Common use of Budget Neutrality Expenditure Limit Clause in Contracts

Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in STC 69 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State in accordance with the requirements outlined in STC 60, for each EG, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (iii) below. Should EGs 3 and 4 be incorporated into the budget neutrality expenditure limit, as outlined in STC 56, the PMPM costs may be revised. ii. The PMPM costs in subparagraph (iii) below are net of any premiums paid by Demonstration eligibles. iii. The PMPM costs for the calculation of the annual budget neutrality expenditure limit for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. (1) To reflect the additional demonstration year that was authorized through temporary extensions (DY 12), the PMPM cost for each EG in Demonstration year 11 has been increased by the appropriate growth rate from the prior extension period. These figures are displayed below. Eligibility Group DY 11 (10/1/08 – 9/30/09) Trend Rate DY 12 (10/1/09 – 9/30/10) TANF Children under age 1 through 20 $549.19 6.7% $585.99 TANF Adults 21-64 $751.73 6.6% $801.34 FHPlus Adults with Children $586.82 6.6% $625.55 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. (2) For the current extension period, the PMPM cost for each EG in Demonstration year 12 has been increased by the appropriate growth rate included in the President‟s Federal fiscal year 2011 budget for DYs 13 through 16, as outlined below. In addition, because the Family Planning Expansion Adults are going to be treated as a “hypothetical state plan population” beginning in DY 13, a PMPM cost was constructed based on State expenditures in DY 10, and increased by the rate of growth in the medical care component of the Consumer Price Index between 2004 and 2008. Because DYs 16 and 17 combined are less than 12 months in duration, they are assigned the PMPM costs equal to what would have been calculated for the full year starting October 1, 2013 and ending September 30, 2014. The FHPlus Adults with Children and Family Planning Expansion Adults groups will end on December 31, 2013, so no PMPM is defined for those groups for DY 17. The budget neutrality expenditure limit will end March 31 ,2014; expenditures made after that date for DSHP must be offset by accumulated savings from DYs 1 through 17. TANF Children under age 1 through 20 $585.99 6.6% $624.67 $665.90 $709.85 $756.70 $756.70 TANF Adults 21-64 $801.34 6.4% $852.63 $907.20 $965.26 $1,027.04 $1,027.04 FHPlus Adults with Children $625.55 6.4% $665.59 $708.19 $753.51 $801.73 N/A Family Planning Expansion Adults 4.1% $20.23 $21.06 $21.92 $22.81 N/A Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. iv. The annual budget neutrality expenditure limit for the Demonstration as a whole is the sum of the projected annual expenditure limits for each EG calculated in subparagraph (i) above. b) The overall budget neutrality expenditure limit for the demonstration period is the sum of the annual budget neutrality expenditure limits calculated in subparagraph (a)(iv) above for each year. The Federal share of the overall budget neutrality expenditure limit represents the maximum amount of FFP that the State may receive for expenditures on behalf of Demonstration populations and expenditures described in STC 55(g) during the Demonstration period.

Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in STC 69 68 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State in accordance with the requirements outlined in STC 6059, for each EG, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (iii) below. Should EGs 3 and 4 be incorporated into the budget neutrality expenditure limit, as outlined in STC 5655, the PMPM costs may be revised. ii. The PMPM costs in subparagraph (iii) below are net of any premiums paid by Demonstration eligibles. iii. The PMPM costs for the calculation of the annual budget neutrality expenditure limit for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. (1) To reflect the additional demonstration year that was authorized through temporary extensions (DY 12), the PMPM cost for each EG in Demonstration year 11 has been increased by the appropriate growth rate from the prior extension period. These figures are displayed below. Eligibility Group DY 11 (10/1/08 – 9/30/09) Trend Rate DY 12 (10/1/09 – 9/30/10) TANF Children under age 1 through 20 $549.19 6.7% $585.99 TANF Adults 21-64 $751.73 6.6% $801.34 FHPlus Adults with Children $586.82 6.6% $625.55 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. (2) For the current extension period, the PMPM cost for each EG in Demonstration year 12 has been increased by the appropriate growth rate included in the President‟s President’s Federal fiscal year 2011 budget for DYs 13 through 16, as outlined below. In addition, because the Family Planning Expansion Adults are going to be treated as a “hypothetical state plan population” beginning in DY 13, a PMPM cost was constructed based on State expenditures in DY 10, and increased by the rate of growth in the medical care component of the Consumer Price Index between 2004 and 2008. Because DYs 16 and 17 combined are less than 12 months in duration, they are assigned the PMPM costs equal to what would have been calculated for the full year starting October 1, 2013 and ending September 30, 2014. The FHPlus Adults with Children and Family Planning Expansion Adults groups will end on December 31, 2013, so no PMPM is defined for those groups for DY 17. The budget neutrality expenditure limit will end March 31 ,2014; expenditures made after that date for DSHP must be offset by accumulated savings from DYs 1 through 17. TANF Children under age 1 through 20 $585.99 6.6% $624.67 $665.90 $709.85 $756.70 $756.70 TANF Adults 21-64 $801.34 6.4% $852.63 $907.20 $965.26 $1,027.04 $1,027.04 FHPlus Adults with Children $625.55 6.4% $665.59 $708.19 $753.51 $801.73 N/A Family Planning Expansion Adults 4.1% $20.23 $21.06 $21.92 $22.81 N/A Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. iv. The annual budget neutrality expenditure limit for the Demonstration as a whole is the sum of the projected annual expenditure limits for each EG calculated in subparagraph (i) above. b) The overall budget neutrality expenditure limit for the demonstration period is the sum of the annual budget neutrality expenditure limits calculated in subparagraph (a)(iv) above for each year. The Federal share of the overall budget neutrality expenditure limit represents the maximum amount of FFP that the State may receive for expenditures on behalf of Demonstration populations and expenditures described in STC 55(g54(g) during the Demonstration period.

Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstrationdemonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in STC 69 87 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State state in accordance with the requirements outlined in STC 6079, for each EG, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (iii) below. Should EGs 3 and 4 be incorporated into the budget neutrality expenditure limit, as outlined in STC 5676, the PMPM costs may be revised. ii. The PMPM costs in subparagraph (iii) below are net of any premiums paid by Demonstration demonstration eligibles. iii. The PMPM costs for the calculation of the annual budget neutrality expenditure limit for the eligibility groups subject to the budget neutrality agreement under this Demonstration demonstration are specified below. (1) To reflect the additional demonstration year that was authorized through temporary extensions (DY 12), the PMPM cost for each EG in Demonstration demonstration year 11 has been increased by the appropriate growth rate from the prior extension period. These figures are displayed below. Eligibility Group DY 11 (10/1/08 – 9/30/09) Trend Rate DY 12 (10/1/09 – 9/30/10) TANF Children under age 1 through 20 $549.19 6.7% $585.99 TANF Adults 21-21through 64 $751.73 6.6% $801.34 FHPlus Adults with Children $586.82 6.6% $625.55 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. (2) For the current extension period, the PMPM cost for each EG in Demonstration demonstration year 12 has been increased by the appropriate growth rate included in the President‟s Federal President’s federal fiscal year 2011 budget for DYs 13 through 16, as outlined below. In addition, because the Family Planning Expansion Adults are going to be treated as a “hypothetical state plan population” beginning in DY 13, a PMPM cost was constructed based on State state expenditures in DY 10, and increased by the rate of growth in the medical care component of the Consumer Price Index between 2004 and 2008. Because DYs 16 and 17 combined are less than 12 months in duration, they are assigned the PMPM costs equal to what would have been calculated for the full year starting October 1, 2013 and ending September 30, 2014. The FHPlus Adults with Children and Family Planning Expansion Adults groups will end on December 31, 2013, so no PMPM is defined for those groups for DY 17. The budget neutrality expenditure limit will end March 31 ,31, 2014; expenditures made after that date for DSHP must be offset by accumulated savings from DYs 1 through 17. Eligibility Group DY 12 (10/1/09 – 9/30/10)` Trend Rate DY 13 (10/1/10 – 9/30/11) DY 14 (10/1/11 – 9/30/12) DY 15 (10/1/12 – 9/30/13) DY 16 (10/1/13 – 12/31/13) DY 17 (1/1/14 – 3/31/14) TANF Children under age 1 through 20 $585.99 6.6% $624.67 $665.90 $709.85 $756.70 $756.70 TANF Adults 21-21 through 64 $801.34 6.4% $852.63 $907.20 $965.26 $1,027.04 1027.04 $1,027.04 FHPlus 1027.04 MLTC Adults with Children $625.55 6.418through 64 - Dual 1.19% $665.59 4009.38 $708.19 4057.09 $753.51 4105.37 $801.73 N/A Family Planning Expansion 4105.37 MLTC Adults 4.165 and above - Dual 3.23% $20.23 4742.15 $21.06 4895.32 $21.92 5053.44 $22.81 N/A 5053.44 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. iv. The annual budget neutrality expenditure limit for the Demonstration demonstration as a whole is the sum of the projected annual expenditure limits for each EG calculated in subparagraph subparagraph (i) above. b) The overall budget neutrality expenditure limit for the demonstration period is the sum of the annual budget neutrality expenditure limits calculated in subparagraph (a)(iv) above for each year. The Federal federal share of the overall budget neutrality expenditure limit represents the maximum amount of FFP that the State state may receive for expenditures on behalf of Demonstration demonstration populations and expenditures described in STC 55(g75 (e) during the Demonstration demonstration period.

Budget Neutrality Expenditure Limit. The following describes the method for calculating the budget neutrality expenditure limit for the Demonstration: a) For each year of the budget neutrality agreement an annual budget neutrality expenditure limit is calculated for each EG described in STC 69 83 as follows: i. An annual EG estimate must be calculated as a product of the number of eligible member months reported by the State state in accordance with the requirements outlined in STC 6074, for each EG, times the appropriate estimated per member per month (PMPM) costs from the table in subparagraph (iii) below. Should EGs 3 and 4 be incorporated into the budget neutrality expenditure limit, as outlined in STC 5670, the PMPM costs may be revised. ii. The PMPM costs in subparagraph (iii) below are net of any premiums paid by Demonstration eligibles. iii. The PMPM costs for the calculation of the annual budget neutrality expenditure limit for the eligibility groups subject to the budget neutrality agreement under this Demonstration are specified below. (1) To reflect the additional demonstration year that was authorized through temporary extensions (DY 12), the PMPM cost for each EG in Demonstration year 11 has been increased by the appropriate growth rate from the prior extension period. These figures are displayed below. Eligibility Group DY 11 (10/1/08 – 9/30/09) Trend Rate DY 12 (10/1/09 – 9/30/10) TANF Children under age 1 through 20 $549.19 6.7% $585.99 TANF Adults 21-64 $751.73 6.6% $801.34 FHPlus Adults with Children $586.82 6.6% $625.55 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. (2) For the current extension period, the PMPM cost for each EG in Demonstration year 12 has been increased by the appropriate growth rate included in the President‟s Federal federal fiscal year 2011 budget for DYs 13 through 16, as outlined below. In addition, because the Family Planning Expansion Adults are going to be treated as a “hypothetical state plan population” beginning in DY 13, a PMPM cost was constructed based on State state expenditures in DY 10, and increased by the rate of growth in the medical care component of the Consumer Price Index between 2004 and 2008. Because DYs 16 and 17 combined are less than 12 months in duration, they are assigned the PMPM costs equal to what would have been calculated for the full year starting October 1, 2013 and ending September 30, 2014. The FHPlus Adults with Children and Family Planning Expansion Adults groups will end on December 31, 2013, so no PMPM is defined for those groups for DY 17. The budget neutrality expenditure limit will end March 31 ,2014; expenditures made after that date for DSHP must be offset by accumulated savings from DYs 1 through 17. TANF Children under age 1 through 20 $585.99 6.6% $624.67 $665.90 $709.85 $756.70 $756.70 TANF Adults 21-64 $801.34 6.4% $852.63 $907.20 $965.26 $1,027.04 $1,027.04 FHPlus Adults with Children $625.55 6.4% $665.59 $708.19 $753.51 $801.73 N/A Family Planning Expansion Adults 4.1% $20.23 $21.06 $21.92 $22.81 N/A MLTC Adults age 18 - 64 1.19% $3,962.23 $4,009.38 $4,057.09 $4,105.37 MLTC Adults 65 and above 3.23% $4,593.77 $4,742.15 $4,895.32 $5,053.44 Note: Demonstration Populations 3 and 4 are no longer part of the calculation of the budget neutrality expenditure limit under this demonstration, but under demonstration 11-W-00234/2, The Federal-State Health Reform Partnership. iv. The annual budget neutrality expenditure limit for the Demonstration as a whole is the sum of the projected annual expenditure limits for each EG calculated in subparagraph (i) above. b) The overall budget neutrality expenditure limit for the demonstration period is the sum of the annual budget neutrality expenditure limits calculated in subparagraph (a)(iv) above for each year. The Federal federal share of the overall budget neutrality expenditure limit represents the maximum amount of FFP that the State state may receive for expenditures on behalf of Demonstration populations and expenditures described in STC 55(g68 (g) during the Demonstration period.