Capitation Payment means a payment the STATE makes periodically to the MCO for each Enrollee covered under the Contract for the provision of services as defined in Article 6 regardless of whether the Enrollee receives these services during the period covered by the payment.
Capitation Payment means monthly prepayment to a PHP for health services the PHP provides to members.
Capitation Payment means the payment the Department makes to the Contractor on behalf of each Enrollee for the provision of Covered Services. The Department makes the payment regardless of whether the Enrollee receives services during the period covered by the payment. Capitation Rate means the rate negotiated between the Contractor and Department for each Medicaid eligibility group or Capitation Rate cell. In developing actuarially sound Capitation Rates, the Department will apply the elements required in 42 CFR 438.6(c).
Examples of Capitation Payment in a sentence
Capitation payment can have important implications on market structure and competitive behavior among providers subject to capitation payment incentives.
Capitation payment, compared to fee-for-service, can be a useful tool in reducing the cost of service.
Capitation payment was also used with some clinics.•Utilization reviewUtilization review measures were applied to the subcontractors.
The extent to which MCs engage in these activities depends on how capitation incentives are passed on to the doctors and managers within the MCs (internal incentives) and to the subcontractors (external incentives).5) Capitation payment provides MCs incentives to spread risk by increasing risk pool size and by shifting risk to subcontractors.
More Definitions of Capitation Payment
Capitation Payment means monthly prepayment to an MCE for capitated services to MCE members.
Capitation Payment means the aggregate amount paid by HHSC to the HMO on a monthly basis for the provision of Covered Services to enrolled Members in accordance with the Capitation Rates in the Contract.
Capitation Payment means the payment the Department makes periodically to the Contractor on behalf of each Enrollee for the provision of Covered Services under the Contract and based on the actuarially sound Capitation Rate. The Department makes the payment regardless of whether the particular Enrollee receives services during the period covered by the payment. Capitation Rate means the rate negotiated between the Contractor and Department for each Medicaid eligibility group or Capitation Rate cell. In developing actuarially sound Capitation Rates, the Department shall apply the elements required in 42 CFR § 438.6(c). Centers for Medicare and Medicaid Services (CMS) means the federal agency within the Department of Health and Human Services (HHS) that administers the Medicare and Medicaid programs, and works with states to administer the Medicaid program. Claim means:
Capitation Payment means a monthly payment to the managed care contractor on behalf of each member for the provision of health services under the managed care entity contract. Payment is made by the department regardless of whether the member receives services during the month. The managed care capitation payment varies based on the eligible member’s sex, age, and eligibility aid type.
Capitation Payment means a payment, based on an actuarially sound capitation rate for the provision of Oklahoma Medicaid State Plan services under a managed care contract, that OHCA makes periodically to the MCO or DBM behalf of each enrollee enrolled in that MCO or DBM, regardless of whether the enrollee actually receives services during the period covered by the payment.
Capitation Payment means a payment model where providers receive a payment on a per "covered person" basis, for specified calendar periods, for the coverage of specified health care services regardless of whether the patient obtains care. Capitation payments include, but are not limited to, global capitation arrangements that cover a comprehensive set of health care services, partial capitation arrangements for subsets of services, and care management payments.
Capitation Payment means a payment the department makes periodically to a contractor on behalf of each recipient enrolled under a contract for the provision of medical services under the State Plan, regardless of whether the particular recipient receives services during the period covered by the payment.