Common use of Return of Withheld Funds for SNBC Clause in Contracts

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌ (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌ (3) The difference between 4.12.5.2(1) and 4.12.5.2(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌ (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and Non-Performance- Based Total will be returned to the MCO according to section 4.1.3.

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 4.13.5.1 For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 4.13.5.2 The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌ (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌4.12.5.2(3).‌‌‌ (3) The difference between 4.12.5.2(1) and 4.12.5.2(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌Total.‌‌‌‌‌ (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and Non-Performance- Based Total will be returned to the MCO according to section 4.1.3.4.1.3.‌‌ 4.14 PAYMENT ERRORS.‌ 4.14.1 Report to the STATE of Overpayment of Capitation Payment‌ The MCO shall report to the STATE within sixty (60) calendar days when the MCO has identified capitation payments or other payments in excess of amounts specified in the Contract. [42 CFR §438.608(c)(3); Minnesota Statutes, §256B.064, subd. 1c]

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 ‌ For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 ) The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌ (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌4.7.4(B)(3).‌ (3) The difference between 4.12.5.2(14.7.4(B)(1) and 4.12.5.2(24.7.4(B)(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌ (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and NonNon- Performance-Performance- Based Total will be returned to the MCO according to section 4.1.34.1.2(E).

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌ (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌4.12.5.2(3).‌‌‌ (3) The difference between 4.12.5.2(1) and 4.12.5.2(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌Total.‌‌‌‌‌ (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and Non-Performance- Based Total will be returned to the MCO according to section 4.1.3.4.1.3.‌‌‌‌‌

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 (A) For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 (B) The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌Total. (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌4.7.4(B)(3). (3) The difference between 4.12.5.2(14.7.4(B)(1) and 4.12.5.2(24.7.4(B)(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌Total. (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and NonNon- Performance-Performance- Based Total will be returned to the MCO according to section 4.1.34.1.2(E).

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 ) The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌Total. (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌4.7.4(B)(3). (3) The difference between 4.12.5.2(14.7.4(B)(1) and 4.12.5.2(24.7.4(B)(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌Total. (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and NonNon- Performance-Performance- Based Total will be returned to the MCO according to section 4.1.34.1.2(E).

Return of Withheld Funds for SNBC. ‌ 4.12.5.1 For this Contract the total amount of the withheld funds available to be returned (the Withheld Total) shall be calculated as the difference between: (1) The total Contract Year basic care portion minus NF add-on of the SNBC Plan Reimbursement Amounts to the MCO (as of May 31 of the year subsequent to the Contract Year), divided by 0.92 (92%) and (2) The total Contract Year basic care portion of the SNBC Plan Reimbursement Amount to the MCO (as of May 31st of the year subsequent to the Contract Year.) 4.12.5.2 The amount of the withheld funds to be returned to the MCO shall be calculated as follows: (1) The Withheld Total shall be multiplied by 0.625 (5.0 / 8.0) or 62.5% to determine the Performance-Based Total.‌Total. (2) The Performance-Based Total shall be multiplied by the Withhold Score, subject to the Loss Limit in 4.12.5.2(3).‌4.12.5.2(3). (3) The difference between 4.12.5.2(1) and 4.12.5.2(2), the Loss Limit or amount of the unreturned funds that are kept by the STATE shall not exceed five percent (5%) of the Performance-Based Total.‌Total. (4) The Withheld Total shall be multiplied by 0.375 (3.0 / 8.0) or 37.5% to determine the Non-Performance-Based Total. (5) The resulting amount from adding the Performance-Based Total and Non-Performance- Based Total will be returned to the MCO according to section 4.1.3.