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

• The amount of the Loss on the Medical Component of the Capitation Rate Payment for the Contract Year shall be defined as the difference between the Medical Component of the Capitation Rate Payment for the Contract Year and the Contractor’s actual medical expenditures for SKSC MCO Covered Services for the Contract Year, if such actual expenditures are greater than the Medical Component of the Capitation Rate Payment for the Contract Year.

• The Capitation Rate shall be comprised of a Medical Component and Administrative Component.

• EOHHS intends that the SKSC Capitation Rate shall be consistent for all MCOs contracted to provide services under the SKSC Program.

• This Category of Service represents a portion of the Medical Component of the SKSC Capitation Rate.

• SKSC Estimated Capitation Payment (ECP): a prospective monthly payment made by EOHHS to the Contractor based on the number of days in the month and an estimation of the number of member months multiplied by the applicable per Enrollee per month SKSC Capitation Rate.

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 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 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 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.