Risk Corridor Payment Adjustment Sample Clauses

Risk Corridor Payment Adjustment. The Net Capitation Payment made to the Contractor for ACA Expansion Members and their associated healthcare costs shall be evaluated against a designated risk corridor to determine whether a Risk Corridor Payment Adjustment is warranted for Calendar Years 2014 and 2015, and from January 1 to June 30 for Calendar Year 2016. While the Symmetrical Risk Corridor is no longer applicable, this provision is contained herein to ensure continuity and to note the Contractor’s obligation under previous contracts to complete a preliminary and final Risk Corridor Adjustment process. A Symmetrical Risk Corridor shall be established around a target Medical Loss Ratio, as defined in Appendix B “Medical Loss Ratio Calculation,” of eighty- seven (87) percent of net capitation paid by the Department on behalf of ACA Expansion members for each Calendar Year. A range of plus or minus five (5) percent, for which no premium adjustment shall be made, will be established around the Medical Loss Ratio target. If the Contractor has a Medical Loss Ratio outside of the target range, it shall be subject to an adjustment to total ACA Expansion Members capitation payments for the Calendar Year. The adjustment will be computed as eighty (80) percent of the difference between the actual countable ACA Expansion Members medical expenses of the Contractor and the dollar amount corresponding to the upper or lower risk corridor boundary. Total medical expenses below the lower risk corridor boundary of eighty-two (82) percent will result in a premium refund from the Contractor to the Department. Total medical expenses above the upper risk corridor boundary of ninety-two (92) percent will result in an additional premium payment from the Department to the Contractor. The first period of operation subject to this adjustment shall be Calendar Year 2014 and the last period subject to this adjustment shall be January 1 to June 30, 2016. The preliminary Risk Corridor Payment Adjustment process will begin six (6) months after the end of each calendar year. The Final Risk Corridor Payment Adjustment process will begin twelve (12) months after the end of each Calendar Year. If the Contract with the Contractor is not renewed or is terminated at any time, the risk corridor process will be unchanged except that the Medical Loss Ratio and Annual Statement will reflect an appropriately reduced number of months of experience instead of the full twelve (12) months. As part of the preliminary and final financial ...
Sample 1Sample 2See All (4)
AutoNDA by SimpleDocs

Related to Risk Corridor Payment Adjustment

  • Subsequent Adjustments In the event that the Assuming Institution or the Receiver discovers any errors or omissions as contemplated by Section 8.2 or any error with respect to the payment made under Section 8.3 after the Settlement Date, the Assuming Institution and the Receiver agree to promptly correct any such errors or omissions, make any payments and effect any transfers or assumptions as may be necessary to reflect any such correction plus interest as provided in Section 8.4.

  • Structural Adjustment 1. Exceptional measures of limited duration which derogate from the provisions of Article 4 may be taken by the Parties in the form of increased customs duties.

  • ECONOMIC PRICE ADJUSTMENT is the adjustment to the Aircraft Basic Price (Base Airframe, Engine and Special Features) as calculated pursuant to Exhibit D.

  • Wage Adjustment Notwithstanding any provision in this Agreement on the contrary, the wages of employees shall be reduced by the amount of employee contributions made by the employer pursuant to the provisions hereof.

  • CPI Adjustment In this Agreement, “CPI-Adjusted” in reference to an amount means that amount is adjusted under the following formula: N  C  (1 CPIn  CPIc ) CPIc where: ”N” is the new amount being calculated; and “C” is the current amount being adjusted; and

  • Adjustments to Purchase Price The Purchase Price shall be adjusted as follows:

  • Contract Price Adjustment The basis upon which the Contract Price shall be adjusted is as set out in paragraph 9.2 of Schedule IVB.

  • Workforce Adjustment (a) The Parties recognize that workforce adjustment may be necessary due to the elimination of positions resulting from a reduction in the amount of work required to be done by the Commission, reorganization or program termination.

  • Second Year Wage Adjustment Effective July 1, 2020, all salary ranges and rates shall be increased by two and one-half percent (2.50%), rounded to the nearest cent. Salary increases provided by this Section shall be given to all employees including those employees whose rates of pay exceed the maximum rate for their class. The compensation grids for classes covered by this Agreement are contained in Appendix E-2. Conversion to the new compensation grid shall not change an employee’s eligibility for step progression increases.

  • Reallocation to a Class with a Lower Salary Range Maximum 1. If the employee meets the skills and abilities requirements of the position and chooses to remain in the reallocated position, the employee retains existing appointment status and has the right to be placed on the Employer’s internal layoff list for the classification occupied prior to the reallocation.

Time is Money Join Law Insider Premium to draft better contracts faster.