Sec. 613. Payments to comprehensive health service organizations
174 words·~1 min read·
/bill/113/hr/1200/ih/section-613·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Payment under a State health security program to a comprehensive health service organization to its enrollees shall be determined by the State— based on a global budget described in section 611; or based on the basic capitation amount described in subsection
(b)for each of its enrollees. The basic capitation amount described in this subsection for an enrollee shall be determined by the State health security program on the basis of the average amount of expenditures that is estimated would be made under the State health security program for covered health care services for an enrollee, based on actuarial characteristics (as defined by the State health security program). The State health security program shall adjust such average amounts to take into account the special health needs, including a disproportionate number of medically underserved individuals, of populations served by the organization. The State health security program shall adjust such average amounts to take into account the cost of covered health care services that are not provided by the comprehensive health service organization under section 303(a).