Common use of Performance-Based Clause in Contracts

Performance-Based. Capitation Rate (5%-at-risk) HHSC will place each MCO at risk for 5% of the Capitation Payment. HHSC retains the right to reduce the percentage of the Capitation Payment placed at risk in a given FSR Reporting Period. During the FSR Reporting Period, HHSC will pay the MCO the full monthly Capitation Payments as described in Section 6.2. Then, at the end of each FSR Reporting Period, HHSC will evaluate if the MCO has demonstrated that it has fully met the performance expectations for which the MCO is at risk. If the MCO falls short on some or all of the performance expectations, HHSC will adjust a future monthly Capitation Payment in accordance with Uniform Managed Care Manual Chapter 6.2, Financial Incentive Methodology, by an appropriate portion of the aggregate at-risk amount. HHSC's objective is that all MCOs achieve performance levels that enable them to retain the full at-risk amount. HHSC will determine the extent to which the MCO has met the performance expectations by assessing the MCO's performance for each applicable MCO Program relative to performance targets for the FSR Reporting Period. HHSC will conduct separate accounting for each MCO Program's at-risk Capitation Payment amount. HHSC will identify no more than 10 at-risk performance indicators for each MCO Program. Some of the performance indicators will be standard across all Programs while others may apply to only one (1) Program. Specific contractual requirements are set forth in the Uniform Managed Care Manual, Chapter 6.2, Financial Incentive Methodology. Failure to timely provide HHSC with necessary data related to the calculation of the performance indicators will result in HHSC's assignment of a zero percent (0%) performance rate for each related performance indicator. MCOs will report actual Capitation Payments received on the Financial Statistical Report (FSR) during the FSR Reporting Period that is at risk (i.e., the MCO will not report Revenues at a level equivalent to 95% of the payments received, leaving five percent (5%) as contingent). Actual Capitation Payments received include all of the at-risk Capitation Payment paid to the MCO. Any loss of the at-risk amount that may be realized in a subsequent FSR Reporting Period, via reduction to a monthly payment, will not be reported in the FSR as a reduced amount of capitation revenue, but will instead be reported below the income line, as an informational item, as described in the Uniform Managed Care Manual, Chapter 5.3.1, "Financial Statistical Report and Instructions." Any performance assessment based on performance for a FSR Reporting Period will appear on the final (334-day) FSR for that FSR Reporting Period. HHSC will evaluate the performance-based Capitation Rate methodology annually in consultation with MCOs. HHSC may then modify the methodology as it deems necessary and appropriate, in order to motivate, recognize, and reward MCOs for superior performance. The methodologies for all FSR Reporting Periods will be included in Uniform Managed Care Manual Chapter 6.2, "Financial Incentive Methodology."

Appears in 5 contracts

Samples: Centene Corp, Centene Corp, Centene Corp

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Performance-Based. Capitation Rate (5%-at-risk) HHSC will place each MCO at risk for five percent (5% %) of the Capitation PaymentPayment(s). HHSC retains the right to reduce vary the percentage of the Capitation Payment placed at risk in a given FSR Reporting Period. During the FSR Reporting Period, HHSC will pay the MCO the full monthly Capitation Payments as described in Section 6.2. Then, at the end of each FSR Reporting Period, HHSC will evaluate if the MCO has demonstrated that it has fully met the performance expectations for which the MCO is at risk. If the MCO falls short on some or all of the performance expectations, HHSC will adjust a future monthly Capitation Payment in accordance with Uniform Managed Care Manual Chapter 6.2, Financial Incentive Methodology, ,” by an appropriate portion of the aggregate at-risk amount. HHSC's ’s objective is that all MCOs achieve performance levels that enable them to retain the full at-risk amount. HHSC will determine the extent to which the MCO has met the performance expectations by assessing the MCO's ’s performance for each applicable MCO Program relative to performance targets for the FSR Reporting Period. HHSC will conduct separate accounting for each MCO Program's ’s at-risk Capitation Payment amount. HHSC will identify no more than 10 at-risk performance indicators for each MCO Program. Some of the performance indicators will be standard across all Programs while others may apply to only one (1) Program. Specific contractual requirements are set forth in the Uniform Managed Care Manual, Chapter 6.2, Financial Incentive Methodology. .” Failure to timely provide HHSC with necessary data related to the calculation of the performance indicators will result in HHSC's ’s assignment of a zero percent (0%) performance rate for each related performance indicator. MCOs will report actual Capitation Payments received on the Financial Statistical Report (FSR) during the FSR Reporting Period that is at risk (i.e., the MCO will not report Revenues at a level equivalent to 95% of the payments received, leaving five percent (5%) as contingent). Actual Capitation Payments received include all of the at-risk Capitation Payment paid to the MCO. Any loss of the at-risk amount that may be realized in a subsequent FSR Reporting Period, via reduction to a monthly payment, will not be reported in the FSR as a reduced amount of capitation revenue, but will instead be reported below the income line, as an informational item, as described in the Uniform Managed Care Manual, Chapter 5.3.1, "Financial Statistical Report and Instructions." Any performance assessment based on performance for a FSR Reporting Period will appear on the final (334-day) FSR for that FSR Reporting Period. HHSC will evaluate the performance-based Capitation Rate methodology annually in consultation with MCOs. HHSC may then modify the methodology as it deems necessary and appropriate, in order to motivate, recognize, and reward MCOs for superior performance. The methodologies for all FSR Reporting Periods will be included in Uniform Managed Care Manual Chapter 6.2, "Financial Incentive Methodology."

Appears in 4 contracts

Samples: Centene Corp, Centene Corp, Centene Corp

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Performance-Based. Capitation Rate (5%-at-risk) HHSC will place each MCO at risk for five percent (5% %) of the Capitation PaymentPayment(s). HHSC retains the right to reduce vary the percentage of the Capitation Payment placed at risk in a given FSR Reporting Rate Period. During the FSR Reporting Rate Period, HHSC will pay the MCO the full monthly Capitation Payments as described in Section 6.2. Then, at the end of each FSR Reporting Rate Period, HHSC will evaluate if the MCO has demonstrated that it has fully met the performance expectations for which the MCO is at risk. If the MCO falls short on some or all of the performance expectations, HHSC will adjust a future monthly Capitation Payment in accordance with Uniform Managed Care Manual Chapter 6.2, Financial Incentive Methodology, ,” by an appropriate portion of the aggregate at-risk amount. HHSC's ’s objective is that all MCOs achieve performance levels that enable them to retain the full at-risk amount. HHSC will determine the extent to which the MCO has met the performance expectations by assessing the MCO's ’s performance for each applicable MCO Program relative to performance targets for the FSR Reporting Periodrate period. HHSC will conduct separate accounting for each MCO Program's ’s at-risk Capitation Payment amount. HHSC will identify no more than 10 at-risk performance indicators for each MCO Program. Some of the performance indicators will be standard across all Programs while others may apply to only one (1) Program. Specific contractual requirements are set forth in the Uniform Managed Care Manual, Chapter 6.2, Financial Incentive Methodology. .” Failure to timely provide HHSC with necessary data related to the calculation of the performance indicators will result in HHSC's ’s assignment of a zero percent (0%) performance rate for each related performance indicator. MCOs will report actual Capitation Payments received on the Financial Statistical Report (FSR) during the FSR Reporting Rate Period that is at risk (i.e., the MCO will not report Revenues at a level equivalent to 95% of the payments received, leaving five percent (5%) as contingent). Actual Capitation Payments received include all of the at-risk Capitation Payment paid to the MCO. Any loss of the at-risk amount that may be realized in a subsequent FSR Reporting Rate Period, via reduction to a monthly payment, will not be reported in the FSR as a reduced amount of capitation revenue, but will instead be reported below the income line, as an informational item, as described in the Uniform Managed Care Manual, Chapter 5.3.1, "Financial Statistical Report and Instructions." Any performance assessment based on performance for a FSR Reporting Period contract period will appear on the final (334-day) FSR for that FSR Reporting Periodcontract period. HHSC will evaluate the performance-based Capitation Rate methodology annually in consultation with MCOs. HHSC may then modify the methodology as it deems necessary and appropriate, in order to motivate, recognize, and reward MCOs for superior performance. The methodologies for all FSR Reporting Rate Periods will be included in Uniform Managed Care Manual Chapter 6.2, "Financial Incentive Methodology."

Appears in 2 contracts

Samples: Centene Corp, Centene Corp

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