Medicare / Medicaid Capitation Rates

[MaxW210726]

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,

[RichardW604749]

try this linkhttps://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medic... 

[MaxW210726]

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, 

[RichardW604749 · Accepted solution]

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