Medical groups or provider networks are capitated for physician, lab and x-ray services. Individual physicians may or may not be capitated. Hospitals are contracted separately. This has only been used once in the Medicaid program in Travis County. PHP are administered by the State and through a contract administrator.
Providers are at full financial risk for the services that are capitated.
The provider is paid a fixed amount per member enrolled, regardless of the number of services provided to that member. S3620 - Newborn metabolic screening panel.