Capitation rate definition

Capitation rate means the fee the department pays monthly to an HMO for each enrolled recipient for the provision of covered medical and health services whether or not the enrolled recipient received services during the month for which the fee is intended.

Capitation rate means the fee the department pays monthly to a participating health or dental plan for each enrollee for the provision of covered medical or dental services whether or not the enrollee received services during the month for which the fee is intended.

Capitation rate means the fixed monthly amount that the Contractor receives for an Enrollee to provide that Enrollee with the Benefit Package.

Examples of Capitation rate in a sentence

• Rate Cell — A set of mutually exclusive categories of enrollees that is defined by one or more characteristics for the purpose of determining the Capitation rate and making a Capitation payment; such characteristics may include age, gender, eligibility category, and region or geographic area.

• Capitation rate ranges for the Bayou Health program were developed in accordance withrate-setting guidelines established by CMS.

• Nothing in this Article III prevents Contractor from providing the Department with information Contractor believes indicates that an Enrollee’s eligibility was incorrectly determined or has changed so that enrollment with Contractor is no longer appropriate or that the Capitation rate for that Enrollee should be adjusted.

• Capitation rate changes from R2 to P1 are reflected as a programmatic adjustment.

• Until 1992 these subsidies were only available to full time farmers with only one farm.

More Definitions of Capitation rate

Capitation rate means the fee the department pays monthly to the contractor for each enrolled Medicaid member for the provision of covered, required, and optional services, whether or not the enrollee received services during the month for which the fee is paid.

Capitation rate means a fixed predetermined fee paid by HHSC to the HMO each month in accordance with the Contract, for each enrolled Member in a defined Rate Cell, in exchange for the HMO arranging for or providing a defined set of Covered Services to such a Member, regardless of the amount of Covered Services used by the enrolled Member.

Capitation rate means the fixed monthly amount that the Contractor receives from the State for an Enrollee to provide that Enrollee with the Medicaid Advantage Plus Product.

Capitation rate means the monthly fee the department pays to a PACE organization for each Medicaid enrollee for the provision of covered medical and health services, whether or not the enrollee received services during the month for which the fee is intended.

Capitation rate means the actuarially sound per-enrollee, per-month amount, including any adjustments, that OHCA agrees to pay an MCO or DBM for the provision of State Plan services.

Capitation rate means the negotiated Medicaid monthly per capita amount paid to a PACE provider for all services provided to enrollees.

Capitation rate means a monthly fee paid for each member assigned or each event (for example, maternity delivery) regardless of the number of actual cost of services provided under a system of reimbursement for MCOs and PAHPs. Capitation Rates can vary by member based on demographics, location, covered services, or other characteristics. Capitation Rates can be structured so that an MCO or PAHP is fully at risk, or so that an MCO or PAHP shares the risk with other parties.