Common use of Payment Calculation Clause in Contracts

Payment Calculation.  Medicare Minimum Savings Rate (MSR) – CMS will develop a Medicare Minimum Savings Rate for the Demonstration. The MSR will be applied to this Demonstration depending on the size of the Demonstration population. The minimum MSR will be 2%. Figure 6-2 shows examples of the MSRs for various levels of potential enrollment in the Demonstration. This figure demonstrates the MSR as applied at various points. An MSR within this range will be applied each year based on actual number of beneficiaries considered as part of the savings calculation. Beneficiary points not shown below will be extrapolated based on the underlying curve. Figure 6-2. Medicare MSR Range Number of Beneficiaries MSR 5,000 4.50% 10,000 3.20% 20,000 2.45% 50,000+ 2.00%  Application of the MSR – Medicare Parts A and B savings, as calculated above, will be compared to the MSR established for the State’s Demonstration. If the Medicare Parts A and B savings calculated are less than the MSR, the State will not qualify for a retrospective performance payment.  Medicaid Significance Factor (MSF) – CMS will develop a Medicaid significance factor for the Demonstration. This factor will be set at the same percentage as the Medicare MSR for the State’s Demonstration.  Application of the MSF – Medicaid costs, as calculated above, will be compared to the MSF established for this Demonstration. If increases in Federal Medicaid costs are less than the MSF, CMS will not deduct from the Medicare savings for the purposes of calculating a retrospective performance payment.  Deduction of Medicaid increases – If increases in Medicaid costs exceed the MSF, then the Federal share of the Medicaid increase (including costs below the MSF) will be deducted from the amount of Medicare savings to establish the net Federal savings for the purposes of calculating a retrospective performance payment.  Net Federal savings available for sharing with the State – If Medicare savings calculated exceed the MSR, the State will qualify to earn up to 50% of the net Federal savings (i.e., 50% of the total Medicare savings after deducting the Federal Medicaid increase, if the Federal Medicaid increase exceeds the MSF).

Payment Calculation.  Medicare Minimum Savings Rate (MSR) – CMS will develop a Medicare Minimum Savings Rate for the Demonstration. The MSR will be applied to this Demonstration depending on the size of the Demonstration population. The minimum MSR will be 2%. Figure 6-2 shows examples of the MSRs for various levels of potential enrollment in the Demonstration. This figure demonstrates the MSR as applied at various points. An MSR within this range will be applied each year based on actual number of beneficiaries considered as part of the savings calculation. Beneficiary points not shown below will be extrapolated based on the underlying curve. Figure 6-2. Medicare MSR Range Number of Beneficiaries MSR 5,000 4.50% 10,000 3.20% 20,000 2.45% 50,000+ 2.00%  • Application of the MSR – Medicare Parts A and B savings, as calculated above, will be compared to the MSR established for the State’s this Demonstration. If the Medicare Parts A and B savings calculated are less than the MSR, the State will not qualify for a retrospective performance payment.  • Medicaid Significance Factor (MSF) – CMS will develop a Medicaid significance factor for the Demonstration. This factor will be set at the same percentage as the Medicare MSR for the State’s DemonstrationMSR.  • Application of the MSF – Medicaid costs, as calculated above, will be compared to the MSF established for this Demonstration. If increases in Federal Medicaid costs are less than the MSF, CMS will not deduct from the Medicare savings for the purposes of calculating a retrospective performance payment.  • Deduction of Medicaid increases – If increases in Medicaid costs exceed the MSF, then the Federal share of the Medicaid increase (including costs below the MSF) will be deducted from the amount of Medicare savings to establish the net Federal savings for the purposes of calculating a retrospective performance paymentsavings.  • Net Federal savings available for sharing with the State – If Medicare savings calculated exceed the MSR, the State will qualify to earn up to 50% of the net Federal savings (i.e., 50% of the total Medicare savings after deducting the Federal Medicaid increase, if the Federal Medicaid increase exceeds the MSF).

Payment Calculation.  Medicare Minimum Savings Rate (MSR) – CMS will develop a Medicare Minimum Savings Rate for the Demonstration. The MSR will be applied to this Demonstration depending on the size of the Demonstration population. The minimum MSR will be 2%. Figure 6-2 shows examples of the MSRs for various levels of potential enrollment in the Demonstration. This figure demonstrates the MSR as applied at various points. An MSR within this range will be applied each year based on actual number of beneficiaries considered as part of the savings calculation. Beneficiary points not shown below will be extrapolated based on the underlying curve. Figure 6-2. Medicare MSR Range Number of Beneficiaries MSR 5,000 4.50% 10,000 3.20% 20,000 2.45% 50,000+ 2.00%  • Application of the MSR – Medicare Parts A and B savings, as calculated above, will be compared to the MSR established for the State’s Demonstration. If the Medicare Parts A and B savings calculated are less than the MSR, the State will not qualify for a retrospective performance payment.  • Medicaid Significance Factor (MSF) – CMS will develop a Medicaid significance factor for the Demonstration. This factor will be set at the same percentage as the Medicare MSR for the State’s Demonstration.  • Application of the MSF – Medicaid costs, as calculated above, will be compared to the MSF established for this Demonstration. If increases in Federal Medicaid costs are less than the MSF, CMS will not deduct from the Medicare savings for the purposes of calculating a retrospective performance payment.  • Deduction of Medicaid increases – If increases in Medicaid costs exceed the MSF, then the Federal share of the Medicaid increase (including costs below the MSF) will be deducted from the amount of Medicare savings to establish the net Federal savings for the purposes of calculating a retrospective performance payment.  • Net Federal savings available for sharing with the State – If Medicare savings calculated exceed the MSR, the State will qualify to earn up to 50% of the net Federal savings (i.e., 50% of the total Medicare savings after deducting the Federal Medicaid increase, if the Federal Medicaid increase exceeds the MSF).

Payment Calculation.  Medicare Minimum Savings Rate (MSR) – CMS will develop a Medicare Minimum Savings Rate for the Demonstration. The MSR will be applied to this Demonstration depending on the size of the Demonstration population. The minimum MSR will be 2%. Figure 6-2 shows examples of the MSRs for various levels of potential enrollment in the Demonstration. This figure demonstrates the MSR as applied at various points. An MSR within this range will be applied each year based on actual number of beneficiaries considered as part of the savings calculation. Beneficiary points not shown below will be extrapolated based on the underlying curve. Figure 6-2. Medicare MSR Range Number of Beneficiaries MSR 5,000 4.50% 10,000 3.20% 20,000 2.45% 50,000+ 2.00%  Application of the MSR – Medicare Parts A and B savings, as calculated above, will be compared to the MSR established for the State’s this Demonstration. If the Medicare Parts A and B savings calculated are less than the MSR, the State will not qualify for a retrospective performance payment.  Medicaid Significance Factor (MSF) – CMS will develop a Medicaid significance factor for the Demonstration. This factor will be set at the same percentage as the Medicare MSR for the State’s DemonstrationMSR.  Application of the MSF – Medicaid costs, as calculated above, will be compared to the MSF established for this Demonstration. If increases in Federal Medicaid costs are less than the MSF, CMS will not deduct from the Medicare savings for the purposes of calculating a retrospective performance payment.  Deduction of Medicaid increases – If increases in Medicaid costs exceed the MSF, then the Federal share of the Medicaid increase (including costs below the MSF) will be deducted from the amount of Medicare savings to establish the net Federal savings for the purposes of calculating a retrospective performance paymentsavings.  Net Federal savings available for sharing with the State – If Medicare savings calculated exceed the MSR, the State will qualify to earn up to 50% of the net Federal savings (i.e., 50% of the total Medicare savings after deducting the Federal Medicaid increase, if the Federal Medicaid increase exceeds the MSF).