Capitation Payment. The aggregate payment CMS and the State make periodically to a STAR+PLUS MMP on behalf of all of the Enrollees enrolled under this Contract for the provision of services within this Demonstration, regardless of whether a specific Enrollees receives services during the period covered by the payment. Except as provided in this Contract, any and all costs incurred by the STAR+PLUS MMP in excess of a Capitation Payment shall be born in full by the STAR+PLUS MMP.
Capitation Payment. The Department shall pay the Contractor on a Capitation basis, based on the age and gender categories of the Enrollee as shown on the table in Attachment I, a sum equal to the product of the approved Capitation rate and the number of Enrollees enrolled in that category as of the first day of that month. Rates reflected in Attachment I are for the period August 1, 2003 through July 31, 2005. At the end of the two year period, the Department will develop an update to the rates which will be offered to the Contractor through an amendment to the Contract.
Capitation Payment. The Department shall pay Contractor on a Capitation basis, based on the rate cell of the Enrollee as shown on the table in Attachment IV, a sum equal to the product of the approved Capitation rate and the number of Enrollees enrolled in that category as of the first day of that month. The Capitation rates for the Nursing Facility rate cell and the HCBS Other Waivers rate cell will include a component for Service Package I and Service Package II. Except as provided in Subsections 7.1.1 through 7.1.4, an Enrollee’s rate cell will be determined by his or her residential status as of the first day of the month (e.g., NF resident, HCBS Waiver Enrollee). The Department will use its eligibility system to determine an Enrollee’s rate cell. Delays in changes to an Enrollee’s residential status being reflected in the Department’s eligibility system will cause adjustments to past Capitation payments to be made. Capitation is due to Contractor by the fifteenth day of the service month. Rates reflected in Attachment IV are for the period as set forth in said Attachment, except as adjusted pursuant to this Article
Capitation Payment. A. The Department will pay a Capitation Payment to the Contractor for each Participant calculated on an actuarially sound basis. The Capitation Payment rates and methodology for calculating the rates are described in Appendix I.
Capitation Payment. The Department shall pay Contractor on a Capitation basis, based on the rate cell of the Enrollee as shown on the table in Attachment IV, a sum equal to the product of the approved Capitation rate and the number of Enrollees enrolled in that category as of the first day of that month. An Enrollee’s rate cell shall be determined by the Department at the time of the Enrollee’s enrollment and the Enrollee’s rate cell shall not change during the first year of the Enrollee’s enrollment, regardless of any change in the Enrollee’s circumstances, except as provided in Section 7.3. Capitation is due to Contractor by the fifteenth day of the service month. Rates reflected in Attachment IV are for the period as set forth in said Attachment, except as adjusted pursuant to this Article VII. Rates may be updated periodically to reflect future time periods, additional Service Packages and additional populations. The Department will provide Contractor with an opportunity to review, comment and accept in writing any such update, including supporting data, before such update is implemented. The Parties will work together to resolve any discrepancies.
Capitation Payment. Capitation Payment means a payment for each premium rate category EOHHS makes periodically to Contractor on behalf of each member enrolled under a contract for the provision of medical services under the State plan. EOHHS makes the payment regardless of whether the particular member receives services during the period covered by the payment.
Capitation Payment. A payment the State agency makes periodically to a contractor on behalf of each member enrolled under a contract and based on the actuarially sound capitation rate for the provision of services under the State Plan. The State agency makes the payment regardless of whether the particular member receives services during the period covered by the payment.
Capitation Payment. On or before the 15th day of each month, Payor shall pay Corporation for Health Services rendered to Members by Providers, a payment of [*] per Member per month ("Capitation Payment"), beginning July 15, 1995. Services which are included in the Capitation Payment are identified in Appendix B. The Capitation Payment shall be calculated based on the total number of Members enrolled in the Plan for the previous month. Adjustments to the Capitation Payment shall be reflected in subsequent calculations as deemed necessary by Plan, and as provided for in Section 2.2 below. In the second year of the contract term, and each year thereafter, Plan shall increase the Capitation Payment by an amount equal to the percentage change CPI for the previous year.
Capitation Payment. On or before the 15th day of each month, Plan, on behalf of Payor, shall pay Corporation for Health Services rendered to Members covered by Plan pursuant to its TEFRA risk contract on a capitation basis with the Health Care Financing Administration by Providers, a payment of [*] per Member per month ("Capitation Payment"), beginning July 15, 1995. Services which are included in the Capitation Payment are identified in Appendix C. The Capitation Payment shall be calculated based on the total number of Members enrolled in the Plan for the previous month Adjustments to the Capitation Payment shall be reflected in subsequent calculations as deemed necessary by Plan, and as provided for in this Appendix. In the second year of the contract term, and each year thereafter, Plan shall increase the Capitation Payment by an amount equal to the percentage change in the CPI for the previous year.
Capitation Payment. The fee that is paid by T ENNCARE to the CONTRACTOR for each member covered by this Agreement. The CONTRACTOR is at financial risk as specified in Section 3 of this Agreement for the payment of services incurred in excess of the amount of the capitation payment. “Capitation Payment” includes Base Capitation Rate payments unless otherwise specified. Capitation Rate – The amount established by T ENNCARE pursuant to the methodology described in Section 3 of this Agreement, including the base capitation rates.
