Medicaid Capitation Rates Sample Clauses

Medicaid Capitation Rates. In full consideration of services in the Medicaid benefit package rendered by the MCO for each enrolled member, the Department agrees to pay the MCO a monthly capitation rate. The capitation rates shall be based on an actuarially sound methodology as required by federal regulations. The capitation rates shall include funding to support relocation of members from institutional settings into the most integrated community setting. The capitation rate shall not include any amount for recoupment of losses incurred by the MCO under previous contracts nor does it include services that are not covered under the State Plan. When the rate cell used to process a member’s capitation payment changes in the middle of a month, the Department will use a daily rate to calculate the capitation payment for the member. This daily rate is based on the annualized monthly capitation rate (i.e. monthly capitation rate times twelve months) divided by the number of days in the contracted calendar year and rounded to the fourth digit to the right of the decimal. Payment of the rate is based on the daily rate multiplied by the number of days the member was enrolled for the month and rounded to the nearest cent. Examples of mid- month changes that would require the use of a daily rate to calculate the capitation rate include enrollment and disenrollments between programs or MCOs, changes in the nursing home level of care for PACE/Partnership members, and changes between a nursing home level of care and a non-nursing home level of care for Family Care members.
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Related to Medicaid Capitation Rates

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