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’s cumulative expenditures exceed the calculated budget neutrality expenditure limit by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan for CMS for approval Demonstration Year Cumulative Expenditure Limit Definition Percentage Year 1 through 17 Budget Neutrality expenditure cap plus 1.0 percent Year 1 through 18 Combined budget neutrality expenditure cap plus 0.5 percent Year 1 through 19 Combined budget neutrality expenditure caps plus 0 percent

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’s cumulative expenditures exceed state exceeds the calculated cumulative budget neutrality expenditure limit by the percentage identified below for any of the Demonstration demonstration years, the State state must submit a corrective action plan for to CMS for approval Demonstration approval. Year Cumulative Expenditure Limit Definition Target Percentage Year 1 through 17 Budget Neutrality expenditure 18 Year 18 budget neutrality cap plus 1.0 percent % Year 1 through 19 Years 18 Combined and 19 combined budget neutrality expenditure cap plus 0.5 percent % Year 1 20 Years 18 through 19 Combined 20 combined budget neutrality expenditure caps cap plus 0 percent0.0 %

Enforcement of Budget Neutrality. The CMS shall enforce budget neutrality over the life of the Demonstration demonstration rather than on an annual basis. However, if the Statestate’s cumulative expenditures exceed the calculated cumulative budget neutrality expenditure limit cap by the percentage identified below for any of the Demonstration demonstration years, the State state must submit a corrective action plan for to CMS for approval approval. The state will subsequently implement the approved corrective action plan. Demonstration Year Cumulative Expenditure Limit Cap Definition Percentage Year 1 through 17 Budget Neutrality expenditure cap plus 1.0 percent Year 1 through 18 Combined budget neutrality expenditure cap plus 0.5 percent Year 1 through 19 Combined budget neutrality expenditure caps plus 0 percent

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’s cumulative expenditures exceed State exceeds the calculated cumulative budget neutrality expenditure limit by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan for to CMS for approval Demonstration approval. Year Cumulative Expenditure Limit Definition Target Percentage Year 1 through 17 Budget Neutrality expenditure 12 Year 12 budget neutrality cap plus 1.0 percent 1% Year 1 through 18 Combined 13 Years 12 and 13 combined budget neutrality expenditure cap plus 0.5 percent .05% Year 1 14 Years 12 through 19 Combined 14 combined budget neutrality expenditure caps cap plus 0 percent0%

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’s cumulative expenditures exceed the calculated budget neutrality expenditure limit by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan for CMS for approval Demonstration Year Cumulative Expenditure Limit Definition Percentage Year 1 through 17 Budget Neutrality expenditure cap plus 1.0 percent Demonstration Year Cumulative Expenditure Limit Definition Percentage 17 Year 1 through 18 Combined budget neutrality expenditure cap plus 0.5 percent Year 1 through 19 Combined budget neutrality expenditure caps plus 0 percent

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’s 's cumulative expenditures exceed the calculated budget neutrality expenditure limit by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan for CMS for approval approval. Demonstration Year Cumulative Expenditure Limit Definition Percentage Year 1 through 17 Budget Neutrality neutrality expenditure cap plus 1.0 percent Year 1 through 18 Combined Combine budget neutrality expenditure cap plus 0.5 percent Year 1 through 19 Combined budget neutrality expenditure caps plus 0 percent

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’s cumulative expenditures exceed State exceeds the calculated budget neutrality expenditure cumulative target limit by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan for to CMS for approval Demonstration Year approval. DY Cumulative Expenditure Limit Definition target definition Percentage Year DY 6 Years 1 through 17 Budget Neutrality expenditure – 6 combined budget neutrality cap plus 1.0 1 percent Year DY 7 Years 1 through 18 Combined – 7 combined budget neutrality expenditure cap plus 0.5 percent Year DY 8 Years 1 through 19 Combined – 8 combined budget neutrality expenditure caps cap plus 0 percent

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’s cumulative expenditures exceed State exceeds the calculated cumulative budget neutrality expenditure limit by the percentage identified below for any of the Demonstration years, the State must submit a corrective action plan for to CMS for approval Demonstration approval. Year Cumulative Expenditure Limit Definition Target Percentage Year 1 through 17 Budget Neutrality expenditure 15 Year 12 budget neutrality cap plus 1.0 percent 1% Year 1 through 18 Combined 16 Years 12 and 13 combined budget neutrality expenditure cap plus 0.5 percent .05% Year 1 17 Years 12 through 19 Combined 14 combined budget neutrality expenditure caps cap plus 0 percent0%