Vermont Medicare Total Cost of Care per Beneficiary Growth definition

Vermont Medicare Total Cost of Care per Beneficiary Growth means the growth rate for Vermont Medicare Total Cost of Care per Beneficiary, as calculated in accordance with section 9.b.i.
Sample 1Sample 2Sample 3

Examples of Vermont Medicare Total Cost of Care per Beneficiary Growth 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, 85 and over.

  • 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).

  • If in Performance Year 3 Vermont achieves at least 65 percent in ACO Scale Target performance for Vermont Medicare Beneficiaries, then for Performance Year 3 the Vermont Medicare Total Cost of Care per Beneficiary will include all Vermont Medicare Beneficiaries, and Vermont Medicare Total Cost of Care per Beneficiary Growth will be calculated in a similar manner as for Performance Years 4-5.

  • 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.

  • CMS may adjust the Vermont Medicare Total Cost of Care per Beneficiary Growth calculation as necessary to avoid duplicative accounting for, and payment of, amounts made to or received by providers, suppliers, or both in the State that are participating in any existing or future Medicare program, demonstration or model, including but not limited to those that involve Shared Savings or incentive payments.

  • If in Performance Year 3 Vermont does not achieve at least 65 percent in ACO Scale Target performance for Vermont Medicare Beneficiaries, then for Performance Year 3 the Vermont Medicare Total Cost of Care per Beneficiary will include only Vermont Medicare Beneficiaries aligned to a Medicare FFS ACO initiative, and Vermont Medicare Total Cost of Care per Beneficiary Growth will be calculated in a similar manner as for Performance Years 1-2.

  • Vermont Medicare Total Cost of Care per Beneficiary Growth will be calculated as a compounded annualized growth rate in aggregate across Performance Years 1-5 of this Model, using 2017 as a baseline.

Related to Vermont Medicare Total Cost of Care per Beneficiary Growth

  • 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.

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

  • 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

  • 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.

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

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

  • 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.

  • Long-term inpatient care means inpatient services for

  • 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.

  • 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.

  • income-related employment and support allowance means an income-related allowance under Part 1 of the Welfare Reform Act 2007;

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

  • Societal benefits charge means a charge imposed by an electric

  • Individualized family service plan means a written plan for providing early intervention services to an eligible child and the child’s family.

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

  • Dependent care assistance program or "DCAP" means a benefit plan whereby school employees may pay for certain employment related dependent care with pretax dollars as provided in the salary reduction plan under chapter 41.05 RCW pursuant to 26 U.S.C. Sec. 129 or other sections of the Internal Revenue Code.

  • 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.

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

  • Specific learning disability (SLD) means a heterogeneous group of conditions wherein there is a deficit in processing language, spoken or written, that may manifest itself as a difficulty to comprehend, speak, read, write, spell, or to do mathematical calculations and includes such conditions as perceptual disabilities, dyslexia, dysgraphia, dyscalculia, dyspraxia and developmental aphasia.

  • Enrollee point-of-service cost-sharing or "cost-sharing" means amounts paid to health carriers directly providing services, health care providers, or health care facilities by enrollees and may include copayments, coinsurance, or deductibles.

  • Continuing care retirement community means a residential

  • 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)).

  • Non-Administrator Coordinated Home Care Program means a Coordinated Home Care Program which does not have an agreement with the Claim Administrator or a Blue Cross Plan but has been certified as a home health agency in accordance with the guidelines established by Medicare.

  • Non-Participating Certified Nurse-Midwife means a Certified Nurse-Midwife 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.

  • Non-Participating Retail Health Clinic means a Retail Health Clinic which 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.