Vermont Medicaid Authority Sample Clauses

Vermont Medicaid Authority. The State represents and warrants that AHS will have the authority under a Section 1115 Medicaid waiver by January 1, 2017, to operate Vermont Medicaid, including Medicaid payment methodologies, to meet the requirements of this Agreement. AHS shall not withdraw or request modification of the Section 1115 Medicaid waiver in such a way as to limit its authority to participate in the Model. In addition, when AHS applies to CMS for a new waiver or a waiver renewal, the application to CMS shall request terms and conditions that are consistent with this Agreement. This Agreement does not limit or modify any rules and regulations or processes applicable to such approvals and as such, CMS intends to support consistency of any new Section 1115 Medicaid waiver or waiver renewal with this Agreement. Additionally, this Agreement does not abrogate the designation of AHS as the Single State Agency as required by 42 C.F.R. § 431.10 or to otherwise alter AHS’s responsibilities as the Single State Agency, to include its sole authority to set rates for Vermont Medicaid.

Vermont Medicaid Authority. By January 1, 2018, the State shall secure approval from CMS under section 1115(a) of the Social Security Act authorizing Vermont’s state Medicaid agency to operate Vermont Medicaid, including Medicaid payment methodologies, to meet the requirements of this Agreement. Vermont must maintain such approval for the duration of the Model. This Agreement does not limit or modify any rules and regulations or processes applicable to such approvals. Additionally, this Agreement does not abrogate the designation of the AHS as the single State agency as required by 42 C.F.R. § 431.10 or alter AHS’s sole authority to set rates for Vermont Medicaid. 4. ACO Scale Targets. a. Percentage of Vermont Beneficiaries Aligned to an ACO. Vermont shall ensure that the percentage of Vermont Medicare Beneficiaries and the percentage of Vermont All-payer Scale Target Beneficiaries aligned to a Scale Target ACO Initiative, as defined in section 4.b, meet or exceed the following percentages for each Performance Year (“ACO Scale Targets”): Percent (%) By end of PY1 (2018) By end of PY2 (2019) By end of PY3 (2020) By end of PY4 (2021) By end of PY5 (2022) Vermont All-Payer Scale Target Beneficiaries 36% 50% 58% 62% 70% Vermont Medicare Beneficiaries 60% 75% 79% 83% 90% b. Scale Target ACO Initiatives. A Scale Target ACO Initiative is an ACO arrangement offered by Vermont Medicaid, Vermont Commercial Plans, Vermont Self-insured Scale Target Plans, and/or Medicare FFS (e.g., Vermont Medicare ACO Initiative, Vermont Modified Next Generation ACO Model, Medicare Shared Savings Program) to a Vermont ACO that incorporates, at a minimum, the following: i. The Vermont ACO has available the possibility of Shared Savings if the Vermont ACO achieves goals related to quality of care and/or utilization; ii. The Vermont ACO’s portion, as a percentage of the ACO’s expenditures less than the ACO’s benchmark, of Shared Savings is, at minimum 30 percent, and if it is also at risk for Shared Losses, the Vermont ACO’s portion, as a percentage of the ACO’s expenditures in excess of the ACO’s benchmark, of Shared Losses for which it is responsible to the payer is, at minimum, 30 percent; iii. Services comparable to, but not limited to, the All-payer Financial Target Services and their associated expenditures are included for determination of the ACO’s Shared Losses and Shared Savings; and iv. The ACO Benchmark is tied to the quality of care it delivers and/or the health of its aligned beneficiaries.