A. The administration shall establish capitation rates based on an actuarial study for the department. The capitation rate shall be based on the estimated cost of providing services pursuant to this article to members who have been determined eligible pursuant to section 36-2933.

Terms Used In Arizona Laws 36-2941

  • Administration: means the Arizona health care cost containment system administration. See Arizona Laws 36-2931
  • Capitation rate: means a mode of payment which the program contractor receives for the delivery of services to members pursuant to this article and which is based on a fixed rate per person notwithstanding the amount of services provided to a member. See Arizona Laws 36-2931
  • Department: means the department of economic security. See Arizona Laws 36-2931
  • including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215

B. At least thirty days before finalizing the capitation rates, the administration shall send written notice of the proposed capitation rates to the department.

C. Capitation rate adjustments shall be limited to utilization of existing services and inflation unless policy changes, including creation or expansion of programs, have been approved by the legislature or are specifically required by federal law or court mandate.

 

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