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ALTCS |
On March 13, 2021, an ALTCS customer died at a nursing home in Maricopa County. The share of cost (SOC) was $1472.00. The customer had Medicare A and B and was enrolled with United Healthcare. The daily capitation rate for United Healthcare in Maricopa County in March 2021 for a person with Medicare is $101.80.
101.80 x 13 (the number of days in March the customer was at the nursing home) = $1323.40. The prorated capitation rate (1323.40) is less than the customer’s SOC. $1323.40 is the adjusted SOC for March 2021.
On April 28, 2021, an ALTCS customer died at a nursing home in Pima County. The assessed share of cost (SOC) was $1335.00. The customer did not have Medicare and was enrolled with Banner University Family Care. The daily capitation rate for Banner University Family Care in Pima County in April 2021 for a person without Medicare is $238.80.
238.80 x 28 (the number of days in April the customer was at the nursing home) = $6686.40. The prorated capitation rate is more than the customer’s share of cost. The customer’s SOC is not adjusted and is still $1335.00.