CAPITATION AMOUNTS Clause Samples
CAPITATION AMOUNTS. 13.1.1 TDH will pay HMO monthly premiums calculated by multiplying the number of Member months by Member risk group times the monthly capitation amount by Member risk group. FOR ADDITIONAL INFORMATION REGARDING THE ACTUARIAL BASIS AND METHODOLOGY USED TO COMPUTE THE CAPITATION RATES, PLEASE REFERENCE THE WAIVER UNDER THE DOCUMENT TITLED "ACTUARIAL METHODOLOGY FOR DETERMINATION OF MAXIMUM MONTHLY CAPITATION AMOUNTS". HMO and network providers are prohibited from billing or collecting any amount from a Member for health care services covered by this contract, in which case the Member must be informed of such costs prior to providing non-covered services.
CAPITATION AMOUNTS. 13.1.1 TDH will pay HMO monthly premiums calculated by multiplying the number of Member months by Member risk group times the monthly capitation amount by Member risk group. For additional information regarding the actuarial basis and methodology used to compute the capitation rates, please reference the waiver under the document titled "Actuarial Methodology for Determination of Maximum Monthly Capitation Amounts". HMO and network providers are prohibited from billing or collecting any amount from a Member for health care services covered by this contract, in which case the Member must be informed of such costs prior to providing non-covered services.
CAPITATION AMOUNTS. FY 2003 Monthly Capitation Amounts Member Risk Groups 11/1/2002 - 8/31/2003 --------------------------------------------------------------------------------- CBA Waiver Clients-Dual Eligible $ 1,294.50 --------------------------------------------------------------------------------- CBA Waiver Clients-Medicaid Only $ 2,917.06 --------------------------------------------------------------------------------- Other Community Clients-Dual Eligible $ 128.77 --------------------------------------------------------------------------------- Other Community Clients-Medicaid Only $ 608.43 --------------------------------------------------------------------------------- Nursing Home-Dual Eligible (4 months) $ 128.77 --------------------------------------------------------------------------------- Nursing Home-Medicaid Only (4 months) $ 608.43 --------------------------------------------------------------------------------- This Amendment is executed by the Parties in accordance with Article 15.2 of the Agreement.
CAPITATION AMOUNTS. 13.1.1 TDH will pay HMO monthly premiums calculated by multiplying the number of Member months by Member risk group times the monthly capitation amount by Member risk group. HMO and network providers are prohibited from billing or collecting any amount from a Member for health care services covered by this contract, in which case the Member must be informed of such costs prior to providing non-covered services.
13.1.2 Delivery Supplemental Payment (DSP). TDH has submitted the delivery supplemental payment methodology to HCFA for approval. THE MONTHLY CAPITATION AMOUNTS FOR SEPTEMBER 1, 1999, THROUGH AUGUST 31, 2000 AND THE DSP AMOUNT ARE LISTED BELOW. THESE AMOUNTS ARE EFFECTIVE SEPTEMBER 1, 1999. THE MONTHLY CAPITATION AMOUNTS ESTABLISHED FOR EACH RISK GROUP IN THE DALLAS SERVICE AREA USING THE STANDARD METHODOLOGY (LISTED IN ARTICLE 13.1.