In Medicaid terminology, a PHP is n ot the same as an HMO even though the terms are often used interchangeably in commercial manage d care business. PHPs can contract on a capitated basis for a non-comprehensive set of services (which is often called partial capitation) or on a cost basis. Federally qualified health cent ers (FQHCs) can also be designated as PHPs if the y meet certain conditions. Also see sub-ca pitation.
A Medicaid managed care program in which an entity contracts to provide certain medical services to enrollees in exchange for a capitation payment. Prepaid health plans are not required to cover the full range of Medicaid benefits.
A term used almost exclusively in the Medicaid program. A PHP is a managed care plan that bears the risk of profit or loss for the provision of a limited range of health care services, rather than the full range of patient services. Organizations that exclusively provide behavioral health services fall into this category.
a entity that either contracts on a prepaid, capitated risk basis to provide services that are not risk-comprehensive services, or contracts on a non-risk basis
A prepaid managed care design that provides less than comprehensive services on an at risk basis or one that provides any benefit package on a non-risk basis.
A health plan, such as an HMO, in which subscribers (or employers) pay the insurer in advance for access to a defined set of health care benefits.
A contract between an insurer and a group of enrollees, whereby the insurer provides a defined set of services for a fixed premium payment.