Pennsylvania Statutes Title 62 P.S. Poor Persons and Public Welfare § 443.5. Prepayment for contracted medical services

For categorically needy or medically needy persons eligible for medical assistance, prepaid capitation payments or insurance premiums for services under the medical assistance State plan may be made on behalf of eligible persons through competitive bidding with profit or non-profit contractors, insurers, or health maintenance organizations. Profit and non-profit insurers must be approved under applicable State laws. Prepaid capitation or premium payments made under such contracts shall not exceed payments made to other third party payers for comparable services and similar benefit conditions. Capitation payments charged for anticipated medical assistance eligible persons under a contract may be prepaid by the Commonwealth subject to monthly, quarterly, and annual adjustment by the department based on actual enrollment and fixed capitation rates.