Risk Corridors; Minimum and Maximum Sample Clauses

Risk Corridors; Minimum and Maximum. Medical Loss Ratio for 2021; Interim and Final Payments in 2022 and 2023.‌‌‌‌
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Risk Corridors; Minimum and Maximum. Medical Loss Ratio for 2021; Interim and Final Payments in 2022 and 2023.‌ 4.6.2.1 Calculation The STATE shall calculate minimum and maximum medical loss ratios (MLR) for the MCO based upon the revenue and incurred claims, as defined in the capitation rate development reports, and reported on the quarterly financial report in section 11.5.1(18). Consistent with the development of the MLRs in 11.5.1(11), revenue will be calculated prior to enhanced hospital payments and assuming all withhold is returned to the MCO. The minimum and maximum MLRs will be one and one-half (1.5) percentage points above or below the Target MLR outlined in the Contract Year 2021 capitation rate development report dated September 17, 2020 (“2021 Rate Development Report”) as shown below. The calculations will be performed after any applicable STATE stop loss provisions are implemented. 4.6.2.2 The amounts will be calculated on the quarterly financial report with zero (0) months of claims runout for the year subsequent to the Contract Year, and on a final basis with twelve
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Risk Corridors; Minimum and Maximum. Medical Loss Ratio for 2021; Interim and Final Payments in 2022 and 2023.‌ 4.3.1.1 Calculation The STATE shall calculate 2021 minimum and maximum medical loss ratios (MLR) for the MCO based upon the revenue and incurred claims, as defined in the capitation rate development reports, and reported on the quarterly financial report in section 11.5.1(15). Consistent with the development of the MLRs in section 11.5.1(8), revenue will be calculated prior to enhanced hospital payments and assuming all withhold is returned to the MCOs. The minimum and maximum MLRs for 2021 will be one and one-half (1.5) percentage points above or below the Target MLR outlined in the Contract Year 2021 capitation rate development report dated September 17, 2020 (“2021 Rate Development Report”) as shown below. 4.3.1.2 The amounts will be calculated on the quarterly financial report on an interim basis with zero (0) months of claims runout, and on a final basis with twelve (12) months of claims runout. The Contract Year 2021 MLRs will be calculated from the quarterly financial report due at the end of the first quarter of 2021 (interim calculation) and the end of the first quarter of 2022 (final calculation). The final risk corridor calculation will address payments or recoupments not already accounted for in the interim calculation. 4.3.1.3 Non-state Plan Services in the financial report will not be included in the numerator of the MLR calculation. The STATE shall notify the MCO of the result of the calculations no later than May 31 of the calculation year. 4.3.1.4 As part of the MLR calculation, the STATE reserves the right to review provider reimbursement for entities with a corporate or financial relationship to the MCO and may adjust reported claim costs accordingly. The STATE also reserves the right to review value- based purchasing or other reimbursement occurring outside of encounter reimbursement and may adjust reported claim costs accordingly. Nothing in this section shall prohibit the MCO from making payments under bona fide value- based agreements evidenced by executed contracts, with providers or entities related to the MCO for the purposes described in 42 CFR §438.8 (titled Medical loss ratio (MLR) standards). As part of the MLR calculation, the STATE shall take into consideration the contractual timing and terms of any payments made by MCOs to providers or entities related to the MCO under value-based arrangements (including ACOs).
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