Common use of Budget Neutrality Expenditure Cap Clause in Contracts

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each eligibility group described in paragraph 61 as follows: i. An annual eligibility group expenditure cap must be calculated as a product of the number of eligible member months reported by the State under paragraph 46 for each eligibility group, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (iii) below. ii. The PM/PM costs in subparagraph (iii) below are net of premiums paid by Demonstration eligibles. iii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. In addition, the PM/PM cost for each eligibility group in DY 1 has been increased by the appropriate growth rate included in the President’s Federal fiscal year 2012 budget for DYs 2, 3, 4 and 5, as outlined below. The AC and Family Planning Extension Program populations are structured as a “pass-through” or a “hypothetical State plan population” beginning in DY 1. Therefore, the State may not derive savings from these populations. AFDC / SOBRA 5.2% $585.28 $615.71 $647.73 $681.41 $716.85 SSI 6.0% $885.41 $938.53 $994.84 $1054.53 $1117.81 AC 0.0% $707.33 $707.58 $707.58 $0 $0 ALTCS - EPD 5.2% $4737.37 $4983.71 $5242.86 $5515.49 $5802.30 ALTCS - DD 6.0% $4922.38 $5217.72 $5530.78 $5862.63 $6214.39 Family Planning Extension Program 5.8% $30.06 $31.80 $33.65 $35.60 $37.66 iv. The annual budget neutrality expenditure cap for the Demonstration as a whole is the sum of DSH allotment, the uncompensated care payments to IHS and tribal facilities, expenditures for the SNCP/DSHP and KidsCare II program plus the annual expenditure caps for each eligibility group calculated in subparagraph 62(a)(i) above. b) The overall budget neutrality expenditure cap for the 5-year demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph 62(a)

Appears in 6 contracts

Samples: Special Terms and Conditions, Special Terms and Conditions, Special Terms and Conditions

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Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstrationdemonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each eligibility group described in paragraph 61 as follows: i. An annual eligibility group expenditure cap must be calculated as a product of the number of eligible member months reported by the State state under paragraph 46 for each eligibility group, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (iii) below. ii. The PM/PM costs in subparagraph (iii) below are net of premiums paid by Demonstration demonstration eligibles. iii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration demonstration are specified below. In addition, the PM/PM cost for each eligibility group in DY 1 has been increased by the appropriate growth rate included in the President’s Federal fiscal year 2012 budget for DYs 2, 3, 4 and 5, as outlined below. The AC and Family Planning Extension Program populations are Expansion State Adults population is structured as a “pass-through” or a “hypothetical State state plan population” beginning in DY 1. Therefore, the State state may not derive savings from these populations. AFDC / SOBRA 5.2% $585.28 $615.71 $647.73 $681.41 $716.85 SSI 6.0% $885.41 $938.53 $994.84 $1054.53 $1117.81 AC Expansion State Adults 0.0% $707.33 $707.58 $707.58 $0 $0 ALTCS - EPD 5.2% $4737.37 $4983.71 $5242.86 $5515.49 $5802.30 ALTCS - DD 6.0% $4922.38 $5217.72 $5530.78 $5862.63 $6214.39 Family Planning Extension Program 5.8% $30.06 $31.80 $33.65 $35.60 $37.66 6214.39 iv. The annual budget neutrality expenditure cap for the Demonstration demonstration as a whole is the sum of DSH allotment, the uncompensated care payments to IHS and tribal facilities, expenditures for the SNCP/DSHP and KidsCare II program plus the annual expenditure caps for each eligibility group calculated in subparagraph 62(a)(i(a)(i) above. b) The overall budget neutrality expenditure cap for the 5-year demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph 62(a)(a) (iv) above for each of the 5 years. The Federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state may receive for expenditures on behalf of demonstration populations and expenditures described in paragraph 48 during the demonstration period. c) Apply the effective FMAP, or enhanced 90 percent match for family planning services, that is determined from the MBES/CBES Schedule C report.

Appears in 5 contracts

Samples: Medicaid Demonstration Agreement, Medicaid Demonstration Agreement, Medicaid Demonstration Agreement

Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each eligibility group described in paragraph 61 as follows: i. An annual eligibility group expenditure cap must be calculated as a product of the number of eligible member months reported by the State under paragraph 46 for each eligibility group, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (iii) below. ii. The PM/PM costs in subparagraph (iii) below are net of premiums paid by Demonstration eligibles. iii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. In addition, the PM/PM cost for each eligibility group in DY 1 has been increased by the appropriate growth rate included in the President’s Federal fiscal year 2012 budget for DYs 2, 3, 4 and 5, as outlined below. The AC and Family Planning Extension Program populations are structured as a “pass―pass-through” through‖ or a “hypothetical ―hypothetical State plan population” population‖ beginning in DY 1. Therefore, the State may not derive savings from these populations. AFDC / SOBRA 5.2% $585.28 $615.71 $647.73 $681.41 $716.85 SSI 6.0% $885.41 $938.53 $994.84 $1054.53 $1117.81 AC 0.0% $707.33 $707.58 $707.58 $0 $0 ALTCS - EPD 5.2% $4737.37 $4983.71 $5242.86 $5515.49 $5802.30 ALTCS - DD 6.0% $4922.38 $5217.72 $5530.78 $5862.63 $6214.39 Family Planning Extension Program 5.8% $30.06 $31.80 $33.65 $35.60 $37.66 iv. The annual budget neutrality expenditure cap for the Demonstration as a whole is the sum of DSH allotment, the uncompensated care payments to IHS and tribal facilities, expenditures for the SNCP/DSHP and KidsCare II program plus the annual expenditure caps for each eligibility group calculated in subparagraph 62(a)(i) above. b) The overall budget neutrality expenditure cap for the 5-year demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph 62(a)

Appears in 2 contracts

Samples: Special Terms and Conditions, Special Terms and Conditions

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Budget Neutrality Expenditure Cap. The following describes the method for calculating the budget neutrality expenditure cap for the Demonstrationdemonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure cap is calculated for each eligibility group described in paragraph 61 60 as follows: i. An annual eligibility group expenditure cap must be calculated as a product of the number of eligible member months reported by the State state under paragraph 46 45 for each eligibility group, times the appropriate estimated per member per month (PM/PM) costs from the table in subparagraph (iii) below. ii. The PM/PM costs in subparagraph (iii) below are net of premiums paid by Demonstration demonstration eligibles. iii. The PM/PM costs for the calculation of the annual budget neutrality expenditure cap for the eligibility groups subject to the budget neutrality agreement under this Demonstration demonstration are specified below. In addition, the PM/PM cost for each eligibility group in DY 1 has been increased by the appropriate growth rate included in the President’s Federal fiscal year 2012 budget for DYs 2, 3, 4 and 5, as outlined below. The AC and Family Planning Extension Program populations are Expansion State Adults population is structured as a “pass-through” or a “hypothetical State state plan population” beginning in DY 1. Therefore, the State state may not derive savings from these populations. AFDC / SOBRA 5.2% $585.28 $615.71 $647.73 $681.41 $716.85 SSI 6.0% $885.41 $938.53 $994.84 $1054.53 $1117.81 AC Expansion State Adults 0.0% $707.33 $707.58 $707.58 $0 $0 ALTCS - EPD 5.2% $4737.37 $4983.71 $5242.86 $5515.49 $5802.30 ALTCS - DD 6.0% $4922.38 $5217.72 $5530.78 $5862.63 $6214.39 Family Planning Extension Program 5.8% $30.06 $31.80 $33.65 $35.60 $37.66 6214.39 iv. The annual budget neutrality expenditure cap for the Demonstration demonstration as a whole is the sum of DSH allotment, the uncompensated care payments to IHS and tribal facilities, expenditures for the SNCP/DSHP and KidsCare II program plus the annual expenditure caps for each eligibility group calculated in subparagraph 62(a)(i(a)(i) above. b) The overall budget neutrality expenditure cap for the 5-year demonstration period is the sum of the annual budget neutrality expenditure caps calculated in subparagraph 62(a)(a) (iv) above for each of the 5 years. The Federal share of the overall budget neutrality expenditure cap represents the maximum amount of FFP that the state may receive for expenditures on behalf of demonstration populations and expenditures described in paragraph 47 during the demonstration period. c) Apply the effective FMAP, or enhanced 90 percent match for family planning services, that is determined from the MBES/CBES Schedule C report.

Appears in 1 contract

Samples: Medicaid Demonstration Agreement

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