36-2999.05. Establishment of capitation rate

A. Under a comprehensive care for the elderly program agreement the program contractor shall make a prospective monthly payment to the comprehensive care for the elderly organization of a capitation rate for each medicaid participant.

B. The comprehensive care for the elderly organization must accept the capitation payment as payment in full for medicaid participants and may not bill, charge, collect or receive any other form of payment from the program contractor, administration or from or on behalf of the comprehensive care for the elderly participant, except as follows:

1. Payment with respect to the share of cost and any amounts due under the posteligibility treatment of income.

2. Medicare payment received from the centers for medicare and medicaid services or from other payors.

3. Adjustments related to enrollment and disenrollment of comprehensive care for the elderly participants in the comprehensive care for the elderly organization.

4. A fee-for-service payment by the administration or the centers for medicare and medicaid services prior to the participant being capitated.

36-2999.05. Establishment of capitation rate

A. Under a comprehensive care for the elderly program agreement the program contractor shall make a prospective monthly payment to the comprehensive care for the elderly organization of a capitation rate for each medicaid participant.

B. The comprehensive care for the elderly organization must accept the capitation payment as payment in full for medicaid participants and may not bill, charge, collect or receive any other form of payment from the program contractor, administration or from or on behalf of the comprehensive care for the elderly participant, except as follows:

1. Payment with respect to the share of cost and any amounts due under the posteligibility treatment of income.

2. Medicare payment received from the centers for medicare and medicaid services or from other payors.

3. Adjustments related to enrollment and disenrollment of comprehensive care for the elderly participants in the comprehensive care for the elderly organization.

4. A fee-for-service payment by the administration or the centers for medicare and medicaid services prior to the participant being capitated.