California
§ 56251. Assumption of Financial Risk.
1 provisions · California regulatory authority
Provisions
Citable source units
22 CCR 56251Reimbursement PaymentCost Reporting
Assumption of Financial Risk.
The provision assigns PCCM plans responsibility for covered capitated service costs, establishes an aggregate risk limit and documentation duties, protects members from cost-based disenrollment, and restricts risk shifting through subcontracts.
Group
Payment Program Integrity
Category
Reimbursement Payment
Domain
Billing Reimbursement
Topics
Capitated payment risk, Risk limit, Cost documentation
Taxonomy
Regulatory category mix