One Time Adjustment for 2004 Increases in Secure Horizons Revenue Sample Clauses

One Time Adjustment for 2004 Increases in Secure Horizons Revenue. The Capitation Percentage set forth above assumes a prospective Secure Horizons Revenue increase of two percent (2%) over the average Secure Horizons Revenue for Assigned Medical Group Members (the “Annual Increase”). Such assumption is based upon the estimated average payment rates for Medicare Parts A and B overall for calendar year 2004 as published by CMS in March 2003. In the event that the actual Annual Increase is more than *** as determined by law or legislative or regulatory action or federal administrative agency interpretation (as calculated by PacifiCare for Assigned Medical Group Members) and the amount of the actual Annual Increase in excess of *** has been specifically determined by CMS to be used for the enhancement of benefits for Medicare+Choice beneficiaries that are the financial responsibility of PacifiCare (“Benefit Enhancements”), PacifiCare shall reduce the Capitation Percentage to an amount that will adjust Medical Group’s Capitation Payments to account for the Benefit Enhancements. The resulting adjustment, if any, in the Capitation Percentage shall be a one-time adjustment limited by that amount, or portion thereof, that has been specifically determined by CMS to be used for the Benefit Enhancements. The new 2004 Capitation Percentage (“Adjusted Capitation Percentage”), if necessary, shall begin with the January 2004 Standard Service Capitation Payment and the Adjusted Capitation Percentage shall be effective through the Term of the Agreement. In the event that the actual Annual Increase is more than ***, as determined by law or legislative or regulatory action or federal administrative agency (as calculated by PacifiCare for Assigned Medical Group Members) and the amount of the actual Annual Increase in excess of two percent (2%) has not been specifically determined by CMS to be used for Benefit Enhancements, the calculation of the Secure Horizons Revenue shall include the entire increase.
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