Projected Benefit Costs Sample Clauses

Projected Benefit Costs. This section provides the documentation of the methodology utilized to develop the benefit cost component of the capitation rates at the rate cell level.
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Projected Benefit Costs. A. Description of Projected Benefit Cost Issues CY 2016 Extension population experience, in the form of adjusted encounter data, is used as the underlying data source for the development of the CY 2018 capitation rates. The 2017 rate setting process placed 75% credibility on cost report data expenditures, with 25% credibility on encounter data expenditures. The CY 2018 rate development process assumes full credibility of MCP encounter data, after applying data quality adjustments. In developing the adjusted base data for the CY 2018 capitation rates, rate cells were reassigned based on each member’s rate cell as of July 1, 2017. For members included in the CY 2016 encounter data but not enrolled as of July 1, 2017, we reassigned member rate cells based on state data exchange (SDX) files for the state of Ohio. The SDX files contain information related to which MMC enrollees receive SSI. This process produced total benefit expense equal to the CY 2016 incurred encounter data, while reflecting post-1634 member rate cell assignment. Other data sources, assumptions, and methodologies are generally consistent with the CY 2017 certification and the July amendment to the CY 2017 certification. Discussion of other assumption changes is provided in the next section. B. Description of Key Assumption C. Changes to Benefit Plan No benefit changes have been made to the Extension benefit plan, other than items discussed in Section I, 2. D. Other Material Changes or Adjustments to Benefit Costs We did not make any other adjustments in the Extension rate development process other than those previously outlined in the report.
Projected Benefit Costs. ‌ III.2.A. Description of Projected Benefit Costs‌ III.2.A.i. Documentation if State Previously Covered the New Adult Group‌
Projected Benefit Costs i. 2014 and 2015 Experience Used in Rate Development 2014 Extension population experience, in the form of both encounter data and cost report data, is used as the underlying data source for the development of the calendar year 2016 capitation rates. Emerging data from these two data sources in the first half of calendar year 2015 was used to assess emerging enrollment and cost patterns, particularly from beneficiaries entering the program in the first half of 2015. ii. Changes in Data Sources, Assumptions, or Methodologies Since Last Certification As mentioned previously, the 2015 Extension rate certification developed by ODM’s previous actuarial vendor was based on a blend of CFC and ABD experience due to the lack of credible data for the Extension population, while the 2016 rate development process uses actual 2014 Extension experience. Discussion of other assumption changes is provided in the next section. iii. Assumption Changes Since 2014 and 2015 Certification Pent-up demand was observed for Extension enrollees entering the MMC delivery system from January 2014 through May 2014, with pent-up demand being the highest amongst enrollees in the January through March time frame. A calendar year 2014 pent-up demand factor for each Extension rate cell was developed based on calculating an estimated calendar year 2014 PMPM expense with and without pent-up demand for the January through May time frame. After rounding, we estimated the pent-up demand included in each Extension rate cell during calendar year 2014 was 1.5%. While total Extension enrollment was approximately 210,000 member months during the January through May 2014 time period, enrollment during the June through December 2014 time period was 2.2 million member months. To the extent enrollment had not increased significantly during the last seven months of the year, the pent-up demand adjustment may have been greater. We summarized calendar year 2014 Extension enrollee experience by month of entry into the population, and calculated a 2014 PMPM by month of entry into the population. We assumed enrollees entering the Extension population after December 31, 2014 would have a acuity profile similar to the population that enrolled in the program during the June 2014 through December 2014 time frame. We estimated the relative acuity mix of 2016 enrollees by using the December 2014 enrollment mix (by month of entry) and estimated growth in enrollment through Calendar Year 2016. This acuity mix was compa...
Projected Benefit Costs i. 2015 Experience Used in Rate Development 2015 Extension population experience, in the form of both encounter data and cost report data, is used as the underlying data source for the development of the CY 2017 capitation rates. ii. Changes in Data Sources, Assumptions, or Methodologies Since Last Certification The data sources, assumptions, and methodologies are consistent with the CY 2016 certification and the July amendment to the CY 2016 certification. Discussion of other assumption changes is provided in the next section. iii. Assumption Changes Since Last Certification

Related to Projected Benefit Costs

  • Final Compensation Final Compensation for an employee, who is employed by the State for the first time and becomes a member of CalPERS prior to January 15, 2011, is based on the highest average monthly pay rate during twelve (12) consecutive months of employment. Final Compensation for an employee, who is employed by the State for the first time and becomes a member of CalPERS on or after January 15, 2011, is based on the highest average monthly pay rate during thirty-six (36) consecutive months of employment.

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  • REFUND OF UNEARNED COMPENSATION The Party of the Second Part agrees to refund the Party of the First Part any compensation received for which no services were rendered. TERMINATION: This contract may be terminated by either party pursuant to law. OTHER CONDITIONS: Any subsequent contracts shall supersede the provisions of this contract. PARTIES: The Fort Xxxxx School District 100, Party of the First Part, and XXXXX XXXXX XXXXX Party of the Second Part, agree as follows:

  • Call Back Compensation (a) Call back is an occasion where an employee has been released from duty and is called back to work prior to his/her normal starting time. On such occasions, the employee’s scheduled or recognized shift shall be made available for work, except that the Agency shall not be obligated to work the employee more than twelve (12) consecutive hours and the employee may choose not to work more than twelve (12) consecutive hours, excluding meal periods, of combined call back time and regular shift time. (b) An employee who is called back to work outside his/her scheduled workshift shall be paid a minimum of the equivalent of two (2) hours pay at the overtime rate of pay computed from when the employee actually begins work. After two (2) hours work, in each call back situation, the employee shall be compensated at the appropriate rate of pay for time worked. (c) This provision does not apply to telephone calls at home or overtime work which is essentially a continuation of the scheduled workshift.

  • Defined Benefit Pension Plans The Borrower will not adopt, create, assume or become a party to any defined benefit pension plan, unless disclosed to the Lender pursuant to Section 5.10.

  • Annual Compensation The Executive's "Annual Compensation" for purposes of this Agreement shall be deemed to mean the highest level of base salary paid to the Executive by the Employers or any subsidiary thereof during any of the three calendar years ending during the calendar year in which the Date of Termination occurs.

  • Total Compensation Contractor shall include Total Compensation in XXX for each of its five most highly compensated Executives for the preceding fiscal year if: 4.1. The total Federal funding authorized to date under the Award is $25,000 or more; and 4.2. In the preceding fiscal year, Contractor received:

  • Extra Compensation The Board shall pay no fees, other than described above, to the PA/E unless authorized by the Board as follows: A. If the scope of the Project or site is changed, the Board and the PA/E shall negotiate a reasonable fee based upon the probable estimated construction cost in changing the scope of the work and the approximate percentage of the estimated construction cost which was used to negotiate this Agreement if, and, as such may be applicable. B. If the DOE or Board requires the PA/E to make major or costly changes to the Schematic, Preliminary or Construction Document Phase submittals, which changes are not caused by architectural or engineering error or oversight, the PA/E shall be paid to redesign for additional expenses in an amount agreed to by the parties. Under no circumstances will the principals of the PA/E and the principals of his consultants be paid a fee in excess of $125.00 per hour.

  • Insured Benefits A transferring employee will be covered by the benefit plans at the designated Employer. There will be no break in coverage and/or no waiting period prior to being able to receive benefits so long as the waiting period has already been served, subject to the requirements of the carrier.

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