Common use of CAPITATION Clause in Contracts

CAPITATION. 2.1 Hospital Capitation Rate (HCR) paid to SCHS: The HCR shall be negotiated as a variable per member, per month (PMPM) for OHP members with physical health benefits 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: Aid to Blind/Disabled & OAA with Medicare Aid to Blind/Disabled & OAA without Medicare CAF Children ACA Ages 19-44 ACA Ages 45-54 ACA Ages 55-64 PLM, TANF and CHIP Children age < 1 PLM, TANF and CHIP Children age 1-5 Poverty Level Medical Adults (includes pregnancy) TANF (Adults only) BCCP 2.2 Hospital Capitation Withhold (HCW): The Hospital Capitation Payment will have an eight percent (8%) Hospital Capitation Withhold.