Common use of CAPITATION Clause in Contracts

CAPITATION. 2.1 Hospital Capitation Rate (HCR) paid to SCHS: The HCR shall be $107.50 per member, per month (PMPM), which has been calculated for the membership in the month of November 2020, and will fluctuate with membership fluctuations in each Rate Category, consistent with the revenue components listed in Section 1,H above. The HCR and the resulting Hospital Capitation Payment to SCHS may vary as Estimated Earned Net Premium Revenue payments from the state of Oregon to Health Plan increase or decrease, and is a weighted average of the following Central Oregon CCO membership in various benefit categories (which will change each month with membership) and PMPM Capitation Rates specific to each Rate Category as indicated below: Rate Category PMPM Capitation Rate Nov. 2020 Membership Aid to Blind/Disabled & OAA with Medicare $20.12 3,474 Aid to Blind/Disabled & OAA w/o Medicare $389.97 2,132 CAF Children $27.66 820 ACA Ages 19-44 $94.35 15,411 ACA Ages 45-54 $186.29 4,089 ACA Ages 55-64 $209.14 4,183 PLM, TANF and CHIP Children age < 1 $425.93 1,217 PLM, TANF and CHIP Children age 1-5 $26.36 6,333 PLM, TANF and CHIP Children age 6-18 $27.11 14,990 PLM Adults (includes pregnancy) $654.94 420 TANF (Adults only) $170.58 5,042 BCCP $433.42 18 Weighted Average $107.50 Total Average Membership, Central Oregon CCO 58,128

CAPITATION. 2.1 Hospital Capitation Rate (HCR) paid to SCHS: The HCR shall be $107.50 negotiated as a variable per member, per month (PMPM)) for OHP members with physical health benefits, which has been calculated for the membership in the month of November 2020, and will fluctuate with membership fluctuations in each Rate Category, consistent with the revenue components listed in Section 1,H above. The HCR and the resulting Hospital Capitation Payment to SCHS may vary as Estimated Earned Net Premium Revenue payments from the state of Oregon to Health Plan increase or decrease, and is a weighted average of the following Central Oregon CCO membership in various benefit categories (which will change each month with membership) and PMPM Capitation Rates specific to each Rate Category as indicated below: Rate Category PMPM Capitation Rate Nov. 2020 Membership Aid to Blind/Disabled & OAA with Medicare $20.12 3,474 Aid to Blind/Disabled & OAA w/o Medicare $389.97 2,132 CAF CAF/▇▇▇▇▇▇ Children $27.66 820 ACA Ages 19-44 $94.35 15,411 ACA Ages 45-54 $186.29 4,089 ACA Ages 55-64 $209.14 4,183 PLM, TANF and CHIP Children age < 1 $425.93 1,217 PLM, TANF and CHIP Children age 1-5 $26.36 6,333 PLM, TANF and CHIP Children age 6-18 $27.11 14,990 PLM Adults Adults/PWO (includes pregnancy) $654.94 420 TANF TANF/PCR (Adults only) $170.58 5,042 BCCP $433.42 18 Weighted Average $107.50 Negotiated Total Average Membership, Central Oregon CCO 58,128