Risk Adjustment Methodology Sample Clauses

Risk Adjustment Methodology. A. The Medicare A/B Demonstration county rate will be risk adjusted based on the risk profile of each enrolled beneficiary. Except as specified in section II.B.g, the existing CMS-HCC risk adjustment methodology will be utilized for the Demonstration.
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Risk Adjustment Methodology. To account for variation in risk for the costs of EW services among Enrollees, the STATE will calculate an MCO-specific risk score for the EW add-on rate in section 4.6 on an annual basis. The STATE agrees not to rebase the base rates for risk adjustment during the term of this Contract.‌‌
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Risk Adjustment Methodology. The MEMA adjustment is applied by region for the NFLOC rate cell for each MCOP. Each population group within the NFLOC rate cell is given a weight based on its relative capitation rate compared to the composite NFLOC capitation rate. Each MCOP will receive a calculated MEMA score based on their enrollment of each population group within the NFLOC rate cell. To ensure budget neutrality, the MEMA scores will be normalized to 1.000 for each region. MEMA methodology uses generally accepted actuarial principles and practices.
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Risk Adjustment Methodology. Medicare Parts A/B: The Medicare Parts A/B Component will be risk adjusted based on the risk profile of each Enrollee. Except as specified in Section 4.3.5.1.1, the existing Medicare Advantage CMS‑HCC and CMS‑HCC ESRD risk adjustment methodology will be used for the Demonstration. Coding Intensity Adjustment Factor CMS will calculate calendar year 2013 rates as if the coding intensity adjustment factor were not applied, to reflect the fact that virtually all Enrollees were receiving care in FFS Medicare and thus there should be no coding pattern differences for which to adjust. Operationally CMS will still apply the coding intensity adjustment factor to the risk scores but will increase the Medicare A/B baseline for non‑ESRD beneficiaries and beneficiaries with an ESRD status of functioning graft, to offset this.
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Risk Adjustment Methodology. In order to account for variation in risk or health status across Enrollees, the STATE will calculate an MCO specific risk score for the Medicaid portion of the acute care rates on a quarterly basis using a capitation risk adjustment method based on disease categories assigned by the Chronic Illness and Disability Payment System (CDPS).
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Risk Adjustment Methodology. 4.2.4.1 Medicare Parts A/B: The Medicare Parts A/B Component will be risk adjusted based on the risk profile of each Enrollee. Except as specified in Section 4.2.4.2, the existing Medicare Advantage CMS-HCC and CMS-HCC ESRD risk adjustment methodology will be used for the Demonstration.
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Risk Adjustment Methodology. The risk adjustment is designed to be cost neutral for each population. Relative risk scores will be normalized to result in a composite risk score of 1.000 for each population group, across all MCPs. The risk adjustment methodology uses generally accepted actuarial principles and practices.
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Risk Adjustment Methodology. Medicare Parts A/B: The Medicare Parts A/B Component will be risk adjusted based on the risk profile of each Enrollee. Except as specified in Sections 4.6.7.5.1 through 4.6.7.5.4, the existing Medicare Advantage CMS-HCC and CMS-HCC ESRD risk adjustment methodology will be used for the Demonstration. In calendar year 2015, CMS will calculate and apply a coding intensity adjustment reflective of all Demonstration Enrollees. This will apply the prevailing Medicare Advantage coding intensity adjustment proportional to the anticipated proportion of Demonstration Enrollees in 2015 with Medicare Advantage experience in 2014, prior to the Demonstration. In calendar year 2016, CMS will apply an appropriate coding intensity adjustment reflective of all Demonstration Enrollees; this will apply the prevailing Medicare Advantage coding intensity adjustment proportional to the anticipated proportion of Demonstration Enrollees in CY 2016 with prior Medicare Advantage experience and/or Demonstration experience based on the Demonstration’s Enrollment phase-in as of September 30, 2015. (This may result in application of the full Medicare Advantage coding intensity adjustment for 2016.) After calendar year 2016, CMS will apply the prevailing Medicare Advantage coding intensity adjustment to all Demonstration Enrollees. The coding intensity adjustment factor will not be applied during the Demonstration to risk scores for Enrollees with an ESRD status of dialysis or transplant, consistent with Medicare Advantage policy. Medicare Part D: The Medicare Part D NAMBA will be risk adjusted in accordance with existing Part D RxHCC methodology. The estimated average monthly prospective payment amount for the low-income cost-sharing subsidy and federal reinsurance amounts will not be risk adjusted. Medicaid: The Medicaid component will employ rating categories described in Section 4.2.1. Risk Mitigation Approaches Risk Corridor Risk corridors will be established for Demonstration Year 1. Risk corridors will not be applied for Demonstration Years 2-10. The Demonstration will utilize a tiered ICO-level symmetrical risk corridor to include all Medicare A/B and Medicaid eligible costs. The risk corridors will be reconciled after application of any risk adjustment methodologies (e.g., CMS-HCC). Risk corridors will be reconciled as if all ICOs had received the full quality withhold payment. Process for collecting cost information CMS and MDHHS will evaluate Encounter Dat...
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Risk Adjustment Methodology. The Medicare A/B Demonstration county rate will be risk adjusted based on the risk profile of each enrolled beneficiary. Except as specified in section II.B.g of this Appendix for calendar year 2013, the existing CMS-HCC risk adjustment methodology will be utilized for the Demonstration. The Medicare Part D national average bid will be risk-adjusted in accordance with existing Part D RxHCC methodology. The Medicaid component will be risk adjusted based on a methodology proposed by the Commonwealth and agreed to by CMS as described below: Under the Massachusetts Demonstration to Integrate Care for Dual Eligible Beneficiaries, the Commonwealth will rely on rating categories described in section I and use High Cost Risk Pools (HCRPs) for certain Rating Categories described in section IX to account for differences in risk among the eligible population. The Commonwealth will be collecting functional data and will be working on the development of an enhanced risk adjustment methodology for the Medicaid component of the rate during the course of the Demonstration.
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Related to Risk Adjustment Methodology

  • Payment Methodology The Contractor shall be compensated based on the payment methodology for goods or services authorized by the State in a total amount as set forth in Section C.1.

  • Non pre-priced Adjustment Factor To be applied to Work determined not to be included in the CTC but within the general scope of the work: 1.1500.

  • Methodology 1. The price at which the Assuming Institution sells or disposes of Qualified Financial Contracts will be deemed to be the fair market value of such contracts, if such sale or disposition occurs at prevailing market rates within a predefined timetable as agreed upon by the Assuming Institution and the Receiver.

  • ECONOMIC ADJUSTMENT Beginning twelve (12) months after the effective date of this Statewide Contract and for every annual anniversary thereafter, the prices set forth in Exhibit B – Prices for Services shall be adjusted, based upon the percent changes (whether up or down) in the United States Department of Labor, Bureau of Labor and Statistics (BLS) indices described below, for the most recent year. Economic adjustment will lag one (1) calendar quarter past the Contract commencement date to allow for publication of BLS data. All calculations for the index shall be based upon the latest version of data published as of one year of the effective date each year. Prices shall be adjusted on February 1st. If an index is recoded (i.e., the recoded index is a direct substitute for the prior index according to the BLS), this Statewide Contract will use the recoded index, as applicable. If an index becomes unavailable, Enterprise Services shall substitute a proxy index. If there is not a direct substitute, the next higher aggregate index available will be used. The economic adjustment shall be calculated as follows: New Price = Old Price x (Current Period Pricing/Base Period Index)

  • Market Adjustment The parties to this Agreement recognize the appropriateness of market pay adjustments in rare instances for compelling reasons. To effectuate judgments in such cases, the President and AAUP Chapter President, in consultation, shall each name three (3) individuals to a university Market Evaluation Committee. Deans may submit recommendations for market pay adjustments with supporting written reasons to the committee. Said Committee shall consult with the President concerning proposed market pay adjustments reporting its advice not later than May 15 in each year. Upon the favorable recommendation of the President and the Chancellor, market pay adjustments may be approved effective at the beginning of that pay period including September 1 of the following year. Not more than one (1) market pay adjustment per one hundred (100) full-time members, or fraction thereof, may be recommended in any contract year. A member’s salary may not be increased beyond the maximum for the rank. Funding for this program shall be governed by Article 12.10.2.

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