PROJECTED NON-BENEFIT COSTS Sample Clauses

PROJECTED NON-BENEFIT COSTS. 16 A. Data, assumptions and methodologies 16 i. Description of the data, assumptions, and methodologies 16 (a) Data 16 (b) Assumptions and methodology 16 ii. Material changes 16 B. Non-benefit costs, by cost category 17 C. PMPM versus percentage 17
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PROJECTED NON-BENEFIT COSTS. This section provides information on the development of projected non-benefit costs.
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PROJECTED NON-BENEFIT COSTS. A. Changes in Data Sources, Assumptions, or Methodologies Since Last Certification Cost report data, including non-benefit costs, was available for CY 2016. We used this information to evaluate the reasonableness of our non-benefit expense assumptions for the Extension population. As reported non-benefit expenses in the CY 2016 cost reports did not differ significantly between the CFC Adult and Extension populations, the non-benefit expense percentage loads have been set equal for the two populations in the development of the CY 2018 rates. This assumption is consistent with the prior certification. B. Assumption Differences Relative to Other Medicaid Populations As stated previously, non-benefit expense assumptions for the Extension population were set equal to the CFC Adult population.
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PROJECTED NON-BENEFIT COSTS. A. RATE DEVELOPMENT STANDARDS ii. PMPM Versus Percentage The non-benefit cost was developed as a percentage of the capitation rate. iii. Basis for Variation in Assumptions Any assumption variation between covered populations is the result of program differences and is in no way based on the rate of federal financial participation associated with the population. iv. Health Insurance Providers Fee Detail regarding the health insurance providers fee is provided in a later section of this letter.
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PROJECTED NON-BENEFIT COSTS. A. RATE DEVELOPMENT STANDARDS i. Overview In accordance with 42 CFR §438.5(e), the non-benefit component of the capitation rate includes reasonable, appropriate and attainable expenses related to MCOP operation of the MyCare program. The remainder of this section provides documentation of the data, assumptions and methodology that we utilized to develop the non-benefit cost component of the capitation rate. ii. PMPM Versus Percentage The non-benefit cost was developed as a percentage of the capitation rate. iii. Basis for Variation in Assumptions Any assumption variation between covered populations is the result of program differences and is in no way based on the rate of federal financial participation associated with the population. iv. Health Insurance Providers Fee Detail regarding the health insurance providers fee is provided in a later section of this report.
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PROJECTED NON-BENEFIT COSTS. ‌ I.5.A. Rate Development Standards‌ This section of the 2025 Guide provides information on the non-benefit component of the capitation rates. I.5.B. Appropriate Documentation‌ I.5.B.i. Description of the Development of Projected Non-Benefit Costs I.5.B.i.(a) Data, Assumptions, and Methodology‌‌‌ The primary data source used to develop the administrative component of the CYE 25 capitation rates for the ACC populations was the historical and projected administrative expense data submitted by the Contractors per a supplemental data request, as noted in Section I.2.B.ii.(b)(ii). The primary data source used to develop the administrative component of the CYE 25 capitation rates for the RBHA populations was the administrative expense PMPM submitted by the Offerors during the CYE 24 CCE, as noted in Section I.2.B.ii.(b)(ii). As part of the CCE, the Offerors were required to bid actuarially sound administrative costs by GSA and risk group with detailed administrative COS information for five years (CYE 23 through CYE 27) as well as provide the projected member months assumed for each of the years by GSA and risk group. The ACC and ACC-RBHA Contractors’ supplemental administrative data request included amounts for administrative expenses for CYE 24 Q1 (through December 31, 2023) actuals, actual/projected amounts for CYE 24, and projected amounts for CYE 25. The Contractors also provided CYE 23 actuals for the ACC risk groups. This data request included administrative breakouts into different categories, breakdowns of fixed and variable administrative costs for the ACC populations, and the ACC and ACC-RBHA Contractors’ member months for each of the time frames. The CYE 23 financial statements and CYE 24 Q1 financial statements for all ACC and ACC-RBHA risk groups were also reviewed. Other sources of data reviewed and utilized in the development of the non-benefit cost projections were trends and forecasts for various Consumer Price Indices (CPI) and Employment Cost Indices (ECI) data from S&P Global Market Intelligence Healthcare Cost Review. The ACC population administrative PMPMs included in the capitation rates were developed primarily using the Contractors’ supplemental administrative data and CYE 25 projected member months from both the Contractors and AHCCCS. For the fixed administrative expenses, the PMPM was developed by using each Contractor’s projected costs, plus some added adjustments for increased contract requirements not known at the time of the Cont...
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PROJECTED NON-BENEFIT COSTS. ‌ III.3.A. Description of Issues‌ III.3.A.i. Changes in Data Sources, Assumptions, Methodologies‌ The development of the projected non-benefit costs, including any changes in data, assumptions, or methodologies since the last rate certification, for the CYE 25 capitation rates for the ACC and ACC-RBHA Program, including the new adult group, are described in Section I.5.
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PROJECTED NON-BENEFIT COSTS. ‌ There have been no changes to administrative costs or the percentages for premium tax and underwriting gain from the original capitation rate certification. Please see the original capitation rate certification for all projected non-benefit costs used in the development of the CYE 24 capitation rates for the ACC and ACC-RBHA Program.
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PROJECTED NON-BENEFIT COSTS. Not applicable to the APSI for the CYE 23 ACC and ACC-RBHA Program rate update.
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Related to PROJECTED NON-BENEFIT COSTS

  • Additional Compensation Notwithstanding anything in this Memorandum of Understanding to the contrary when in the judgment of the Board, it becomes necessary or desirable to utilize the services of County employees in capacities other than those for which they are regularly employed, the Board may authorize and, if appropriate, fix an additional rate of compensation for such employees.

  • Exclusions from Operating Expenses Notwithstanding any term or condition set forth in this Exhibit or the provisions of the Master Lease or Sublease to the contrary, Operating Expenses shall not include any of the following: (a) Any ground lease rental. (b) Costs incurred by Landlord with respect to goods and services (including utilities sold and supplied to tenants and occupants of the Building) to the extent that Landlord is entitled to direct reimbursement for such costs other than through the operating expense pass-through provisions of such tenants’ leases or which Landlord provides selectively to one or more, but not all, tenants without reimbursement. (c) Costs incurred by Landlord for the repair of damage to the Building and/or the Land to the extent that Landlord is reimbursed by insurance or condemnation proceeds or by tenants, warrantors or other third parties. (d) Costs, including permit, license and inspection costs, incurred with respect to the installation of tenant improvements made for any tenants in the Building or incurred in renovating or otherwise improving, decorating, painting or redecorating vacant space for tenants or other occupants of the Building. (e) Salaries and bonuses of officers, executives and employees of Landlord not employed exclusively at the Building or who are above the level of Building Manager. (f) Depreciation and amortization of any type except on materials, tools and supplies purchased by Landlord to enable Landlord to supply services Landlord might otherwise contract for with a third party, all as determined in accordance with generally accepted accounting practices, consistently applied, and when depreciation or amortization is permitted or required, the item shall be amortized over its useful life. (g) Attorneys’ fees and other costs and expenses incurred in connection with negotiations or disputes with present or prospective tenants or other occupants of the Building (including costs incurred due to violations by tenants of the terms and conditions of their leases). (h) Costs of a capital nature, including, without limitation, capital improvements, capital replacements, capital repairs, capital equipment and capital tools, and any improvements or alterations incurred to comply with any applicable Legal Requirements as set forth in Article 5 of the Master Lease all as determined in accordance with generally accepted accounting practices, consistently applied. (i) Brokerage commissions, finders’ fees, attorneys’ fees and other costs incurred by Landlord in leasing or attempting to lease space in the Building. (j) Expenses in connection with services or other benefits, which are not offered to Tenant, or for which Tenant is charged for directly but which are provided to another tenant or occupant of the Building. (k) Costs incurred by Landlord due to the violation by Landlord of the terms and conditions of any lease of space in the Building. (l) Any cost representing an amount paid to any person, firm, corporation or other entity related to or affiliated with Landlord, which amount is in excess of the amount which would have reasonably been paid in the absence of such relationship for comparable work or services involving the Building or comparable buildings in the general vicinity of the Building. (m) Interest, points, and fees on debt or amortization on any mortgage or mortgages encumbering the Building and/or the Land. (n) Landlord’s general corporate overhead. (o) Subject to the provision set forth in subparagraph (h) above, rental payments incurred in leasing air conditioning systems, elevators or other equipment ordinarily considered to be of a capital nature, except equipment not affixed to the Building which is used in providing janitorial, parking lot maintenance, window washing or similar services. (p) Advertising and promotional expenditures and, except for the Building directory and interior signs identifying retail use tenants and signage for various equipment room and common areas, costs of signs in or on the Building and/or the Land identifying the owner or any tenant of the Building. (q) Costs of overtime or other extraordinary expense to Landlord in performing work which Landlord is obligated to perform under any leases which reasonably could have been avoided through the exercise of ordinary diligence. (r) Taxes and assessments attributable to the tenant improvements of tenants or occupants of the Building which are assessed at a valuation higher than the valuation at which Building standard tenant improvements are assessed to the extent that such taxes or assessments for excess valuation are directly billed to and collected from such tenant or occupants. (s) Penalties and interest incurred as a result of Landlord’s negligence or inability or unwillingness to make tax payments when due including tax penalties and interest, so long as such penalties or interest do not result from Tenant’s breach of this Sublease or Tenant’s failure to make timely payment of any sum due under this Sublease. (t) Any charge or expense to the extent that it is materially in excess of that charged by landlords for similar buildings in the general vicinity of the Premises. (u) Costs due to violation of law. (v) The amount of any deductible with respect to Sublandlord’s insurance, the costs of self insurance or any risk which Landlord has elected to self insure against and premiums for any insurance not carried as of the commencement of the Master Lease or Sublease, but subsequently obtained by Master Landlord or Sublandlord. (w) Any increase of, or reassessment in, real estate taxes and assessments resulting from a sale, transfer or other change in ownership of the Building and/or the Land during the lease term or from any major alterations, improvements, modifications or renovations to the Building and/or the Land or from the addition of additional land area to the project or from Landlord’s failure to secure a property tax reduction to the extent such a reduction was obtained for purposes of establishing the base year or expense stop tax component. (x) Income, profit, franchise, rent, sales, gift, estate, succession, inheritance, foreign ownership, foreign control, transfer, capital levy, and/or personal property taxes payable by Landlord. (y) Costs of correcting defects in construction or equipment or in replacing defective equipment. (z) Any and all costs of Landlord in complying with its obligations under Article 5(b) (entitled “Compliance with Law”) of this Lease. (aa) Any and all costs of Landlord in complying with its obligations under Article 26 (entitled “Environmental Matters”) of this Sublease including, but not limited to, the costs and expenses of clean up, remediation, environmental surveys/assessments, compliance with Environmental Laws (as hereinafter defined), consulting fees, treatment and monitoring charges, transportation expenses and disposal fees, etc. (bb) Any and all costs of Landlord for repairs resulting from damage, destruction or condemnation covered by other provisions of this Sublease. (cc) Any and all costs incurred by Landlord in connection with the transfer or disposition of Landlord’s interest in the Property. (dd) Any and all costs incurred by Landlord in the operation of any specialty operations or facilities at the Building such as any health or exercise club, broadcast facility, rooftop antenna facility, helicopter pad, concierge or any luncheon or other restaurant, club, concession or facility. (ee) If Tenant’s responsibility for Operating Expenses is based upon a “base year” or “expense stop”, any new item or category of expense not included in the base year or expense stop shall not be included in Operating Expenses. (ff) Parking area maintenance, operating costs and real estate taxes for any such parking areas to the extent such costs are offset by parking area revenues. (gg) Initial cost and replacement costs of any permanent landscaping, water features, fountains, artwork, sculptures and other decorative treatments. (hh) Contributions to Operating Expense Reserves. (ii) Any other cost or expense which, under generally accepted accounting principles consistently applied, would not be considered to be an operating expense of the Building or any comparable building.

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