire transfer of immediately available funds for credit (not later than 12:00 noon, New York City local time, on the date due) to (i) the account or accounts of such Purchaser specified in the Purchaser Schedule attached hereto in the case of any Series A Note, (ii) the account or accounts of such Purchaser specified in the Confirmation of Acceptance with respect to such Note in the case of any Shelf Note or (iii) such other account or accounts in the United States as such Purchaser may from time to time designate in writing, notwithstanding any contrary provision herein or in any Note with respect to the place of payment. Each Purchaser agrees that, before disposing of any Note, it will make a notation thereon (or on a schedule attached thereto) of all principal payments previously made thereon and of the date to which interest thereon has been paid. The Company agrees to afford the benefits of this paragraph 11A to any Transferee which shall have made the same agreement as the Purchasers have made in this paragraph 11A.

  • Late Payment Fees If you have not paid a bill by the pay-by date, we may require you to pay a late payment fee, which is part of our standing offer prices published on our website.

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