Vermont Medicare Total Cost of Care per Beneficiary definition

Vermont Medicare Total Cost of Care per Beneficiary means the expenditures associated with Medicare Financial Target Services provided to Vermont Medicare Beneficiaries for any given Performance Year divided by the count of Vermont Medicare Beneficiaries for the same Performance Year, calculated in accordance with section 9.b.i. As described further in section 9.b.i, the Vermont Medicare Beneficiaries included in the calculation of Vermont Medicare Total Cost of Care per Beneficiary will transition over the Performance Period from Vermont Medicare Beneficiaries who are aligned to Scale Target ACO Initiatives to all Vermont Medicare Beneficiaries regardless of alignment to Scale Target ACO Initiatives.
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Vermont Medicare Total Cost of Care per Beneficiary means the expenditures associated with Medicare Financial Target Services provided to Vermont Medicare Beneficiaries for any given Performance Year divided by the count of Vermont Medicare Beneficiaries for the same Performance Year. As described further in section 6.b.i, the Vermont Medicare Beneficiaries included in the calculation of Vermont Medicare Total Cost of Care per Beneficiary will transition over the Performance Period from Vermont Medicare Beneficiaries who are aligned to Scale Target ACO Initiatives to all Vermont Medicare Beneficiaries regardless of alignment to Scale Target ACO Initiatives.
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Examples of Vermont Medicare Total Cost of Care per Beneficiary in a sentence

  • Such Shared Losses would be considered as reductions in expenditures and such Shared Savings as additional expenditures for purposes of calculating the Vermont Medicare Total Cost of Care per Beneficiary Growth and All-payer Total Cost of Care per Beneficiary Growth.

  • Vermont Medicare Total Cost of Care per Beneficiary Growth calculations will be adjusted for age differences between Vermont Medicare Beneficiaries and National Medicare Beneficiaries.

  • The Annual Projected National Medicare Total Cost of Care per Beneficiary Growth and Performance Period National Medicare Total Cost of Care per Beneficiary Growth calculations will be based on a blend of the ESRD and non-ESRD MA USPCC FFS Projections according to the relative proportions of Vermont Medicare Beneficiaries included in the Vermont Medicare Total Cost of Care per Beneficiary Growth calculations who have, and do not have, ESRD.

  • This age adjustment will be performed by calculating Vermont Medicare Total Cost of Care per Beneficiary Growth separately for the following age bands, and weighting the age bands according to the age distribution of National Medicare Beneficiaries: under 65, 65-74, 75-84, over 85.

  • For Performance Year 4 and subsequent Performance Years, the Vermont Medicare Total Cost of Care per Beneficiary will include all Vermont Medicare Beneficiaries.

  • If Vermont achieves at least 65 percent in ACO Scale Target performance for Vermont Medicare Beneficiaries in Performance Year 3, then the Vermont Medicare Total Cost of Care per Beneficiary for Performance Year 3 will include all Vermont Medicare Beneficiaries, and Vermont Medicare Total Cost of Care per Beneficiary Growth for that Performance Year will be calculated in a similar manner as for Performance Year 4 and subsequent Performance Years.

  • The Vermont Medicare Total Cost of Care per Beneficiary Growth and All-payer Total Cost of Care per Beneficiary Growth calculations will be adjusted to incorporate any Shared Losses or Shared Savings for any Vermont ACOs participating in a Medicare FFS ACO initiative (e.g., Vermont Medicare ACO Initiative, Next Generation ACO Model, and Medicare Shared Savings Program).

  • The Vermont Medicare Total Cost of Care per Beneficiary Growth and All-payer Total Cost of Care per Beneficiary Growth calculations will be adjusted to incorporate any Shared Losses or Shared Savings for any Vermont ACOs participating in a Medicare FFS ACO initiative (e.g., Vermont Medicare ACO Initiative, Vermont Modified Next Generation ACO Model, and Medicare Shared Savings Program).

  • For Performance Years 1 and 2, the Vermont Medicare Total Cost of Care per Beneficiary will include only Vermont Medicare Beneficiaries who are aligned to Scale Target ACO Initiatives operating pursuant to executed participation agreements with CMS.

  • Vermont Medicare Total Cost of Care per Beneficiary Growth will be calculated as a compounded annualized growth rate in aggregate across Performance Year 1 and subsequent Performance Years of this Model, using 2017 as a baseline.

Related to Vermont Medicare Total Cost of Care per Beneficiary

  • Medicare eligible expenses means expenses of the kinds covered by Medicare Parts A and B, to the extent recognized as reasonable and medically necessary by Medicare.

  • Non-Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has not been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Family child care provider means a person who: (a) Provides

  • Medicare benefit means the Medicare benefit payable within the meaning of Part II of the Health Insurance Act 1973 with respect to a professional service.

  • Medicare Levy Surcharge means an extra charge payable by high income earners beyond the standard Medicare Levy if they do not have qualifying private hospital insurance coverage. This charge is assessed as part of an individual or family’s annual tax return.

  • Pharmacy benefit manager means a person, business or other

  • Health-care-insurance receivable means an interest in or claim under a policy of insurance which is a right to payment of a monetary obligation for health-care goods or services provided.

  • child care element of working tax credit means the element of working tax credit prescribed under section 12 of the Tax Credits Act 2002 (child care element).

  • Child Care Program means a person or business that offers child care.

  • Participating Hospice Care Program Provider means a Hospice Care Program Provider that either: (i) has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield to provide services to participants in this benefits program, or; (ii) a Hospice Care Program Provider which has been designated by a Blue Cross and/or Blue Shield Plan as a Participating Provider Option program.

  • Medical Benefits Schedule means the Medicare Schedule of Benefits produced by the Department of Health to which all fees and benefits relate for inpatient hospital services.

  • Pharmacy benefits management means the administration or management of prescription drug

  • Group long-term care insurance means a long-term care insurance policy which is delivered or issued for delivery in this State and issued to:

  • Non-Participating Certified Nurse Practitioner means a Certified Nurse Practitioner who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Intensive Care Unit means an identified section, ward or wing of a hospital which is under the constant supervision of a dedicated medical practitioner(s), and which is specially equipped for the continuous monitoring and treatment of patients who are in a critical condition, or require life support facilities and where the level of care and supervision is considerably more sophisticated and intensive than in the ordinary and other wards.

  • Licensed health care provider means a physician, physician assistant, chiropractor, advanced registered nurse practitioner, nurse, physical therapist, or athletic trainer licensed by a board.

  • Child care provider means a provider who receives compensation for providing child care services on a regular basis, including an ‘eligible child care provider’ (as defined in section 658P of the Child Care and Development Block Grant Act of 1990 (42 U.S.C. 9858n)).

  • Title IV-E Foster Care means a federal program authorized under §§ 472 and 473 of the Social

  • Disability benefit recipient means a member who is receiving a disability benefit.

  • Long-term care insurance means group insurance that is authorized by the retirement system for retirants, retirement allowance beneficiaries, and health insurance dependents, as that term is defined in section 91, to cover the costs of services provided to retirants, retirement allowance beneficiaries, and health insurance dependents, from nursing homes, assisted living facilities, home health care providers, adult day care providers, and other similar service providers.

  • Dependent care assistance program means a benefit plan

  • Pharmacy benefits manager means a person that performs pharmacy benefits management.

  • Acute care hospital means a Hospital that provides Acute Care Services. Adjudicate means to deny or pay a Clean Claim. Administrative Services see MCO Administrative Services. Administrative Services Contractor see HHSC Administrative Services Contractor.

  • Non-Participating Durable Medical Equipment Provider means a Durable Medical Equipment Provider who does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Primary Care Provider (PCP) means a health care professional who is contracted with BCBSAZ as a PCP and generally specializes in or focuses on the following practice areas: internal medicine, family practice, general practice, pediatrics or any other classification of provider approved as a PCP by BCBSAZ. Your benefit plan does not require you to have a PCP or to have a PCP authorize specialist referrals.

  • Societal benefits charge means a charge imposed by an electric