Assumptions and methodology Sample Clauses

Assumptions and methodology. In developing the administrative costs, we reviewed the CY 2019 through first half 2021 cost reports and found a material amount of variation in the reporting of administrative expenses between the five MCOPs, both in the magnitude of administrative expenses and in the rate cell allocation methodology utilized. Cost report administrative expenses for both the Opt-Out and Opt-In MyCare programs were analyzed by MCOP for reasonableness and completeness of the data provided. For MCOPs with unreasonable administrative expense rate cell allocation, but reasonable total administrative costs, we reallocated their total administrative costs using the rate cell administrative expense distribution of the other MCOPs. This data formed the baseline for projected 2022 administrative expense amounts. Separate administrative expenses amounts were developed for each rating group. In addition, non-benefit expense amounts were developed with consideration for sub capitated administrative expense amounts included in MCOP cost report submissions.
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Assumptions and methodology. In developing the administrative costs, we reviewed historical administrative expenses for the MMC program along with national Medicaid health plan administrative expenses. We considered the size of participating health plans and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the MMC population. Historical reported administrative expenses were reconciled between the available data sources for the purpose of evaluating the quality of the data provided. CY 2018 and 1H 2019 cost report administrative expenses were analyzed by MCP for reasonableness and completeness of the data provided. This data formed the baseline for projected 2020 administrative expense amounts. There is a significant amount of variation in the reporting of administrative expenses between the five MCPs, both in the magnitude of administrative expenses and in the rate cell allocation methodology utilized. We summarized historical reported values for each MCP and reallocated these values using a percent of revenue before taxes allocation methodology. Separate administrative expense amounts were developed for CFC Children, ABD <21, ABD 21+, Delivery, AFK, and the adult CFC/EXT populations. Effective January 1, 2019, ODM required that MCP contracting arrangements with pharmacy benefit managers (PBM) be structured as a pass-through pricing model, consistent with the definition included in Appendix C of the Provider Agreement. Prior to January 1, 2019, MCP PBM contracts were structured as a spread-pricing arrangement. Effective July 1, 2019, MCPs must assess all newly enrolled members using the ODM standard Health Risk Assessment (HRA) tool within 90 calendar days of enrollment (i.e. 90 days includes the date of enrollment + 89 days). All other members must be assessed using the standardized HRA tool by July 1, 2020. In addition, non-benefit expense amounts were developed with consideration for sub capitated administrative expense amounts included in MCP cost report submissions.
Sample 1Sample 2Sample 3
Assumptions and methodology. In developing the administrative costs, we reviewed historical administrative expenses for the MMC program along with national Medicaid health plan administrative expenses. We considered the size of participating health plans and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the MMC population. Historical reported administrative expenses were reconciled between the available data sources for the purpose of evaluating the quality of the data provided. CY 2019 cost report administrative expenses were analyzed by MCP for reasonableness and completeness of the data provided. This data formed the baseline for projected 2021 administrative expense amounts. There is a significant amount of variation in the reporting of administrative expenses between the five MCPs, both in the magnitude of administrative expenses and in the rate cell allocation methodology utilized. We summarized historical reported values for each MCP and reallocated these values using a percent of revenue before taxes allocation methodology. Separate administrative expense amounts were developed for CFC Children, ABD <21, ABD 21+, Delivery, AFK, and the adult CFC/EXT populations. Effective July 1, 2019, MCPs must assess all newly enrolled members using the ODM standard Health Risk Assessment (HRA) tool within 90 calendar days of enrollment (i.e. 90 days includes the date of enrollment + 89 days). All other members must be assessed using the standardized HRA tool by July 1, 2020. In addition, non-benefit expense amounts were developed with consideration for sub capitated administrative expense amounts included in MCP cost report submissions.
Sample 1Sample 2
Assumptions and methodology. In developing the administrative costs, we reviewed historical administrative expenses for the MMC program along with national Medicaid health plan administrative expenses. We considered the size of participating health plans and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the MMC population. Historical reported administrative expenses were reconciled between the available data sources for the purpose of evaluating the quality of the data provided. CY 2017 cost report administrative expenses were analyzed by MCP for reasonableness and completeness of the data provided. This data formed the baseline for projected 2019 administrative expense amounts. There is a significant amount of variation in the reporting of administrative expenses between the five MCPs, both in the magnitude of administrative expenses and in the rate cell allocation methodology utilized. We summarized historical reported values for each MCP and reallocated these values using a percent of revenue before taxes allocation methodology. Separate administrative expense amounts were developed for CFC Children, ABD <21, ABD 21+, Delivery, AFK, and the adult CFC/EXT populations. Effective January 1, 2019, ODM will require that MCP contracting arrangements with pharmacy benefit managers (PBM) be structured as a pass-through pricing model, consistent with the definition included in Appendix C of the Provider Agreement. Prior to January 1, 2019, MCP PBM contracts were structured as a spread-pricing arrangement. As a result of this program adjustment, an amount equal to $3 per script was added to non-benefit expense amounts to account for PBM admin previously included in spread-pricing. In addition, non-benefit expense amounts were developed with consideration for sub capitated administrative expense amounts included in MCP cost report submissions.
Sample 1Sample 2
Assumptions and methodology. In developing the administrative costs, we reviewed the CY 2015 and YTD June 2016 cost reports and found large variations among the MCOPs. We addressed administrative cost projections similar to our approach for the CY 2016 capitation rate development by adjusting the administrative expense percentages to achieve an administrative PMPM increase of approximately 2.0% for the combined MyCare Opt-In and Opt-Out rates. Care management costs, however, were fully rebased from survey data provided by the AAAs and the MCOPs as well as composite expense levels indicated in the cost reports.
Sample 1
Assumptions and methodology. In developing the administrative costs, we reviewed historical administrative expenses for the MMC program along with national Medicaid health plan administrative expenses. We considered the size of participating health plans and the resulting economies of scale that could be achieved, along with the benefits covered and the demographics of the MMC population. Historical reported administrative expenses were reconciled between the available data sources for the purpose of evaluating the quality of the data provided. Calendar year 2014 cost report administrative expenses were analyzed by MCP for reasonableness and completeness of the data provided. This data formed the baseline for projected 2016 administrative expense amounts. In developed administrative expenses, we assumed an annual administrative expense trend of 1%. Calendar year 2014 administrative expenses were adjusted for the assumed economies of scale that could be achieved due to membership increases from 2014 to the projected 2016 membership levels. Separate administrative expense amounts were developed for CFC Children, ABD < 21, ABD 21 +, Delivery, and the adult CFC/EXT populations.
Sample 1
Assumptions and methodology. We summarized the historical cost report data against the assumptions employed in the current capitation rates. There appeared to be general consistency when looking at the care management and overall administrative costs reported by the MCOPs. As such, we established overall administrative costs that were similar on a composite PMPM equivalent basis to the current year assumptions.
Sample 1
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Assumptions and methodology. The Administrator shall establish the assumptions and methodology of calculation used in determining the present or future value of benefits, earnings, payments, fees, expenses or any other amounts required to be calculated under the terms of the Plan. Such assumptions and methodology shall be made available to Participants upon request and may be changed from time to time by the Administrator.
Sample 1
Assumptions and methodology. The assumptions and methodology used to calculate the payment amounts referred to in this Section 2 shall be as set out on Schedule 2(e) attached hereto and made a part hereof.
Sample 1

Related to Assumptions and methodology

  • Non-Assumption of Liabilities Buyer does not assume and shall not be responsible for any liabilities, indebtedness or obligations of the Selling Parties or the Business other than the Assumed Obligations (as defined herein). Without limiting the generality of the foregoing sentence, the Parties hereby agree that except as expressly set forth in Section 7.2 hereof, Buyer shall not, by the execution and performance of this Agreement or otherwise, assume, become responsible for or incur any liability or obligation of any nature of either Seller or Shareholder whether legal or equitable, matured or contingent, known or unknown, foreseen or unforeseen, ordinary or extraordinary, patent or latent, whether arising out of occurrences prior to, at or after the date of this Agreement, including, without limiting the generality of the foregoing, any liability or obligation of Seller or Shareholder arising out of or relating to: (a) any occurrence or circumstance (whether known or unknown) which occurs or exists on or prior to the Closing Date and which constitutes, or which by the lapse of time or giving notice (or both) would constitute, a breach or default under any lease, contract, or other instrument or agreement (whether written or oral); (b) any injury to or death of any person or damage to or destruction of any property, whether based on negligence, breach of warranty, or any other theory; (c) a violation of any Applicable Laws or the requirements imposed by any governmental authority or of the rights of any third person, including, without limitation, any requirements relating to the reporting and payment of federal, state, local or other income, sales, use, franchise, excise or property tax liabilities of Seller other than ad valorem property taxes and similar taxes prorated on closing statement; (d) the generation, collection, transportation, storage or disposal by Seller of any materials, including, without limitation, Hazardous Materials, prior to the Closing Date; (e) an agreement or arrangement between Seller and its employees or any labor or collective bargaining unit representing any such employees; (f) the severance pay obligation of Seller or any employee benefit plan (within the meaning of Section 3(3) of the Employee Retirement Income Security Act of 1974, as amended) or any other fringe benefit program maintained or sponsored by Seller or to which Seller contributes, or any contributions, benefits or liabilities therefor, or any liability for the withdrawal or partial withdrawal from or by reason of the termination of any such plan or program by Seller; (g) indebtedness and all other obligations and liabilities of Seller to any bank or other lender, except to the extent any such obligations or liability is an Assumed Liability; (h) Seller and unrelated to Buyer initiated at any time, whether or not listed on Schedule 4.1(h) (and to the extent any liability or obligation arises out of or relates to both Seller and Buyer, each party's liability shall be proportionately allocated between the parties); (i) any liability, obligation, cost or expense related to the Excluded Assets; (j) any liability, obligation cost or expense related to the Operations Property, including, without limitation, the environmental condition thereof; (k) the liabilities or obligations of Seller for brokerage or other commissions relative to this Agreement or the transactions contemplated hereunder; (l) any liability or obligation of Seller for taxes of any kind, related to periods before the Closing Date, or whether incurred by Seller in connection with this Agreement, the Business or the transactions contemplated hereby, except any taxes incurred in connection with the operation of the Business by Buyer or otherwise attributable to a period of time after the Closing; (m) any liability or obligation to pay for any products, goods, raw materials or services delivered or provided to Seller in respect of the Business or otherwise, except to the extent such liability or obligation is an Assumed Liability; (n) any liability or obligation of Seller under any guarantee or any agreement to provide indemnification to any other person or entity unless as a part of an assumed contract; (o) any liability or obligation arising from the acts or omissions of Seller except to the extent that any such liability or obligation is an Assumed Obligation; (p) all trade payables and accruals of the Seller in respect of the Business or otherwise; (q) that certain Disposal Agreement by and between Waste Reduction of South Carolina, Inc. and Laurens County Landfill, LLC dated October 5, 2001; and (r) that certain Disposal Agreement by and between Waste Reduction of South Carolina, Inc. and R&B Landfill, Inc. dated August 1, 1998, as amended by that certain First Amendment to Disposal Agreement dated June 29, 2000 ((a) through (r) being referred to collectively as the "Retained Liabilities"). The Seller shall retain all of the Retained Liabilities. The assumption of the Assumed Liabilities by Buyer hereunder shall not in any respect enlarge any rights of third parties under contracts or arrangements with Buyer or Seller and nothing herein shall prevent any party from contesting in good faith any of the Assumed Liabilities with any third party. Seller agrees to indemnify Buyer and its successors and assigns from and against any liabilities or obligations related to any Retained Liabilities in accordance with Section 8.1 hereof.

  • Payments and Computations, Etc All amounts to be paid or deposited by Buyer hereunder shall be paid or deposited in accordance with the terms hereof on the day when due in immediately available funds to the account of Originator designated from time to time by Originator or as otherwise directed by Originator. In the event that any payment owed by any Person hereunder becomes due on a day that is not a Business Day, then such payment shall be made on the next succeeding Business Day. If any Person fails to pay any amount hereunder when due, such Person agrees to pay, on demand, the Default Fee in respect thereof until paid in full; provided, however, that such Default Fee shall not at any time exceed the maximum rate permitted by applicable law. All computations of interest payable hereunder shall be made on the basis of a year of 360 days for the actual number of days (including the first but excluding the last day) elapsed.

  • Accounting Methods Implement or adopt any material change in its accounting principles, practices or methods, other than as may be required by GAAP or any Governmental Entity.

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