36-2942
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36-2942. Payments to the department For program contractors pursuant to section 36-2940: 1. The administration shall make at least monthly capitation payments to the department consisting of a portion of the capitation rate provided by the federal government. Prior to making the capitation payment, the administration may retain a specific percentage of the federal portion of the capitation rate for third party payments collected pursuant to this section. 2. The administration shall make at least monthly payments to the department with that portion of federal monies available for administrative costs. 3. Any portion of the capitation rate pursuant to paragraph 1 of this subsection or administrative costs pursuant to paragraph 2 of this section not paid for by federal monies shall be paid by the department. 4. Payments made pursuant to paragraph 1 of this subsection shall begin after a member is enrolled in the system. 5. The department is responsible for any costs of providing services to members that exceed the capitation rate. 6. The director shall require contract terms necessary to ensure adequate performance by the department of the provisions of each contract executed pursuant to this section. |