PMPM. For purposes of this Addendum, any per Member per month ("PMPM") calculation shall be based on Medicare HMO Members only.
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 Example COA Hypothetica l SFY20 MMs NF CRR PMPM Estimate Total Expenditur e 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-20-001 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. 2. No reconciliation will occur for expenditures within a +/- 10% corridor of the target, or between $0.93 and $1.13.
PMPM. For purposes of this Addendum, any per Member per month ("PMPM") calculation shall be based on HMO Commercial Members only.
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 c. 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 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. 4. When both parties have signed this Amendment 1, the Agreement and this Amendment 1 together constitute the Agreement.
PMPM. This is not an inclusive list. OptumRx may charge for any products or services not specifically represented herein. Credits and Allowances
