The length of time a new category is eligible for pass-through payment is At least two years but not more than three years, beginning on the date CMS establishes the category.
What is Pass-through payments?
- Pass-through payment are sums that are added on top of the base capitation rate and given to Medicaid managed care programs. The add-on payment must be transferred by the plans to the specified contractual service providers.
- Pass-through payments are any sums that must be added by the state to the contracted payment rates between managed care plans and providers but are not required for any of the following purposes, according to Section 438.6(a) of the final regulations.
- A particular service or benefit offered to a particular enrollee and covered under the contract
- Acceptable methods for paying providers that are described in 438.6(c)(1) of the final Medicaid managed care regulations
- A sub-capitated payment plan that applies to a particular group of the contract's covered services and subscribers.
- Payments for graduate medical studies
- Wraparound payments to federally qualified health centers (FQHC) or rural health centers (RHC).
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