Common use of L below Clause in Contracts

L below. 5. If the Contractor incurs a loss that would require EOHHS to make a risk sharing payment to the Contractor, and the Contractor has paid an amount for ACO Covered Services that exceeds the amount that EOHHS would have paid for the same services in accordance with EOHHS’s fee schedule, then EOHHS may reprice the Contractor’s paid Claims to reflect EOHHS’s fee schedule for the purposes of calculating the risk-sharing payment described in this section. If EOHHS has approved an Alternative Payment Methodology (APM) for the Contractor, EOHS shall apply an adjustment to the Contractor’s repriced paid claims comparable to the APM adjustment that EOHHS used with respect to the Contractor during Capitation Rate development for the Contract Year. If such repricing results in the Contractor incurring a gain, EOHHS shall cap the EOHHS share of such gain at $0.