Capitation Payment.

22 CCR 56320

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22 CCR 56320

§ 56320. Capitation Payment.

(a)

Payment to each PCCM plan shall be on a monthly capitation payment basis. Each PCCM plan shall be at risk for capitated services provided under the PCCM contract. The capitation payment shall:

(1)

Constitute payment in full by the Department for health care and administrative services rendered under the PCCM contract.

(2)

Be based upon a count of eligible members furnished to the PCCM plan monthly by the Department.

(b)

The capitation payment shall not include payment for recoupment of any losses incurred by the PCCM plan under any prior contractual obligations with the State.

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