Risk corridor definition

Risk corridor means payment limits to prevent immediate large financial gains or losses for Iowa hospitals due to APG implementation.

Risk corridor means a risk sharing mechanism in which OHA and Contractor share in both higher and lower than adjusted expenses under the Contract outside of the predetermined target amount so that if Contractor’s adjusted expenses are outside the corridor in which Contractor is responsible for all adjusted expenses, OHA contributes a portion toward additional adjusted expenses, or receives a portion of lower adjusted expenses.

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State contributes a portion toward any addi- tional losses, and receives a portion of any additional profits.(2) Basic requirements. (i) All pay- ments under risk contracts and all risk-sharing mechanisms in contracts must be actuarially sound.(ii) The contract must specify the payment rates and any risk-sharing mechanisms, and the actuarial basis for computation of those rates and mechanisms.(3) Requirements for actuarially sound rates. In setting actuarially sound capi- tation rates, the State must apply the following elements, or explain why they are not applicable:(i) Base utilization and cost data that are derived from the Medicaid popu- lation, or if not, are adjusted to make them comparable to the Medicaid pop- ulation.(ii) Adjustments made to smooth data and adjustments to account for factors such as medical trend inflation, incomplete data, MCO, PIHP, or PAHP administration (subject to the limits in paragraph (c)(4)(ii) of this section), and utilization;

Examples of Risk corridor in a sentence

• Risk Corridor — A risk sharing mechanism in which the Department and PH- MCOs may share in profits and losses under the Agreement outside of a predetermined threshold amount.

• Risk Corridor Percentage — For each Demonstration Year, the Contractor’s Total Adjusted Expenditures divided by the Adjusted Capitation Rate Revenue for the applicable Demonstration Year, rounded to the nearest one tenth of a percent.

• The Utilization Risk Corridor is defined as the number of Inpatient Days that wrap around the days that State has committed to purchase on a prospective basis in the APM Year.

• The reconciliation process is outlined in Attachment 6: Reconciliations and Risk Corridor Evaluation Methodologies.

• Reinsurance, Risk Corridor and Risk Adjustments - The RRD plans to be the AID liaison for planning and implementation of these adverse selection mitigation strategies.

• Losses and gains will be determined using the Risk Corridor Percentage.

• CALENDAR YEAR 2021 TIMELINE FOR RISK CORRIDOR ACTIVITIES RISK CORRIDOR FUNCTION TENTATIVE TIMELINE Claims Dates of Service January 1, 2021 to December 31, 2021 Claims Paid Date June 30, 2022 Claims Submission Date July 31, 2022 Risk Corridor Calculation September 2022 Risk Corridor Settlement October 2022 APPENDIX F MARKETING AND MEMBER COMMUNICATIONS The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment.

• 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.

• Risk Corridor Share The Medicare and Medicaid contributions to risk corridor payments or recoupments will be in proportion to their contributions to the Adjusted Capitation Rate Revenue.

• Risk Corridor Percentage — The Contractor’s Total Adjusted Expenditures divided by the Adjusted Capitation Rate Revenue for Demonstration Year 1, rounded to the nearest one tenth of a percent.

More Definitions of Risk corridor

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State contributes a portion toward any addi- tional losses, and receives a portion of any additional profits.(2) Basic requirements. (i) All pay- ments under risk contracts and all risk-sharing mechanisms in contracts must be actuarially sound.(ii) The contract must specify the payment rates and any risk-sharing mechanisms, and the actuarial basis for computation of those rates and mechanisms.

Risk corridor means a percentage of financial gain or loss, calculated on the medical services portion of the capitation payment only, for which the MCP and ODJFS agree to share liability.

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State contributes a portion toward any addi- tional losses, and receives a portion of any additional profits.

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State

Risk corridor. A risk sharing mechanism in which States and MCOs, PIHPs, or PAHPs may share in profits and losses under the contract outside of a predetermined threshold amount.