Under the PACE program agreement, CMS shall make a prospective monthly payment to the PACE organization of a capitation amount for each Medicare participant, in accordance with 42 CFR § 460.180.
Under the PACE program agreement, DHCF shall make a prospective monthly payment to the PACE organization of a capitation amount for each Medicaid participant, in accordance with 42 CFR § 460.182.
The monthly capitation payment amount is negotiated between the PACE organization and DHCF and specified in the PACE program agreement. The monthly capitation amount represents the following:
The PACE organization must accept the capitation amount as payment in full for Medicaid participants and may not bill, charge, collect, or receive any other form of payment from DHCF or from, or on behalf of, the participant or authorized representative, except as follows:
D.C. Mun. Regs. r. 29-8811