Common use of Interest on Experience Rebate Clause in Contracts

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 days after the due date for the 90-day FSR Report. For example, any Experience Rebate payment (s) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-date for submission of the 90-day FSR. The HMO has the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before the interest commencement date above, then such a payment would be counted as part of the Primary Settlement. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMO. (3) Any interest obligations that are incurred pursuant to Section 10.11 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will continue to accrue interest. If interim payments are made, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 days after the start of interest, then the $75,000 will be subject to 45 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (f) will not stop during any period of dispute. If a dispute is resolved in the HMO’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO incurs an interest obligation pursuant to Section 10.11 for an Experience Rebate payment due on or after September 1, 2008, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 is not an Allowable Expense for reporting purposes on the FSR.

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(110.10(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 days after the due date for the 90-day FSR Report. For example, any Experience Rebate payment (s) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-date for submission of the 90-day FSR. The HMO MCO has the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before the interest commencement date above, then such a payment would be counted as part of the Primary Settlement. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMOMCO. (3) Any interest obligations that are incurred pursuant to Section 10.11 10.10 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 10.10 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will continue to accrue interest. If interim payments are made, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 days after the start of interest, then the $75,000 will be subject to 45 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (f10.10(f) will not stop during any period of dispute. If a dispute is resolved in the HMOMCO’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO MCO incurs an interest obligation pursuant to Section 10.11 10.10 for an Experience Rebate payment due on or after September 1, 2008, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 10.10 is not an Allowable Expense for reporting purposes on the FSR.

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(110.10(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 days after the due date for the 90-day FSR Report. For example, any Experience Rebate payment (s) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-date for submission of the 90-day FSR. The HMO MCO has the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before the interest commencement date above, then such a payment would be counted as part of the Primary Settlement. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMOMCO. (3) Any interest obligations that are incurred pursuant to Section 10.11 10.10 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 10.10 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will continue to accrue interest. If interim payments are made, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 days after the start of interest, then the $75,000 will be subject to 45 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (f10.10(f) will not stop during any period of dispute. If a dispute is resolved in the HMOMCO’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO incurs an interest obligation pursuant to Section 10.11 for an Experience Rebate payment due on or after September 1, 2008, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 is not an Allowable Expense for reporting purposes on the FSR.

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will shall be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 thirty (30) days after the due date for each settlement, as described in Section 10.11.1(e). In addition, if any adjusted amount is owed to HHSC at the 90-day FSR Report. For examplefinal settlement date, any Experience Rebate payment then interest will be charged on the adjusted amount owed beginning thirty (s30) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-second settlement date for submission to the date of the 90final settlement payment. HHSC will calculate interest at the Department of Treasury’s Median Rate (resulting from the Treasury’s auction of 13-day FSR. The HMO has week bills) for the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before week in which the interest commencement date above, then such a payment would be counted as part of the Primary Settlementliability is assessed. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMO. (3) Any interest obligations that are incurred pursuant to Section 10.11 10.11.1 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 10.11.1 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will shall continue to accrue interest. If interim payments are made, such as between the first and second settlements, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 35 days after the start of interest, then the $75,000 will be subject to 45 35 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (f) will not stop during any period of dispute. If a dispute is resolved in the HMO’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO incurs an interest obligation pursuant to Section 10.11 for an Experience Rebate payment due on or after September 1, 2008, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 is not an Allowable Expense for reporting purposes on the FSR.

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will shall be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 thirty (30) days after the due date for each settlement, as described in Section 10.11(e). In addition, if any adjusted amount is owed to HHSC at the 90-day FSR Report. For examplefinal settlement date, any Experience Rebate payment then interest will be charged on the adjusted amount owed beginning thirty (s30) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-second settlement date for submission to the date of the 90final settlement payment. HHSC will calculate interest at the Department of Treasury’s Median Rate (resulting from the Treasury’s auction of 13-day FSR. The HMO has week bills) for the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before week in which the interest commencement date above, then such a payment would be counted as part of the Primary Settlementliability is assessed. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMO. (3) Any interest obligations that are incurred pursuant to Section 10.11 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will shall continue to accrue interest. If interim payments are made, such as between the first and second settlements, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 35 days after the start of interest, then the $75,000 will be subject to 45 35 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (f) will not stop during any period of dispute. If a dispute is resolved in the HMO’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO incurs an interest obligation pursuant to Section 10.11 for an Experience Rebate payment due on or after September 1, 2008, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 is not an Allowable Expense for reporting purposes on the FSR.

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will shall be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 thirty (30) days after the due date for each settlement, as described in Section 10.11.1(e). In addition, if any adjusted amount is owed to HHSC at the 90-day FSR Report. For examplefinal settlement date, any Experience Rebate payment then interest will be charged on the adjusted amount owed beginning thirty (s30) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-second settlement date for submission to the date of the 90final settlement Responsible Office: HHSC Office of General Counsel (OGC) Subject: Attachment A -- HHSC Uniform Managed Care Contract Terms & Conditions Version 1.7 payment. HHSC will calculate interest at the Department of Treasury’s Median Rate (resulting from the Treasury’s auction of 13-day FSR. The HMO has week bills) for the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before week in which the interest commencement date above, then such a payment would be counted as part of the Primary Settlementliability is assessed. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMO. (3) Any interest obligations that are incurred pursuant to Section 10.11 10.11.1 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 10.11.1 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will shall continue to accrue interest. If interim payments are made, such as between the first and second settlements, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 35 days after the start of interest, then the $75,000 will be subject to 45 35 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (f) will not stop during any period of dispute. If a dispute is resolved in the HMO’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO incurs an interest obligation pursuant to Section 10.11 for an Experience Rebate payment due on or after September 1, 2008, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 is not an Allowable Expense for reporting purposes on the FSR.

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will shall be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(1). Thus, any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 thirty (30) days after the due date for each settlement, as described in Section 10.11(e). In addition, if any adjusted amount is owed to HHSC at the 90-day FSR Report. For examplefinal settlement date, any Experience Rebate payment then interest will be charged on the adjusted amount owed beginning thirty (s30) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-second settlement date for submission to the date of the 90final settlement payment. HHSC will calculate interest at the Department of Treasury’s Median Rate (resulting from the Treasury’s auction of 13-day FSR. The HMO has week bills) for the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before week in which the interest commencement date above, then such a payment would be counted as part of the Primary Settlementliability is assessed. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMO. (3) Any interest obligations that are incurred pursuant to Section 10.11 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will shall continue to accrue interest. If interim payments are made, such as between the first and second settlements, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 35 days after the start of interest, then the $75,000 will be subject to 45 35 days of interest, and the $25,000 balance will continue to accrue interest until paid. Section 10.11.1 STAR+PLUS Experience Rebate (a) HMO’s duty to pay. At the end of each Rate Year beginning with Rate Year 1, the HMO must pay an Experience Rebate to HHSC for the STAR+PLUS Program if the HMO produces a positive Net Income in STAR+PLUS. The accrual STAR+PLUS Experience Rebate is calculated in accordance with the tiered rebate method set forth below based on the consolidated Net Income before Taxes for all of interest as defined under Section 10.11 (f) will not stop during any period of dispute. If a dispute is resolved in the HMO’s favorSTAR+PLUS Service Areas included within the scope of the Contract, then interest will only be assessed as measured by any positive amount on the revised unpaid amountFinancial-Statistical Report (FSR) as reviewed and confirmed by HHSC. (5b) If Graduated STAR+PLUS Experience Rebate Sharing Method. HHSC and the HMO incurs an interest obligation pursuant to Section 10.11 will share the Net Income before Taxes for the STAR+PLUS Program as follows, unless HHSC provides the HMO an Experience Rebate payment due on or after September 1, 2008, Reward in accordance with Section 6 of Attachment B-1 to the HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal Managed Care Contract document and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 is not an Allowable Expense for reporting purposes on the FSR.HHSC’s Uniform Managed Care Manual:

Interest on Experience Rebate. (1) Interest on any Experience Rebate owed to HHSC will be charged beginning 35 days after the due date of the Primary Settlement, as described in Section 10.11(e)(110.05(e)(1). Thus, Dental Services for Texas Children’s Medicaid and Children’s Health Insurance Program Contract No. HHS0002879-00003 Attachment B – Dental Contract Terms and Conditions any Experience Rebate due or paid on or after the Primary Settlement will accrue interest starting at 35 days after the due date for the 90-day FSR Report. For example, any Experience Rebate payment (spayment(s) made in conjunction with the 334-day FSR, or as a result of audit findings, will accrue interest back to 35 days after the due-date for submission of the 90-day FSR. The HMO Dental Contractor has the option of preparing an additional FSR based on 120 days of claims run-out (a “120- day FSR”). If a 120-day FSR, and an Experience Rebate payment based on it, are received by HHSC before the interest commencement date above, then such a payment would be counted as part of the Primary Settlement. (2) If an audit or adjustment determines a downward revision of income after an interest payment has previously been required for the same State Fiscal Year, then HHSC will recalculate the interest and, if necessary, issue a full or partial refund or credit to the HMODental Contractor. (3) Any interest obligations that are incurred pursuant to Section 10.11 10.05 that are not timely paid will be subject to accumulation of interest as well, at the same rate as applicable to the underlying Experience Rebate. (4) All interest assessed pursuant to Section 10.11 10.05 will continue to accrue until such point as a payment is received by HHSC, at which point interest on the amount received will stop accruing. If a balance remains at that point that is subject to interest, then the balance will continue to accrue interest. If interim payments are made, then any interest that may be due will only be charged on amounts for the time period during which they remained unpaid. By way of example only, if $100,000 is subject to interest commencing on a given day, and a payment is received for $75,000 45 days after the start of interest, then the $75,000 will be subject to 45 days of interest, and the $25,000 balance will continue to accrue interest until paid. The accrual of interest as defined under Section 10.11 (fSection10.05(f) will not stop during any period of dispute. If a dispute is resolved in the HMODental Contractor’s favor, then interest will only be assessed on the revised unpaid amount. (5) If the HMO Dental Contractor incurs an interest obligation pursuant to Section 10.11 for an Experience Rebate payment due on or after September 1, 200810.05, HHSC will assess such interest at 12% per annum, compounded daily. If any interest rate stipulated hereunder is found by a court of competent jurisdiction to be outside the range deemed legal and enforceable, then in such specific case the rate hereunder will be adjusted as little as possible so as to be deemed legal and enforceable. (6) Any such interest expense incurred pursuant to Section 10.11 10.05 is not an Allowable Expense for reporting purposes on the FSR.