Methodology to Determine High Cost Risk Pool Withholds (Where Applicable Sample Clauses

Methodology to Determine High Cost Risk Pool Withholds (Where Applicable. The amount that is withheld from the capitation rates to fund the High Cost Risk Pool (HCRP) is based on an analysis of data (FFS or managed care) from the population and services covered, as well as the design of the HCRP (e.g., threshold levels). This data is considered the primary source of information for developing the withhold amounts. Since any one (1) year may reflect unusual occurrences, when available, multiple years of information are reviewed and combined together. Because the data is generally historical in nature and the withholds are applicable to the future capitation rates, the data must be trended and adjusted as necessary to coincide with the time period in which the rates will be paid. These trends are estimates of the future costs of services provided. Given the programs' narrow specificity of risk and high per recipient cost, total risk pool costs may fluctuate substantially from year to year. Federal HC Agreement APPENDIX 3j Physician Fee Increase Arrangement Effective January 1, 2013, this appendix establishes an arrangement (Arrangement) between the Department and the PH-MCO for revenue associated with increased expenditure for eligible Evaluation and Management (E&M) procedure codes and Vaccine Administration (VA) procedure codes in accordance with Section 1202 of the Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reform Act of 2010, and 42 CFR 438.6 and 42 CFR 438.804. This Xxxxxxxx 0x supersedes any previous version to define the Arrangement beginning January 1, 2013.
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  • Long Term Cost Evaluation Criterion # 4 READ CAREFULLY and see in the RFP document under "Proposal Scoring and Evaluation". Points will be assigned to this criterion based on your answer to this Attribute. Points are awarded if you agree not i ncrease your catalog prices (as defined herein) more than X% annually over the previous year for years two and thr ee and potentially year four, unless an exigent circumstance exists in the marketplace and the excess price increase which exceeds X% annually is supported by documentation provided by you and your suppliers and shared with TIP S, if requested. If you agree NOT to increase prices more than 5%, except when justified by supporting documentati on, you are awarded 10 points; if 6% to 14%, except when justified by supporting documentation, you receive 1 to 9 points incrementally. Price increases 14% or greater, except when justified by supporting documentation, receive 0 points. increases will be 5% or less annually per question Required Confidentiality Claim Form Required Confidentiality Claim Form This completed form is required by TIPS. By submitting a response to this solicitation you agree to download from th e “Attachments” section, complete according to the instructions on the form, then uploading the completed form, wit h any confidential attachments, if applicable, to the “Response Attachments” section titled “Confidentiality Form” in order to provide to TIPS the completed form titled, “CONFIDENTIALITY CLAIM FORM”. By completing this process, you provide us with the information we require to comply with the open record laws of the State of Texas as they ma y apply to your proposal submission. If you do not provide the form with your proposal, an award will not be made if your proposal is qualified for an award, until TIPS has an accurate, completed form from you. Read the form carefully before completing and if you have any questions, email Xxxx Xxxxxx at TIPS at xxxx.xxxxxx@t xxx-xxx.xxx

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