Material Adjustment definition

Material Adjustment. An adjustment that, using reasonable actuarial judgment, has a significant impact on the development of the capitation payment such that its omission or misstatement could impact a determination whether the development of the capitation rate is consistent with generally accepted actuarial principles and practices. Medicaid: The BadgerCare Plus and Medicaid SSI Program operated by the Wisconsin Department of Health Services under Title XIX of the Federal Social Security Act, Wis. Stats., Ch. 49, and related state and federal rules and regulations. Medicaid SSI (Supplemental Security Income): Wisconsin’s Medicaid plans for the elderly, blind or disabled provide health care for members who are:
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Material Adjustment. An adjustment that, using reasonable actuarial judgment, has a significant impact on the development of the nonrisk prepayment such that its omission or misstatement could impact a determination whether the development of the nonrisk prepayment rate is consistent with generally accepted actuarial principles and practices. Medicaid: The BadgerCare Plus and Medicaid SSI Program operated by the Wisconsin Department of Health Services under Title XIX of the Federal Social Security Act, Wis. Stats. Ch. 49, and related state and federal rules and regulations. Medical Home: The provision of care that is accessible, family-centered, continuous, comprehensive, coordinated, compassionate and culturally competent, per the American Academy of Pediatrics (AAP). The term “medical home” describes a structure and concept of coordinated medical care and is designed to provide high-quality, cost- effective health care services. The medical home is distinguished from other models of care by the provider’s level of expertise in serving children with complex needs and the fundamental commitment to address not only medical, but also psychosocial and community issues affecting the physical and emotional health of the child and family. The goal of a medical home is to link children to services and resources in a coordinated effort to maximize their developmental potential and provide them with optimal health care. The medical home model provides the family with central point of information, access, and service coordination from a trusted professional that is concerned for the wellbeing of the child and family. Pediatric health care professionals and parents act as partners in a medical home to identify and access all the essential medical and non- medical services needed to help children and their families achieve their maximum potential. Medically Necessary: A medical service, device or item that meets the definition of Wis. Adm. Code §DHS 101.03(96m).
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Material Adjustment. An adjustment that, using reasonable actuarial judgment, has a significant impact on the development of the capitation payment such that its omission or misstatement could impact a determination whether the development of the capitation rate is consistent with generally accepted actuarial principles and practices.
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Examples of Material Adjustment in a sentence

  • Labor and Material Adjustment - a modification of the contract base price on the basis of increases or decreases of wage rates, specific material costs, or both, using agreed upon standards or indices.

  • Shall be in accordance with Section 402.19, except the Material Adjustment Factor (MAF) shall not apply.

  • The second method provides for offsetting (dual) adjustments to condition or purpose code in a single Material Adjustment Document.

  • The Material Adjustment Document, DD Form 1487, is designed for either a single or dual transaction.

  • Where no long term basis for material properties as noted above is available provide rationale for the use of Material Adjustment Factors to convert short term testing results to conservative long term values in a manner satisfactory to the Contract Administrator.

  • The Contractor must complete and submit to the Contracting Authority Form CF152, Material Adjustment Report.

  • This is possible by using the "FROM" and "TO" data fields in the Material Adjustment Document.

  • Hazardous Material Adjustment Clause (Rider HMAC) base rate amount.

  • The City prefers to have a full tolerance band, one hundred percent (100%) with no Material Adjustment Clause (MAC); however, this is not a requirement.

  • Price Adjustment - a modification of the base purchase order price on the basis of increases or decreases in published or established prices of specific items.8.10.5.1.2 Labor and Material Adjustment - a modification of the contract base price on the basis of increases or decreases of wage rates, specific material costs, or both, using agreed upon standards or indices.


More Definitions of Material Adjustment

Material Adjustment. As defined in 42 CFR § 438.2, an adjustment that, using reasonable actuarial judgment, has a significant impact on the development of the capitation payment such that its omission or misstatement could impact a determination whether the development of the capitation rate is consistent with generally accepted actuarial principles and practices. “Medallion 4.0” A statewide mandatory Medicaid program, approved by the Centers for Medicare & Medicaid Services through a 1915(b) waiver, which utilizes contracted managed care organizations (MCOs) to provide medical services to qualified individuals. . “(Medallion 4.0) Carved-Out Services” The subset of covered services which the Contractor shall not be responsible for covering under the program.
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Material Adjustment. An adjustment that, using reasonable actuarial judgment, has a significant impact on the development of the capitation payment such that its omission or misstatement could impact a determination whether the development of the capitation rate is consistent with generally accepted actuarial principles and practices. Outcomes: Changes in patient health, functional status, satisfaction or goal achievement that result from health care or supportive services. Rate Cell: A set of mutually exclusive categories of enrollees that is defined by one or more characteristics for the purpose of determining the capitation rate and making a capitation payment; such characteristics may include age, gender, eligibility category, and region or geographic area. Each enrollee should be categorized in one of the rate cells for each unique set of mutually exclusive benefits under the contract. Rating Period: A period of 12 months selected by the Department for which the actuarially sound capitation rates are developed and documented in the rate certification submitted to CMS as required by 42 CFR §438.7(a).
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Material Adjustment means an amount in excess of $1 million with respect to the Wholesale Business or $1 million with respect to the Retail Business (determined, in each case, individually or in the aggregate). If such audit results in any dispute as to whether any adjustment to the Base Purchase Price was made in accordance with this Agreement, the dispute shall be resolved pursuant to the dispute resolution provisions of Section 15.1 (and, for certainty, for the purposes of determining any applicable time periods or limitation periods for any dispute, including pursuant to Applicable Law or pursuant to the terms of this Agreement, such time period shall not commence until the completion of any audit and the results of such audit are made known to the Parties).
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Material Adjustment has the meaning set forth in Section 4.10;
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Material Adjustment shall have the meaning given such term in the definition of “Applicable Base Rate Margin.”
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Related to Material Adjustment

  • Potential Adjustment Event means any of the following:

  • Informal adjustment means an agreement reached among the parties, with consultation, but not the consent, of the victim of the crime or other persons specified in KRS 610.070 if the victim chooses not to or is unable to participate, after a petition has been filed, which is approved by the court, that the best interest of the child would be served without formal adjudication and disposition;

  • Material Project EBITDA Adjustments means, with respect to each Material Project:

  • Final Adjustment Amount has the meaning set forth in Section 2.4(c).

  • SOFR Adjustment means 0.10% (10 basis points).

  • Consolidated Working Capital Adjustment means, for any period on a consolidated basis, the amount (which may be a negative number) by which Consolidated Working Capital as of the beginning of such period exceeds (or is less than) Consolidated Working Capital as of the end of such period.

  • Final Adjustment Statement has the meaning set forth in Section 2.6(c).

  • Net Working Capital Adjustment means (a) the amount by which Net Working Capital as of immediately prior to the Closing exceeds Target Net Working Capital or (b) the amount by which Net Working Capital as of immediately prior to the Closing is less than Target Net Working Capital, in each case, if applicable; provided, that any amount which is calculated pursuant to clause (b) above shall be deemed to be a negative number.

  • Working Capital Adjustment shall have the meaning set forth in Section 3.5(c)(i).

  • Lot line adjustment means the relocation of the property boundary line in a