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.

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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

• HHSC will calculate the fixed monthly Capitation Payments by multiplying the number of Members enrolled on the first day of the month by the Capitation Rate.

• HHSC will determine the administrative expense component of the applicable Capitation Rate structure for the MCO prior to each applicable Rate Period.

• The spreadsheet(s) show the fixed amount and percentage of premium components for the administrative component of the Capitation Rate.

• HHSC therefore will perform an actuarial calculation to account for the HIP Fee within actuarially sound Capitation Rates each year, and apply this Capitation Rate adjustment to the regular Capitation Rates already paid to the MCO.

• The components of the administrative expense portion of the Capitation Rate can also be found on Under each Program, there is a separate Rate-Setting document for each Rate Period that describes the development of the Capitation Rates.

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 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 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 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 fixed predetermined fee paid by HHSC to the MCO each month in accordance with the Contract, for each enrolled Member in exchange for the MCO 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.