MCO Plan definition
Examples of MCO Plan in a sentence
The Department and its actuaries will recalculate the RAR MCO Plan Factors monthly, or every six (6) months effective January 1 and July 1 of each year, or in accordance with another periodicity schedule determined by the Department.
The Department will multiply the Base Capitation Rate by a RAR MCO Plan Factor, as provided to the PH-MCO, to compute a Risk Adjusted Rate.
This amount will be the payment for each month the MCO Plan Factor remains at 0.971.
As each recalculation of the MCO Plan Factor occurs, the PH-MCO will be paid a revised Capitation Payment Rate in effect for each month that each TANF Philadelphia Member is enrolled in the PH-MCO’s program.
Concerned NRAs agreed that, for the sake of coherence with the MCO Plan request for amendments, no explicit reference to PCR and XBID shall be made in CRIDA proposal.
If Base Capitation Rates are risk adjusted, the Department and its actuarial consultant will develop each RAR MCO Plan Factor to reflect the health status and demographics of Members enrolled in the PH-MCO’s program within one Recipient Group and one County Group.
The categorization approval, sharing, reporting, settlement and invoicing of the costs incurred under this Agreement shall be done in accordance with the CACM Regulation, MCO Plan and the details set forth in Annex VII (Cost sharing, monitoring and settlement).
Provider further agrees that during the time of an Enrollee’s enrollment in the applicable MCO Plan, Provider will not ▇▇▇▇ DHS or the State for Dental Services within the Enrollee’s benefits package under the applicable MCO Plan.
If Base Capitation Rates are risk adjusted, the Department and its actuarial consultant will develop each RAR MCO Plan Factor to reflect the health status and demographics of Members enrolled in the PH-MCO’s program within one Recipient Group and one County Group or combinations thereof.
As each recalculation of the MCO Plan Factor occurs, the PH-MCO will be paid the revised Capitation Payment Rate in effect for each month that each TANF Philadelphia Member is enrolled in the PH-MCO’s program.