Modifications to Capitation Rates. CMS and the Department will jointly notify the Contractor in advance and in writing as soon as practicable, but in no event less than thirty (30) days prior to processing the change to the Capitation rate, of any proposed changes to the Capitation rates, and the Contractor shall accept such changes as payment in full as described in Section 4.7. Any mid-year rate changes would be articulated in a rate report, subject to the signature requirement in Section 4.1.1.3.
Modifications to Capitation Rates. EOHHS will notify the Contractor in advance and in writing of any proposed changes to the Capitation Rates by RC. Updated MassHealth Capitation Rates will be established by amendment to this Contract.
Modifications to Capitation Rates. Base Capitation Rates will be updated for January 1st of each calendar year, and as otherwise indicated by EOHHS. EOHHS shall meet with the Contractor annually, upon request, to announce and explain the Base Capitation Rates for the upcoming calendar year. EOHHS will notify the Contractor in advance and in writing of any proposed changes to the Capitation Rates, and the Contractor shall accept such changes as payment in full as described in Section 4.6. Prior to the beginning of the Contract Year, EOHHS shall incorporate, by amendment, the Base Capitation Rates by Rating Category, Region, and Dual Eligible vs. Medicaid-only status into the Contract at Appendix D. Prior to the beginning of the Contract Year, the Contractor shall accept the Base Capitation Rates for the new Contract Year as follows: In writing, in a form and format specified by EOHHS, by a deadline specified by EOHHS that allows sufficient time for EOHHS to load such Base Capitation Rates into EOHHS’s payment system. Prior to the beginning of the Contract Year, by executing an amendment to the Contract incorporating the new Base Capitation Rates, as described above. EOHHS may amend the Base Capitation Rates at such other times as may be necessary as determined by EOHHS, or as a result of changes in federal or state law, including but not limited to, to account for changes in SCO participation requirements, SCO Covered Services, or primary payer assignment between Medicare and Medicaid. Timing of Capitation Payments EOHHS shall make monthly per Member per month capitation payments to the Contractor. The PMPM capitation payment for a particular month will reflect payment for the Enrollees with effective enrollment into the Contractor’s SCO Plan as of the first day of that month, as described in Section 2.4. The final per Member per month capitation payment made by EOHHS to the Contractor for each Enrollee shall be for the month in which the disenrollment was submitted in accordance with Section 2.4, the Enrollee loses eligibility (i.e., the month in which the Enrollee’s last day of eligibility occurs). Enrollee Contribution to Care Amounts If, in the financial eligibility process conducted by EOHHS, an Enrollee residing in a nursing facility is determined to owe a monthly Enrollee‑paid amount, such amounts are the Enrollee’s contribution to care. At the time of enrollment, and as adjusted thereafter, EOHHS will advise the Contractor of the amount of the Enrollee’s contribution to care. When an...
Modifications to Capitation Rates. CMS and DHCS will jointly notify the Contractor in advance and in writing of any proposed changes to the Capitation Rates, and the Contractor shall accept such changes as payment in full as described in Section 4.7.
Modifications to Capitation Rates. CMS and the NYSDOH will jointly notify the FIDA Plan in advance and in writing of any proposed changes to the Capitation rates, and the FIDA Plan shall accept such changes as payment in full as described in Section 4.5.
Modifications to Capitation Rates. 4.3.6.1. CMS and ODM will jointly notify the ICDS Plan in advance and in writing of any proposed changes to the capitation rates, and the ICDS Plan shall accept such changes as payment in full as described in Section 4.4.
Modifications to Capitation Rates. 4.4.5.1.CMS and HHSC will jointly notify the STAR+PLUS MMP in advance and in writing as soon as practicable, but no less than thirty (30) days prior to processing the change to the Capitation Rate, of any proposed changes to the Capitation Rates, and the STAR+PLUS MMP shall accept such changes as payment in full as described in Section 4.8.
