Risk Corridor. Funding from other sources or arrangements identified as funding formula, categorical, all fee-for-service, PECPM MIChild and Adults Benefits Waiver payments are completely excluded from the shared-risk arrangement, as the PIHP assumes full risk of operating within the boundaries of the approved expenditure and revenue budgets of each of these funding arrangements. The shared risk arrangements shall cover all Medicaid 1915, 1915(b)(3) capitation and 1915(c) Habilitation Supports Waiver payments. The risk corridor is administered across all services, with no separation for mental health and substance abuse funding A. The PIHP shall retain unexpended risk-corridor-related funds between 95% and 100% of said funds. The PIHP shall retain 50% of unexpended risk-corridor related funds between 90% and 95% of said funds. The PIHP shall return unexpended risk-corridor-related funds to the MDCH between 0% and 90% of said funds and 50% of the amount between 90% and 95%.
Risk Corridor. 1. The Parties agree that the ETCOC serves as the benchmark upon which the Risk Corridor is based.
Risk Corridor. This Appendix establishes a risk corridor arrangement (Arrangement) between the Department and the PCO.
Risk Corridor. The APM PAYMENT in this contract is a risk sharing arrangement. In the pilot APM Year 1, Contractor shall be subject to the following risk corridor.
Risk Corridor a. A risk corridor arrangement between the PHP and the Department will apply to share in gains and losses of the PHP as defined in this section. The Risk Corridor payments to and recoupments from the PHP will be based on a comparison of the PHP’s reported Risk Corridor Services Ratio (“Reported Serves Ratio”) for the Risk Corridor Measurement Period as defined in this section, to the Target Services Ratio consistent with capitation rate setting and set forth in the Standard Plan Rate Book (“Target Services Ratio”).
Risk Corridor. Funding from other sources or arrangements identified as funding formula, categorical, all fee- for-service, PECPM MIChild and Adults Benefits Waiver payments are completely excluded from the shared-risk arrangement, as the PIHP assumes full risk of operating within the boundaries of the approved expenditure and revenue budgets of each of these funding arrangements. The shared risk arrangements shall cover all Medicaid 1915, 1915(b)(3) capitation and 1915(c) Habilitation Supports Waiver payments. The risk corridor is administered across all services, with no separation for mental health and substance abuse funding.
Risk Corridor. Funding from other sources or arrangements identified as funding formula, categorical, all fee-for-service, PECPM MIChild and Adults Benefits Waiver payments are completely excluded from the shared-risk arrangement, as the PIHP assumes full risk of operating within the boundaries of the approved expenditure and
Risk Corridor. 4.2.4.1. As a result of the unknown risk level associated with the emerging MAGI childless adults population, the State has developed the following risk corridor as a risk- mitigation strategy: Min Max MCO Share Federal/State Share 0% 98% 50% 50% Min Max MCO Share Federal/State Share 98% 102% 100% 0% 102% + 50% 50%
Risk Corridor. Risk Corridor Calculation The CHC-MCO must report the necessary elements of the risk corridor calculation and provide a calculation to the Department. The risk corridor calculation will include a numerator, denominator, and Capitation Service Ratio (CSR). The Department will provide a format for this report that will require an attestation by an independent Certified Public Accountant. The risk corridor numerator represents the CHC-MCO’s experience specific to CHC and shall be reported by the CHC-MCO as required by 42 C.F.R. § 438.8(e). Similarly, the denominator shall be reported by the CHC-MCO as required by 42 C.F.R. § 438.8(f) with the following exception: the risk corridor denominator shall not include any projected risk corridor payments or receipts for the applicable Arrangement Year. The CHC-MCO must comply with any additional requirements, guidance, or instructions released by CMS that relate to the computation of the MLR as required by 42 C.F.R. § 438.8. No credibility adjustment, as described in 42 CFR § 438.8(h), may be applied during the risk corridor calculation.
Risk Corridor. Agency shall include a risk corridor for the rate period beginning July 1, 2023 running through June 30, 2024. The Agency reserves the right to prospectively modify the terms of the risk corridor described though a contract amendment.
