Vetting and Developing Financial and Actuarial Models as necessary Sample Clauses

Vetting and Developing Financial and Actuarial Models as necessary. The Contractor shall review payment and delivery models for a risk bearing ACO or ACOs, and participating providers inside and outside of an ACO or ACOs (Hospitals, FQHCs, Physician Owned Practices, Specialists, etc). The Contractor shall assist in calculating and/or confirming base year expenditures for Medicare, Medicaid, and Commercial payers. The Contractor shall be expected to work with other State contractors with expertise and experience with the Medicaid 1115 Global Commitment Waiver as well as Medicaid reimbursement. The Contractor shall also identify any boundaries in regard to trend, achievable Medicare savings, if any, and other considerations that would make an all-payer model and Medicare waiver agreement acceptable or unacceptable to Vermont. The Contractor shall test healthcare expenditure data to be certain it is accurate and appropriate for model inclusion. Further, the Contractor shall recommend a growth trend for incorporation in the all-payer model agreement, based on historical trends examining various time series. The Contractor shall also conduct actuarial or other financial analyses including, but not limited to, those necessary to develop various additional financial models and confirm their reasonableness. This process shall involve documentation and review to make sure that modeling matches the proposed program’s plan design. The Contractor shall analyze the potential effect of alternative waiver terms and conditions on Vermont. Throughout the process, the Contractor shall provide State project leaders and coordinators with ongoing feedback and updates regarding model testing and or development.
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