Common use of Loss on the ABA Add-On to the Risk Adjusted Capitation Rate Clause in Contracts

Loss on the ABA Add-On to the Risk Adjusted Capitation Rate. If the amount paid to the Contractor, as determined by the calculation described in Section 4.5.E.1.a above, is less than the Contractor’s adjusted expenditures, as determined by the calculation described in Section 4.5.E.1.b above, then the Contractor shall be considered to have experienced a loss with respect to ABA Services for the Contract Year. EOHHS and the Contractor shall share such loss in accordance with the table below: Loss up to $100,000 99% 1% Loss of more than $100,000 100% 0% 1. Gain on the HCV Medical Component of the Risk Adjusted Capitation Rate Payment 2. Loss on the HCV Medical Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor Share 1. Gain on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate Payment 2. Loss on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor Share 1. Gain on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Gain MassHealth Share Contractor Share 2. Loss on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost

Loss on the ABA Add-On to the Risk Adjusted Capitation Rate. If the amount paid to the Contractor, as determined by the calculation described in Section 4.5.E.1.a above, is less than the Contractor’s adjusted expenditures, as determined by the calculation described in Section 4.5.E.1.b above, then the Contractor shall be considered to have experienced a loss with respect to ABA Services for the Contract Year. EOHHS and the Contractor shall share such loss in accordance with the table below: Loss up to $100,000 99% 1% Loss of more than $100,000 100% 0% 1. Gain on the HCV Medical Component of the Risk Adjusted Capitation Rate PaymentPayment Gain MassHealth Share Contractor Share 2. Loss on the HCV Medical Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor Share 1. Gain on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate PaymentPayment Gain MassHealth Share Contractor Share 2. Loss on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor Share 1. Gain on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Gain MassHealth Share Contractor Share 2. Loss on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Loss MassHealth Share Contractor Share Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost

Loss on the ABA Add-On to the Risk Adjusted Capitation Rate. If the amount paid to the Contractor, as determined by the calculation described in Section 4.5.E.1.a above, is less than the Contractor’s adjusted expenditures, as determined by the calculation described in Section 4.5.E.1.b above, then the Contractor shall be considered to have experienced a loss with respect to ABA Services for the Contract Year. EOHHS and the Contractor shall share such loss in accordance with the table below: Loss up to $100,000 99% 1% Loss of more than $100,000 100% 0% 1. Gain on the HCV Medical Component of the Risk Adjusted Capitation Rate PaymentPayment Gain MassHealth Share Contractor Share 2. Loss on the HCV Medical Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor Share 1. Gain on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate PaymentPayment Gain MassHealth Share Contractor Share 2. Loss on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor Share 1. Gain on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Gain MassHealth Share Contractor ShareRate 2. Loss on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost

Loss on the ABA Add-On to the Risk Adjusted Capitation Rate. ‌ If the amount paid to the Contractor, as determined by the calculation described in Section 4.5.E.1.a above, is less than the Contractor’s adjusted expenditures, as determined by the calculation described in Section 4.5.E.1.b above, then the Contractor shall be considered to have experienced a loss with respect to ABA Services for the Contract Year. EOHHS and the Contractor shall share such loss in accordance with the table below: Loss up to $100,000 99% 1% Loss MassHealth Share Contractor Share Loss of more than $100,000 100% 0% 1. Gain on the HCV Medical Component of the Risk Adjusted Capitation Rate Payment 2. Loss on the HCV Medical Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor SharePayment 1. Gain on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate Payment 2. Loss on the Non-HCV High Cost Drug Component of the Risk Adjusted Capitation Rate Payment Loss MassHealth Share Contractor SharePayment 1. Gain on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Gain MassHealth Share Contractor Share 2. Loss on the SUD Risk Sharing Services Add-On to the Risk Adjusted Capitation Rate Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost Category of Service Procedure Code Modifier Group Procedure Description Unit Cost