Common use of Rate Adjustments Clause in Contracts

Rate Adjustments. The Health Plan and the Agency acknowledge that the capitation rates paid under this Contract, as specified in Attachment I of this Contract, are subject to approval by the federal government. a. Adjustments to funds previously paid and to be paid may be required. Funds previously paid shall be adjusted when capitation rate calculations are determined to have been in error, or when capitation payments have been made for Medicaid recipients who are determined to be ineligible for Health Plan enrollment during the period for which the capitation payments were made. In such events, the Health Plan agrees to refund any overpayment and the Agency agrees to pay any underpayment. b. If the Agency receives legislative direction as specified in subsection F.1., Payment Assessments, Choice Counseling, respectively, the Agency shall annually, or more frequently, determine the actual expenditures for enrollment and disenrollment services rendered by the choice counselor/enrollment broker. The Agency will compare capitation rate assessments to the actual expenditures for such enrollment and disenrollment services. The following factors will enter into the cost settlement process: (1) If the amount of capitation rate assessments is less than the actual cost of providing enrollment and disenrollment services rendered by the choice counselor/enrollment broker, the Health Plan shall pay the difference to the Agency within thirty (30) calendar days of settlement. (2) If the amount of capitation assessments exceeds the actual cost of providing enrollment, and disenrollment services, the Agency will pay the difference to the Health Plan within thirty (30) calendar days of the settlement. c. As the Agency adjusts the plan factor based on updated historical data, the Health Plan’s capitation rates will be adjusted according to the methodology indicated in the capitation rate tables. d. The Agency may adjust the Health Plan’s capitation rates if the percentage deducted for the enhanced benefit accounts fund is modified due to program needs.

Rate Adjustments. The Health Plan and the Agency acknowledge that the capitation rates Capitation Rates paid under this Contract, as specified in Attachment I Payment and Maximum Authorized Enrollment Levels of this Contract, are subject to approval by the federal government. a. Adjustments to funds previously paid and to be paid may be required. Funds previously paid shall be adjusted when capitation rate Capitation Rate calculations are determined to have been in error, or when capitation payments have been made for Medicaid recipients Recipients who are determined to be ineligible for Health Plan enrollment Enrollment during the period for which the capitation payments were made. In such events, the Health Plan agrees to refund any overpayment and the Agency agrees to pay any underpayment. b. If the Agency receives legislative direction as specified in Section XIII, subsection F.1., Payment Assessments, Choice Counseling, respectively, the Agency shall annually, or more frequently, determine the actual expenditures for enrollment Enrollment and disenrollment Disenrollment services rendered by the choice counselorChoice Counselor/enrollment brokerEnrollment Broker. The Agency will compare capitation rate Capitation Rate assessments to the actual expenditures for such enrollment Enrollment and disenrollment Disenrollment services. The following factors will enter into the cost settlement process: (1) If the amount of capitation rate Capitation Rate assessments is are less than the actual cost of providing enrollment Enrollment and disenrollment Disenrollment services rendered by the choice counselorChoice Counselor/enrollment brokerEnrollment Broker, the Health Plan shall pay the difference to the Agency within thirty (30) calendar days Calendar Days of settlement. (2) If the amount of capitation assessments exceeds the actual cost of providing enrollmentEnrollment, and disenrollment Disenrollment services, the Agency will pay the difference to the Health Plan within thirty (30) calendar days Calendar Days of the settlement. c. As the Agency adjusts the plan factor Plan Factor based on updated historical data, the Health Plan’s capitation rates Capitation Rates will be adjusted according to the methodology indicated in the capitation rate Capitation Rate tables. d. The Agency may adjust the Health Plan’s capitation rates Capitation Rates if the percentage deducted for the enhanced benefit accounts Enhanced Benefit Accounts fund is modified due to program needs.

Rate Adjustments. The Health Plan and the Agency acknowledge that the capitation rates paid under this Contract, as specified in Attachment I of this Contract, are subject to approval by the federal government. a. Adjustments to funds previously paid and to be paid may be required. Funds previously paid shall be adjusted when capitation rate calculations are determined to have been in error, or when capitation payments have been made for Medicaid recipients who are determined to be ineligible for Health Plan enrollment during the period for which the capitation payments were made. In such events, the Health Plan agrees to refund any overpayment and the Agency agrees to pay any underpayment. b. If the Agency receives legislative direction as specified in subsection F.1E.1., Payment Assessments, Choice Counseling, respectively, the Agency shall annually, or more frequently, determine the actual expenditures for enrollment and disenrollment services rendered by the choice counselor/enrollment broker. The Agency will compare capitation rate assessments to the actual expenditures for such enrollment and disenrollment services. The following factors will enter into the cost settlement process: (1) If the amount of capitation rate assessments is less than the actual cost of providing enrollment and disenrollment services rendered by the choice counselor/enrollment the broker, the Health Plan shall pay the difference to the Agency within thirty (30) calendar days of settlement. (2) If the amount of capitation assessments exceeds the actual cost of providing enrollment, and disenrollment services, the Agency will pay the difference to the Health Plan within thirty (30) calendar days of the settlement. c. As the Agency adjusts the plan factor based on updated historical data, the Health Plan’s capitation rates will be adjusted according to the methodology indicated in the capitation rate tables. d. The Agency may adjust the Health Plan’s capitation rates if the percentage deducted for the enhanced benefit accounts fund is modified due to program needs.

Rate Adjustments. The Health Plan and the Agency acknowledge that the capitation rates paid under this Contract, as specified in Attachment I of this Contract, are subject to approval by the federal government. a. Adjustments to funds previously paid and to be paid may be required. Funds previously paid shall be adjusted when capitation rate calculations are determined to have been in error, or when capitation payments have been made for Medicaid recipients who are determined to be ineligible for Health Plan enrollment during the period for which the capitation payments were made. In such events, the Health Plan agrees to refund any overpayment and the Agency agrees to pay any underpayment. b. If the Agency receives legislative direction as specified in subsection F.1., Payment Assessments, Choice Counseling, respectively, the Agency shall annually, or more frequently, determine the actual expenditures for enrollment and disenrollment services rendered by the choice counselor/enrollment broker. The Agency will compare capitation rate assessments to the actual expenditures for such enrollment and disenrollment services. The following factors will enter into the cost settlement process: (1) If the amount of capitation rate assessments is less than the actual cost of providing enrollment and disenrollment services rendered by the choice counselor/enrollment broker, the Health Plan shall pay the difference to the Agency within thirty (30) calendar days of settlement. (2) If the amount of capitation assessments exceeds the actual cost of providing enrollment, and disenrollment services, the Agency will pay the difference to the Health Plan within thirty (30) calendar days of the settlement. c. As the Agency adjusts the plan factor based on updated historical data, the Health Plan’s capitation rates will be adjusted according to the methodology indicated in the capitation rate tables. d. The Agency may adjust the Health Plan’s capitation rates if the percentage deducted for the enhanced benefit accounts fund is modified due to program needs.

Rate Adjustments. The Health Plan and the Agency acknowledge that the capitation rates paid under this Contract, as specified in Attachment I of this Contract, are subject to approval by the federal government. a. Adjustments to funds previously paid and to be paid may be required. Funds previously paid shall be adjusted when capitation rate calculations are determined to have been in error, or when capitation payments have been made for Medicaid recipients who are determined to be ineligible for Health Plan enrollment during the period for which the capitation payments were made. In such events, the Health Plan agrees to refund any overpayment and the Agency agrees to pay any underpayment. b. If the Agency receives legislative direction as specified in subsection F.1., Payment Assessments, Choice Counseling, respectively, the Agency shall annually, or more frequently, determine the actual expenditures for enrollment and disenrollment services rendered by the choice counselor/enrollment broker. The Agency will compare capitation rate assessments to the actual expenditures for such enrollment and disenrollment services. The following factors will enter into the cost settlement process:: AMERIGROUP Florida, Inc. d/b/a Medicaid Non-Reform and Reform AMERIGROUP Community Care HMO Contract (1) If the amount of capitation rate assessments is less than the actual cost of providing enrollment and disenrollment services rendered by the choice counselor/enrollment broker, the Health Plan shall pay the difference to the Agency within thirty (30) calendar days of settlement. (2) If the amount of capitation assessments exceeds the actual cost of providing enrollment, and disenrollment services, the Agency will pay the difference to the Health Plan within thirty (30) calendar days of the settlement. c. As the Agency adjusts the plan factor based on updated historical data, the Health Plan’s capitation rates will be adjusted according to the methodology indicated in the capitation rate tables. d. The Agency may adjust the Health Plan’s capitation rates if the percentage deducted for the enhanced benefit accounts fund is modified due to program needs.