12. Medicaid Payments

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.

Library: Policy