Calculating Vermont Medicare Total Cost of Care per Beneficiary Growth Sample Clauses

Calculating Vermont Medicare Total Cost of Care per Beneficiary Growth. For Performance Years 1 and 2, the Vermont Medicare Total Cost of Care per Beneficiary will include only Vermont Medicare Beneficiaries who are aligned to Scale Target ACO Initiatives operating pursuant to executed participation agreements with CMS. Vermont Medicare Total Cost of Care per Beneficiary Growth for Performance Years 1 and 2 will be calculated by comparing: (a) Vermont Medicare Total Cost of Care per Beneficiary for Vermont Medicare Beneficiaries who are aligned to such Scale Target ACO Initiatives in a given Performance Year (referenced as “Vermont ACO-aligned Medicare beneficiaries” in the applicable formula, below) with (b) the Vermont Medicare Total Cost of Care per Beneficiary for Vermont Medicare Beneficiaries who would have been aligned to such Scale Target ACO Initiatives in the year prior to the Performance Year given the same alignment methodology and providers who participated in the Vermont ACO during the Performance Year (referenced as “Vermont ACO comparison Medicare beneficiaries” in the applicable formula, below). For Performance Year 4 and subsequent Performance Years, the Vermont Medicare Total Cost of Care per Beneficiary will include all Vermont Medicare Beneficiaries. Vermont Medicare Total Cost of Care per Beneficiary Growth for Performance Year 4 and subsequent Performance Years will be calculated by comparing Vermont Medicare Total Cost of Care per Beneficiary for all Vermont Medicare Beneficiaries who are residing in Vermont in the Performance Year to Vermont Medicare Total Cost of Care per Beneficiary for all Vermont Medicare beneficiaries who were residing in Vermont in the year prior to the Performance Year according to CMS data, regardless of alignment to Scale Target ACO Initiatives. If Vermont achieves at least 65 percent in ACO Scale Target performance for Vermont Medicare Beneficiaries in Performance Year 3, then the Vermont Medicare Total Cost of Care per Beneficiary for Performance Year 3 will include all Vermont Medicare Beneficiaries, and Vermont Medicare Total Cost of Care per Beneficiary Growth for that Performance Year will be calculated in a similar manner as for Performance Year 4 and subsequent Performance Years. If Vermont does not achieve at least 65 percent in ACO Scale Target performance for Vermont Medicare Beneficiaries in Performance Year 3, then the Vermont Medicare Total Cost of Care per Beneficiary for Performance Year 3 will include only Vermont Medicare Beneficiaries who are aligned to Scal...
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