California
Savings Sharing.
22 CCR 56322.1
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22 CCR 56322.1
22 CCR 56322.1
§ 56322.1. Savings Sharing.
(a)
Notwithstanding section 56320, the Department shall calculate and disburse savings sharing to PCCM plans in accordance with the methodology and disbursement schedule specified in the PCCM contract.
(b)
The savings sharing amount for a given PCCM plan is determined by comparing the expected fee-for-service cost for all services provided to PCCM plan members to the actual cost, which is the capitation payment plus the cost of noncapitated services paid through the fee-for-service system. If the expected fee-for-service cost exceeds the actual cost minus the State savings on the capitation payment, the difference is the amount saved, a portion of which is paid to the PCCM plan.
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