Calculation of the Revenue-Based Loss Sharing Limit Sample Clauses

Calculation of the Revenue-Based Loss Sharing Limit. If the Track 1+ ACO is subject to the revenue-based loss sharing limit for a performance year, CMS does all of the following to determine the loss sharing limit for that year: a. Determines ACO participant Medicare fee-for-service revenue, which includes total Parts A and B fee-for-service revenue for all providers and suppliers that bill for items and services through the Taxpayer Identification Number of an ACO participant for the applicable performance year. b. Determines 8 percent of the total Parts A and B fee-for-service revenue for ACO participants, which is the generally applicable nominal amount standard for an Advanced Alternative Payment Model (“APM”) specified in 42 CFR 414.1415(c)(3)(i)(A). c. If the loss sharing limit determined under Section V.B.4.i.b exceeds the amount that is 4 percent of the Track 1+ ACO’s updated historical benchmark, then the loss sharing limit is capped and set at 4 percent of the Track 1+ ACO’s updated historical benchmark for the applicable performance year.

Calculation of the Revenue-Based Loss Sharing Limit. Revised subparagraph (a) to state CMS determines Medicare Parts A and B fee-for- service revenue of ACO participants, as adjusted to remove expenditures for episodes of care for treatment of COVID-19 in accordance with the methodology set forth in Shared Savings Program regulations. Revised subparagraphs (b) and (c) to make clarifying edits. May 8th COVID-19 IFC and Second Amended and Restated Agreement Sections V.B.4.i.b and V.B.4.i.c Section V.B.6 Extreme and Uncontrollable Circumstances Revised to clarify the months affected by an extreme and uncontrollable circumstance for the COVID-19 pandemic will begin with January 2020 and continue through the end of the COVID-19 PHE. May 8th COVID-19 IFC

Calculation of the Revenue-Based Loss Sharing Limit. If the Track 1+ ACO is subject to the revenue-based loss sharing limit for a performance year, CMS does all of the following to determine the loss sharing limit for that year: a. Determines ACO participant Medicare fee-for-service revenue, which includes total Parts A and B fee-for-service revenue for all providers and suppliers that bill for items and services through the Taxpayer Identification Number of an ACO participant for the applicable performance year, as adjusted to remove expenditures for episodes of care for treatment of COVID-19 in accordance with the methodology set forth in 42 CFR 425.611. b. Determines 8 percent of the Parts A and B fee-for-service revenue for ACO participants as determined under Section V.B.4.i.a which is the revenue-based loss sharing limit for the performance year. c. If the revenue-based loss sharing limit determined under Section V.B.4.i.b exceeds the amount that is 4 percent of the Track 1+ ACO’s updated historical benchmark for the applicable performance year, then the ACO will be subject to the benchmark-based loss sharing determined under Section V.B.5.