PCC Payment definition

PCC Payment stands for “Primary Care Capitation Payment” and means a Capitation Payment Mechanism available for selection by the ACO for a Performance Year as described in Section 8.01. If the ACO selects PCC Payment, the ACO may also select its maximum Enhanced PCC Percentage as described in Section 8.01 and may select to participate in the APO as described in Section 8.01. If the ACO selects PCC Payment, CMS will make a prospective monthly payment to the ACO for PCC Eligible Services furnished to REACH Beneficiaries by those Participant Providers and Preferred Providers participating in PCC Payment. The amount of the PCC Payment is calculated in accordance with Appendix E of the Agreement.
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Examples of PCC Payment in a sentence

  • Unless CMS rejects or later terminates the ACO’s selection to participate in PCC Payment, CMS shall make PCC Payments to the ACO in accordance with Appendix E.

  • If the ACO wishes to participate in PCC Payment for a Performance Year, it must select PCC Payment as the ACO’s Capitation Payment Mechanism as described in Section 8.01.

  • If the ACO has selected the Global Risk Sharing Option, the ACO may select TCC Payment or PCC Payment as its Capitation Payment Mechanism.

  • If the ACO has selected the Professional Risk Sharing Option, the ACO may only select PCC Payment as its Capitation Payment Mechanism.

  • If the ACO selects PCC Payment as its Capitation Payment Mechanism, the ACO must select the maximum Enhanced PCC Percentage as described in Section 8.01 from within the range specified in Appendix E, and may select to participate in the APO as described in Section 8.01.

  • CMS will use Prospective Plus Alignment to calculate quarterly updates to the ACO’s Performance Year Benchmark and to determine the amount of the PCC Payment, TCC Payment, or APO payment the ACO will receive from CMS for each month of the applicable calendar quarter.

  • If the ACO has selected PCC Payment as its Capitation Payment Mechanism, the arrangement prohibits a Participant Provider that is added to the Participant Provider List during a Performance Year or a Preferred Provider that is added to the Preferred Provider List during a Performance Year from participating in the ACO’s selected Capitation Payment Mechanism for the Performance Year in which the Participant Provider or Preferred Provider is so added.

  • An update to the maximum Enhanced PCC Percentage for the ACO’s first Performance Year within the range specified in Appendix E, if the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year and wants to adjust the maximum Enhanced PCC Percentage the ACO previously selected for its first Performance Year as described in Section 8.01.A.4.

  • If the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year, the ACO shall certify that each individual and entity listed on either the Proposed Participant Provider List or the Proposed Preferred Provider List as participating in PCC Payment at the start of the ACO’s first Performance Year has agreed to a PCC Fee Reduction that is a percentage within the range of 10% and 100%.

  • If the ACO selected PCC Payment as its Capitation Payment Mechanism for the ACO’s first Performance Year, the ACO shall certify that each individual and entity listed on either the Proposed Participant Provider List or the Proposed Preferred Provider List as participating in PCC Payment at the start of the ACO’s first Performance Year has agreed to a PCC Fee Reduction that is a percentage within the range of 5% and 100%.

Related to PCC Payment

  • Interim Payment has the meaning specified in Section 10.1.

  • Delta Payment means as it is described in this Agreement.

  • PAGA Payment means the penalties pursuant to PAGA that the Parties have agreed is a

  • Co-payment means a relatively small amount of money paid by the insured person towards the cost of each day in a private hospital per episode of care, with Latrobe paying the rest of the cost.

  • Down payment means all partial payments, whether made in cash or otherwise, received by or for the benefit of the seller before or substantially contemporaneous with either the execution of the installment sale contract or the delivery of the motor vehicle sold under that contract, whichever occurs later.