N.J. Admin. Code § 10:74-12.3

Current through Register Vol. 57, No. 1, January 6, 2025

Section 10:74-12.3 - Adjustment of capitation rates

(a) Capitation rates are prospective in nature and will not be adjusted retroactively.

(b) Capitation rates shall not be subject to renegotiation during the contract period, except when any changes in Federal and/or State laws, rules, regulations or covered services so require.

(c) Capitation rates will be paid only for eligible beneficiaries enrolled during the period for which the adjusted capitation payments are being made.

(d) Payments provided for under the contract will be denied for new enrollees when, and for so long as, payments for those enrollees are denied by CMS in accordance with 42 CFR 438.730.

N.J. Admin. Code § 10:74-12.3

Recodified from N.J.A.C. 10:74-12.4 by R.2000 d.370, effective 9/18/2000 (operative October 1, 2000).
See: 32 New Jersey Register 1352(a), 32 New Jersey Register 3426(a).
Former N.J.A.C. 10:74-12.3, Derivation of capitation rates, recodified to N.J.A.C. 10:74-12.2.
Amended by R.2006 d.17, effective 1/3/2006.
See: 37 New Jersey Register 2787(a), 38 New Jersey Register 294(d).
Added (c) and (d).