Part A Fund Sample Clauses

Part A Fund. A Part A Fund shall be established which will consist of the "Part A Revenue" and "Part A Expenses". The fund shall be calculated as follows: Part A Fund Revenue Part A Fund Revenue shall consist of amounts equal to the appropriate funding as outlined in the Funding Table for those Medicare and Medicaid Members for each product covered under this Agreement multiplied by the number of Members assigned to IPA Primary Care Physician in each category covered under this Agreement. Such amounts shall be credited to the Part A Fund as "Part A Revenue". Part A Fund Expenses Part A Fund Expenses shall consist of amounts equal to the claims and/or capitation paid to providers by Humana for Covered Services provided to Members assigned to IPA Primary Care Physician, plus an actuarially determined amount for claims incurred but not reported or paid (IBNR) and a catastrophic withhold amount as calculated by Humana for Part A Expenses. Part A Expenses include, but are not limited to, costs identified for inpatient hospital (medical and surgical services), inpatient hospital psychiatric services, selected outpatient surgery procedures at Humana contracted facilities, skilled nursing home services, applicable disease management programs, home health care services, and the cost of stop-loss coverage if provided by Humana. Part A Expenses also include the cost of other Covered Services or costs which may be determined to be Part A Expenses by Humana in the normal course of business

Part A Fund. A Part A Fund shall be established which will consist of the "Part A Revenue," "Part A Expenses," and "Claims Reserve Fund." The fund shall be calculated as follows:

Part A Fund. A Part A Fund shall be established which will consist of the "Part A Revenue" and "Part A Expenses". The fund shall be calculated as follows: Part A Fund Revenue Part A Fund Revenue shall consist of amounts equal to the appropriate funding for those MA HMO Members covered under this Agreement. Such amounts shall be credited to the Part A Fund as "Part A Revenue". Part A Fund Expenses Part A Fund Expenses shall consist of amounts equal to the claims and/or capitation paid to providers by Humana for Covered Services provided to Members assigned to PPM Primary Care Physician, plus an actuarially determined amount for claims incurred but not reported (IBNR) as calculated by Humana for Part A Expenses. Part A Expenses include, but are not limited to, costs identified for inpatient hospital (medical and surgical services), inpatient hospital psychiatric services, selected outpatient surgery procedures at Humana contracted facilities, skilled nursing home services, applicable disease management programs, home health care services, and the cost of stop-loss coverage if provided by Humana. Part A Expenses also include the cost of other Covered Services or costs which may be determined to be Part A Expenses by Humana in the normal course of business or as may be determined by CMS to be a Part A Covered Service.