Common use of Enforcement of Budget Neutrality Clause in Contracts

Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration rather than on an annual basis. However, if the State exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State must submit a corrective action plan to CMS for approval. Cumulative Demonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Budget neutrality expenditure cap plus Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 0.0 %

Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration demonstration rather than on an annual basis. However, if the State state exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State state must submit a corrective action plan to CMS for approval. Cumulative Demonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Budget neutrality expenditure cap plus Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 0.0 %

Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration rather than on an annual basis. However, if the State exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State must submit a corrective action plan to CMS for approval. Cumulative Demonstration CumulativeDemonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Budget neutrality expenditure cap plus Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 0.0 %

Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration demonstration rather than on an annual basis. However, if the State state exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State state must submit a corrective action plan to CMS for approval. Cumulative Demonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Budget neutrality expenditure cap plus Year 2 Year 3 Year 4 Year 5 Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 1.0 % 0.75 % 0.5 % 0.25 % 0.0 %

Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration demonstration rather than on an annual basis. However, if the State state exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State state must submit a corrective action plan to CMS for approval. Cumulative Demonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Year 2 Budget neutrality expenditure cap plus Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps 1.0 % plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 0.0 %

Enforcement of Budget Neutrality. CMS shall enforce budget neutrality over the life of the Demonstration demonstration rather than on an annual basis. However, if the State state exceeds the calculated cumulative budget neutrality expenditure cap by the percentage identified below for any of the DYs, the State state must submit a corrective action plan to CMS for approval. Cumulative Demonstration Years Cumulative Expenditure Cap Definition Percentage Year 1 Budget neutrality expenditure cap plus Year 1 Budget Cap 1.0 % Year 2 Combined budget neutrality expenditure caps plus Year 1 through 2 Budget Cap 0.75 % Year 3 Combined budget neutrality expenditure caps plus Year 1 through 3 Budget Cap 0.5 % Year 4 Combined budget neutrality expenditure caps plus Year 1 through 4 Budget Cap 0.25 % Year 5 Combined budget neutrality expenditure caps plus Year 1 through 5 Budget Cap 0.0 %