PMPM Sample Clauses

PMPM. For purposes of this Addendum, any per Member per month ("PMPM") calculation shall be based on Medicare HMO Members only.
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PMPM. No reconciliations will occur for expenditures within a +/- 10% corridor of the target, or between $0.86 and $1.05.
PMPM. An illustrative example of the calculation for (B) is shown below, with the “Hypothetical SFY20 MMs Estimate” being based on statewide SFY18 MMs for illustrative purposes: llustrative COA Hypothetical SFY20 MMs Estimate NF CRR PMPM Estimate Total Expenditure Estimate Custodial Care Nursing Facility <65 20,704 $40.77 $844,102 Custodial Care Nursing Facility 65+ 119,686 $40.77 $4,879,598 Non-Dual Skilled Nursing Facility 1,786 $40.77 $72,815 $5,796,516 In this example, (B) would be $5,796,516; this total dollar amount will vary depending upon the actual SFY20 MMs for these cohorts for each of the MCOs. The State will calculate a value (C) = (A) – (B), which represents how much more or less was paid for the NF CRR payments than originally estimated. If the amount (C) is within a +/-1% band of the original estimate (B) then no risk corridor payment will be made. In this example, the band for which (C) must fall in order for no risk corridor payment to take place is a value of (C) that is between -$57,965 and $57,965. MED-16-018 Any difference (C) in costs between actual utilization (A) and the original estimate (B) outside the 1% band would result in a payment to or from the State of the amount by which (C) exceeds 1% of (B) or falls below -1% of (B). The reconciliation will consist of the State paying the MCO a risk corridor settlement in the case of actual utilization (A) exceeding the original estimates
PMPM. This is not an inclusive list. OptumRx may charge for any products or services not specifically represented herein.
PMPM. The $ .09 PMPM fee will be assessed when scanning functionality is utilized by CLIENT. - Provide an allowance of up to $25,000 for license, implementation, integration, conversion and support fees for a CLIENT selected accounting package. - QCSI has provided an estimate of communication costs and incorporated these costs into the PMPM fee. If at a future date, significant cost savings are realized due to CLIENT's ability to contract for such services locally and/or newer technology is utilized which provides significant cost savings, such savings will be passed on to CLIENT. CLIENT will be required to use the communication lines as outlined in this Agreement until QCSI's contract for such lines expires and the lines can be converted. - QCSI will facilitate the ability of CLIENT to retrieve IVR information from the QMACS(TM) database. Quality Care Solutions, Inc. Rev. 02/16/99 10 EXHIBIT C IMPLEMENTATION SERVICES PROGRAM DATA CENTER ASSESSMENT AND IMPLEMENTATION FEE [Confidential treatment has been requested] CLIENT agrees to pay QCSI [****] for assessment, implementation, QCSI purchase of hardware and communications link, set-up and training. The Assessment and Implementation fee is payable as follows: [****] Execution of Software License [****] Remaining four (4) payments due on the first (1st) day of each month following execution of the Software License.
PMPM. For any Assigned Life whose coverage ends mid-month and who is dropped from the Program as a result, ACO will cease to pay the $3.25 PMPM as of the month in which the Assigned Life did not complete the full month of coverage within the Program.
PMPM. For purposes of this Addendum, any per Member per month ("PMPM") calculation shall be based on HMO Commercial Members only.
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PMPM a. The Contractor shall receive an actuarially-determined, capitated per member per month (PMPM) payment to provide NET services covered under this Scope of Work. Experience data used to establish rates may be adjusted to reflect only allowable services. A percentage of the PMPM payment shall be contingent on meeting Value-Based Purchasing performance measures, as described in Section
PMPM. When both parties have signed this Amendment 1, the Agreement and this Amendment 1 together constitute the Agreement.

Related to PMPM

  • Salary Scale The salary scale applicable to Employees shall be set out hereinafter in the Wage Schedule.

  • Step 4 In the event the dispute is not resolved at Step 3 above, either party may serve upon the other and the COORDINATOR written notice by certified mail, within five (5) working days, requesting that the dispute be resolved by arbitration. If such a written notice is served, the parties shall jointly request the Federal Mediation and Conciliation Service to submit the names of five (5) qualified arbitrators, from which list the UNION and the EMPLOYER shall alternately strike names until only one name is left, which person shall hear and resolve the dispute. A hearing shall be conducted by the arbitrator, at which time the parties to the dispute shall be given the opportunity to appear and offer evidence in support of their positions. A decision by the arbitrator shall be rendered in writing within a reasonable time, not to exceed ten (10) days after the conclusion of the hearing. The decision by the arbitrator shall be final and binding upon the parties; provided, however, that the arbitrator shall not have the authority to alter or amend the provisions of this AGREEMENT in any way. The reasonable expenses and fees of the arbitrator shall be borne equally by the parties.

  • Step 3 i. The employer shall investigate the complaint. The investigation shall be conducted by a person who shall have training and/or experience in investigating complaints of harassment. The complainant may request that the investigator shall be of the same gender as the complainant and where practicable the request will not be denied. ii. The investigation shall be conducted as soon as is reasonably possible and shall be completed in ten (10) working days unless otherwise agreed to by the parties, such agreement not to be unreasonably withheld.

  • Salary Scales ‌ 2.5.1 Effective from 1 January 2024, and subject to the Remuneration provisions in the Terms of Settlement, a 4% increase will apply to all paid and printed rates. The following Allied Divisions shall refer to the applicable schedules for their scales: MIT, UCOL and Otago. 2.5.2 Effective from 1 January 2025, kaimahi will be translated into the following salary scale, which includes the 4% salary increase: Band Step (N/A for UCOL and TOPNZ) Scale Scale 2025 (4%) 40 hours Band Step(N/A for UCOL and TOPNZ Scale 2025 (4%) Scale 2025 (4%)

  • Cost of Living Adjustment For each year following the Initial Term, unless the parties shall otherwise agree and provided that the service mix and volumes remain consistent as previously provided in the Initial Term, the total fee for all services shall equal the fee that would be charged for the same services based on a fee rate (as reflected in a fee rate schedule) increased by the percentage increase for the twelve-month period of such previous calendar year of the CPI-W (defined below) or, in the event that publication of such index is terminated, any successor or substitute index, appropriately adjusted, acceptable to both parties. As used herein, “CPI-W” shall mean the Consumer Price Index for Urban Wage Earners and Clerical Workers (Area: Boston-Brockton-Nashua, MA-NH-ME-CT; Base Period: 1982-84=100), as published by the United States Department of Labor, Bureau of Labor Statistics.

  • Night Shift Differential Unit 12 employees who regularly work shifts shall receive a night shift differential as set forth below: A. Employees shall qualify for the first night shift pay differential of forty (40) cents per hour where four (4) or more hours of the regularly scheduled work shift falls between 6 p.m. and 12 midnight. B. Employees shall qualify for the second night shift pay differential of fifty (50) cents per hour where four (4) or more hours of the regularly scheduled work shift fall between 12 midnight and 6 a.m. C. A "regularly scheduled work shift" are those regularly assigned work hours established by the department director or designee.

  • Step 2 (a) If the grievance is not resolved at Step 1, the grievant or designated representative may submit the grievance in writing on a grievance form as contained in Appendix B of this Agreement, to the Agency Head or designated representative within 15 days following receipt of the decision at Step 1. The grievance form must contain the same information as the grievance filed at Step 1. The grievance shall include a copy of the grievance form submitted at Step 1, together with the written response and documents in support of the grievance. (b) The Agency Head or designated representative shall communicate a decision in writing to the grievant and the PBA Grievance Representative, if any, within 15 days following receipt of the written grievance. If the Agency Head fails to respond within the time limit, it shall be deemed a denial. (c) If a grievance, alleging that a disciplinary action (reduction in base pay, demotion, involuntary transfer of more than 50 miles by highway, suspension, or dismissal) was taken without cause, is not resolved at Step 2, the PBA representative, or the grievant or grievant’s representative, if not represented by PBA, may appeal the grievance to arbitration as provided in Article 6, Section 3(G)(4), below, within 15 days after receipt of the Step 2 decision.

  • Shift and Weekend Premium (a) An employee shall be paid a shift premium of eighty-five cents (85¢) per hour for each hour worked between the hours of 1500-0700 hours. (b) Effective July 1, 2013, an employee shall be paid a weekend premium of one dollar ($1.00) per hour for each hour worked between 2300 hours Friday and 2300 hours Sunday, or such other forty-eight (48) hour period as the local parties may agree upon or as defined in the Collective Agreement. If an employee is receiving premium pay pursuant to a local scheduling regulation with respect to consecutive weekends worked, the employee will not receive weekend premium under this provision.

  • Estimated Number of Participating Households Approximately 6,460. This figure is based on loans with unpaid principal balances ranging from $200,000 to $400,000 with an average funding of $5,000.00.

  • EMPLOYEE EVALUATION A. Formal evaluation of employees shall be in writing and shall be for the purpose of establishing a record of the employee’s work performance. The evaluation may include but is not limited to: establishing performance standards and outcome measures, recognition of an employee’s efforts, as well as planning for improvement. Issues of attendance and punctuality may be addressed if they have previously been discussed with the employee. The employee’s job description shall be a basis for the evaluation. B. The evaluator shall review the written evaluation with the employee and provide the employee with a copy. The employee shall sign the evaluation acknowledging receipt. If the employee has objections to the evaluation, s/he, may within twenty (20) working days following receipt of the evaluation put such objections in writing and have them attached to the evaluation report and placed in his/her personnel file. C. The frequency of evaluations shall be determined by the District and generally occur every other year by April 1st for bargaining unit employees. If the District chooses to do so, it may conduct formal evaluations on an annual basis. An employee may request to receive one (1) annual evaluation. Such request shall be in writing to the employee’s supervisor with a copy to the Human Resources Department. D. The Human Resources Department will consult with the Federation in developing an outline of best practices to be used in conducting employee evaluations. E. When the District determines that an employee’s work performance is unsatisfactory, it shall inform the employee in writing of any deficiency and the improvement expected and provide the employee with the opportunity to correct the unsatisfactory performance within a reasonable time period established by the District. F. The judgment of an employee’s work performance by an evaluating supervisor shall not be the subject of a grievance. A grievance concerning an evaluation shall be limited to an allegation that the evaluation was done in bad faith or clearly untrue. The burden of proof shall rest with the grievant. Such grievance shall be filed at the next administrative level above that of the evaluator and that administrator shall provide a written decision within ten (10) working days of any hearing. If the grievance is not resolved, it may be appealed by submitting a written statement to the Human Resources Department within ten (10) working days following receipt of the administrative written decision. The written statement must clearly set forth why the previous decision is in error regarding the allegation of bad faith or being clearly untrue. The Director of Labor Relations, or designee, may review the record of the grievance and/or conduct a hearing and shall issue a written decision within ten (10) working days following such review or hearing. Such decision shall be final. G. Effective July 1, 2013, Sign Language Interpreters will be evaluated using the Educational Interpreter Performance Assessment (EIPA) pursuant to OAR 581-015-2035 and/or the District’s evaluation form.

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