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Medicare / Medicaid Capitation Rates

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Medicare / Medicaid Capitation Rates

Hi,
 
I'm doing research on Capitation Rates set by the CMS to compensate health care providers that operate on a "valued-based" / "capitated care" model. This basically means that the CMS pays healthcare insurers a fixed-dollar, pre-determined amount on a per patient per month basis. This amount then become revenue / budget for the healthcare insurer to take care of the patient. Any healthcare provider service charges then comes out of this amount. For instance, if CMS pays a insurer $1,100 per month for a patient under the healthcare insurer, the insurer and all healthcare provider would perform service and charges to this $1,100. If the total amount charged is under $1,100, then the residual becomes business profit for the healthcare insurer/providers. If the amount charged is over $1,100, the healthcare provider/insurer takes a loss for the excess amount. 

This CMS Capitation Rate for medicare medicaid patients is supposedly set on a monthly basis, ahead of the actual month. Wondering where I can find information on how this rate is set / where can I find the rates for future months / how to forecast this rate? 

Any info would be appreciated. If there are other forums better suited to answer this, please let me know. Thank you,
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You may be able to answer your questions by emailing   MMCOcapsmodel@cms.hhs.gov

 

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Periodic Contributor
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I had already sifted through that before posting on this forum and found the content to be technical and difficult to understand for layman, so I was hoping someone on here may be able to break it down in simple terms.

Thank you regardles, 

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Periodic Contributor

You may be able to answer your questions by emailing   MMCOcapsmodel@cms.hhs.gov

 

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