Catastrophic Component Threshold Clause Samples
Catastrophic Component Threshold. (Capitated Reform Health Plans in counties where no HMO is present and Reform FFS PSNs only) - The point at which the cost of covered services, based on Medicaid fee-for-service payment levels, reaches $50,000 for an enrollee in a Contract year. For a Health Plan that accepts the comprehensive capitation rate only, the Agency begins reimbursing the Health Plan for the cost of covered services received by the enrollee for the remainder of the Contract year. This reimbursement is based on a percentage of Medicaid fee-for-service payment levels.
Catastrophic Component Threshold. The point when the cost of Covered Services, based on Medicaid Fee-for-Service payment levels, reaches $50,000 for an Enrollee in a state fiscal year. For a Health Plan that accepts the Comprehensive Capitation Rate only, the Agency begins reimbursing the Health Plan for the cost of Covered Services received by the Enrollee for the remainder of the Contract Year. This reimbursement is based on a percentage of Medicaid Fee-for-Service payment levels,. Cause— Special reasons that allow Mandatory Enrollees to change their Health Plan option outside their Open Enrollment period. May also be referred to as “Good Cause.”