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Library: Policy

317:35-18-12. Medicaid Payments

Issued 9-12-14

(a) The OHCA makes a prospective monthly payment to the PACE organization of a capitation amount for each Medicaid participant.

(b) The payment amount represents:

  • (1) is less than the amount that would otherwise have been paid under the State plan if the participants were not enrolled under the PACE program.

  • (2) Takes into account the comparative frailty of PACE participant.

  • (3) is a fixed amount regardless of changes in the participant's health status.

(c) The PACE organization must accept the capitation payment amount as payment in full for Medicaid participants.

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