EPS4
CMS-Required Outcome
CMS-required outcome
The state uses encounter data to calculate capitation rates and performs payment comparisons with FFS claims data.
Default metrics
- State can validate that solution supports capability to set and edit capitation targets – Pass/Fail
- State can validate that solution supports the capability to flag cases where MCO payments exceed FFS upper limit – Pass/Fail
Regulatory sources
- 42 CFR Part 438