Risk corridor definition

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

Split View

AI-Powered Contracts

Draft, Review & Redline at the Speed of AI

Get StartedSchedule a Demo

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 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.

Examples of Risk corridor in a sentence

• Risk corridor reporting will be submitted by the MCOPs in a format and frequency determined by ODM.

• For the purpose of risk corridor reporting, the actual MLR should be calculated consistent with 42 CFR § 438.8. Risk corridor reporting will be submitted by the MCPs in a format and frequency determined by ODM.

• Risk corridor share: The Medicare and Medicaid contributions to risk corridor payments or recoupments will be in proportion to their contributions to the capitated rates, not including Part D, with the maximum Medicare payment/recoupment equaling two percent (2%) of the risk-adjusted Medicare baseline.

• Risk corridor tiers: CMS and MDHHS will use the bands as described in Exhibit 6 to address potential ICO gains/losses in Demonstration Year.

• Risk corridor tiers CMS and the Commonwealth will use the following bands to address potential Participating Plan gains/losses in Demonstration Year 1: Greater than 10.0% gain/loss, Participating Plans would bear 100% of the risk/reward.

More Definitions of Risk corridor

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.

Risk corridor somehow means that payments must be made annually. Pl.’s Opp’n at 14. But as Land of Lincoln’s complaint makes clear, a risk corridor merely refers to a designated percentage range represented by an issuer’s ratio of allowable costs to the target amount. See Compl. ¶ 69 (reproducing American Academy of Actuaries illustration of the various allowable cost-to-target corridors). HHS is required to assign one of several risk corridors (i.e., 92-97%, 103-108%, etc.) to every participating plan in each year. See 42 U.S.C. § 18062(b) (setting forth applicable corridors under the ACA); see also 42 U.S.C. § 1395w-115(e)(3) (“For each plan year the Secretary shall establish a risk corridor for each . . . plan.”) (emphasis added). Thus, Land of Lincoln’s contention that there is only “one [risk corridor] for each calendar year” is wrong. Pl.’s Opp’n at 14. Congress’s use of the plural denotes the fact that each issuer is assigned one of several possible risk corridors in each year. It says nothing about when payments will take place.