What Is A Capitation Agreement Medicaid

In practice, to follow the HIO-PCCM approach, a state establishes an organization (sometimes called a “health authority”) that is not itself a health care provider, but that meets the requirements of state insurance and is willing to pay for all or most acute care Medicaid services on a risk basis. The state then requests an exemption from the Health Care Funding Administration to allow the HIO to implement a GCCP system. The HIO subcontracts with real service providers (general practitioners and clinics, specialists and hospitals) and pays them in a variety of ways, including performance fees, partial capitation, per diem or prospective payment based on diagnostic-related groups. .

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