Risk corridor definition

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

  • Note: Risk corridor provisions do not apply to fallback plans (§1860D-11(g)(5)) or PFFS plans (§1860D-21(d)(5)), and reduced risk sharing is applied to limited risk plans as detailed in Section 13.3 below.

  • Risk corridor calculations remain largely unchanged (see Section 13); CMS will share risk with the plan around 75 percent of adjusted allowable risk corridor costs in the initial coverage period and 15 percent of adjusted allowable risk corridor costs above the OOP threshold.

  • Autism is cost settled separately from Medicaid; however the amount of funding available from MDHHS is utilized in the calculation of Medicaid Savings / Lapse and Shared Risk corridor (Section 3 of the Medicaid Contract Settlement Worksheet).

  • Risk corridor payables to issuers are obligations of the United States Government under the Health Care Reform law which requires the Secretary of HHS to make full payments to issuers.

  • Risk corridor settlements will also affect the CWM-eligible portion of a CCO’s MLR, but those settlements are expected to be cost neutral on average.

  • Risk corridor collections received for the next year will first be used to pay off the payment reductions issuers experienced in the previous year in a proportional manner, up to the point where issuers are reimbursed in full for the previous year, and will then be used to fund current year payments.

  • Target amount means an amount equal to the total premiums incurred by a QHP, including any premium tax credit under any governmental program, reduced by the allowable administrative costs of the plan.§153.510 Risk corridor establishment and payment methodology.

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


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.
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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.
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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.
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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.
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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
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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.
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Related to Risk corridor

  • Corridor or "Detroit-Chicago corridor" means the area between Detroit and Chicago within which a high speed rail line is to be located. The corridor shall run between the general geographic areas established by the proposal submitted to the commission.

  • Railway Corridor means, prior to the grant of a Special Railway Licence, the land for the route of the Railway the subject of that licence, access roads (other than Lateral Access Roads), areas from which stone, sand, clay and gravel may be taken, temporary accommodation facilities for the railway workforce, water bores and Additional Infrastructure (if any) which is the subject of a subsisting agreement pursuant to subclause (3)(a) and after the grant of the Special Railway Licence the land from time to time the subject of that Special Railway Licence;

  • Core means a pedestrian-oriented area of commercial and civic uses serving the surrounding municipality, generally including housing and access to public transportation.

  • Structural pest control means a use requiring a license under Chapter 14 (commencing with Section 8500), Division 3, of the Business and Professions Code.

  • Sailboat means the same as that term is defined in Section 73-18-2.

  • Deck means a walkway immediately adjacent to a swimming pool.

  • Gate means any structure or device located to limit or prohibit access or entry to any cave.

  • Dike means an embankment or ridge of either natural or man-made materials used to prevent the movement of liquids, sludges, solids, or other materials.

  • Flowgate means a representative modeling of facilities or groups of facilities that may act as potential constraint points.

  • Plumber means a person who has passed a qualifying Trade Test in Plumbing or has been issued with a certificate of proficiency in terms of the Manpower Training Act, 1981 (Act No 56 of 1981) or such other qualification as may be required under national legislation;

  • Uppermost aquifer means the geologic formation nearest the natural ground surface that is an aquifer, as well as lower aquifers that are hydraulically interconnected with this aquifer within the facility's property boundary.

  • HUB means Historically Underutilized Business, as defined by Chapter 2161 of the Texas Government Code.

  • Master plumber means an individual who possesses the necessary skills and qualifications to plan and supervise the installation of plumbing and who is licensed as a master plumber.

  • Structural Engineer means the Engineer appointed or to be appointed from time to time by Promoter for the preparation of the structural design and drawings of the buildings .

  • Elevation means the vertical distance of a point or a level, on or affixed to the surface of the earth, measured from mean sea level;

  • Bulkhead means an airtight structure separating the working chamber from free air or from another chamber under a lower pressure than the working pressure;

  • JetBrains or “We” means JetBrains s.r.o., having its principal place of business at Xx Xxxxxxxxx XX 0000/00, Xxxxxx, 00000, Xxxxx Xxxxxxxx, registered in the Commercial Register maintained by the Xxxxxxxxx Xxxxx xx Xxxxxx, Xxxxxxx X, Xxxx 00000, ID. No.: 265 02 275.

  • Lot Frontage means lot frontage as defined in Town's Zoning By-law No. 1136 (1987), as amended, or any successor thereto.

  • Architectural coating means a coating applied to stationary structures and their appurtenances, to mobile homes, to pavements, or to curbs.

  • Fire fighter means any person employed by the state or any political subdivision as a member or officer of a fire depart- ment or a member of a volunteer department, including the state fire marshal and deputies.

  • Interconnector means a transmission line which crosses or spans a border between Member States for the purpose of connecting the national transmission system of those Member States or a transmission line between a Member State and a third country up to the territory of the Member States or the territorial sea of that Member State;

  • fire hydrant means a fire plug or fixed pillar fire hydrant;

  • Historic building means a building, including its structural components, that is located in this state and that is either individually listed on the national register of historic places under 16 U.S.C. 470a, located in a registered historic district, and certified by the state historic preservation officer as being of historic significance to the district, or is individually listed as an historic landmark designated by a local government certified under 16 U.S.C. 470a(c).

  • Grading means the movement or redistribution of the soil, sand, rock, gravel, sediment, or other material on a site in a manner that alters the natural contour of the land.

  • Passenger compartment means the space for occupant accommodation, bounded by the roof, floor, side walls, doors, outside glazing and front bulkhead and the plane of the rear compartment bulkhead or the plane of the rear-seat back support.

  • Public building and "public work" means a public building of, and a public work of, a governmental entity (the United States; the District of Columbia; commonwealths, territories, and minor outlying islands of the United States; State and local governments; and multi-State, regional, or interstate entities which have governmental functions). These buildings and works may include, without limitation, bridges, dams, plants, highways, parkways, streets, subways, tunnels, sewers, mains, power lines, pumping stations, heavy generators, railways, airports, terminals, docks, piers, wharves, ways, lighthouses, buoys, jetties, breakwaters, levees, and canals, and the construction, alteration, maintenance, or repair of such buildings and works.