C Prorating Share of Cost When a Customer Dies Examples

Example

1) The capitation rate is less than the assessed share of cost

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.

2) The capitation rate is more than the assessed share of cost

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.