Common use of Payments in Future Years and Mid-Year Rate Adjustments Clause in Contracts

Payments in Future Years and Mid-Year Rate Adjustments. A. Rates will be updated using a similar process for each calendar year. Changes to the baseline (and therefore to the corresponding payment rate) outside of the annual Medicare Advantage rate announcement would occur only if and when CMS and MDCH jointly determine the change is necessary to calculate accurate payment rates for the Demonstration. For changes solely affecting the Medicare program baseline, CMS will consult with MDCH prior to making any adjustment, but MDCH concurrence will not be required. Changes may be based on the following factors: shifts in enrollment assumptions; major changes or discrepancies in federal law and/or State law or policy compared to assumptions about federal law and/or State law or policy used in the development of baseline estimates; and changes in coding intensity. CMS and/or MDCH will make changes to baseline estimates within 30 days of identification of the need for such changes, and changes will be applied on a retrospective basis, if necessary, to effectuate accurate payment rates for each month. B. Changes to the savings percentages would occur if and when CMS and MDCH jointly determine that changes in Part D spending have resulted in materially higher or lower savings that need to be recouped through higher or lower savings percentages applied to the Medicare A/B baselines.

Payments in Future Years and Mid-Year Rate Adjustments. A. Rates will be updated using a similar process for each calendar year. Changes to the baseline (and therefore to the corresponding payment rate) outside of the annual Medicare Advantage rate announcement or as otherwise specified in this appendix would occur only if and when CMS and MDCH the State jointly determine the change is necessary to calculate accurate payment rates for the Demonstration. For changes solely affecting the Medicare program baseline, CMS will consult with MDCH the State prior to making any adjustment, but MDCH State concurrence will not be required. Changes Such changes may be based on the following factors: shifts in enrollment assumptions; major changes or discrepancies in federal law and/or State state law or policy policy, compared to assumptions about federal Federal law and/or State law or policy used in the development of baseline estimates; and changes in coding intensity. CMS and/or MDCH the State will make changes to baseline estimates within 30 days of identification of the need for such changes, and changes will be applied applied, if necessary on a retrospective basis, if necessary, to effectuate accurate payment rates for each month. B. Changes to the savings percentages would occur if and when CMS and MDCH the State jointly determine that changes in Part D spending have resulted in materially higher or lower savings that need to be recouped through higher or lower savings percentages applied to the Medicare A/B baselines.

Payments in Future Years and Mid-Year Rate Adjustments. A. Rates will be updated using a similar process for each calendar year. Changes to the baseline (and therefore to the corresponding payment rate) outside of the annual Medicare Advantage rate announcement would occur only if and when CMS and MDCH DMAS jointly determine the change is necessary to calculate accurate payment rates for the Demonstration. For changes solely affecting the Medicare program baseline, CMS will consult with MDCH DMAS prior to making any adjustment, but MDCH DMAS concurrence will not be required. Changes may be based on the following factors: shifts in enrollment assumptions; major changes or discrepancies in federal Federal law and/or State law or policy policy, compared to assumptions about federal Federal law and/or State law or policy used in the development of baseline estimates; and changes in coding intensity. CMS and/or MDCH DMAS will make changes to baseline estimates within 30 days of identification of the need for such changes, and changes will be applied applied, if necessary on a retrospective basis, if necessary, to effectuate accurate payment rates for each month. B. Changes to the savings percentages would occur if and when CMS and MDCH DMAS jointly determine that changes in Part D spending have resulted in materially higher or lower savings that need to be recouped through higher or lower savings percentages applied to the Medicare A/B baselines.

Payments in Future Years and Mid-Year Rate Adjustments. A. Rates will be updated using a similar process for each calendar year. Changes to the baseline Medicare baselines (and therefore to the corresponding payment rate) outside of the annual Medicare Advantage rate announcement would occur only if and when CMS and MDCH jointly the State determine the change is necessary to calculate accurate payment rates for the Demonstration. For changes solely affecting the Medicare program baseline, CMS will consult with MDCH the State prior to making any adjustment, but MDCH State concurrence will not be required. Changes may be based on the following factors: shifts in enrollment assumptions; major changes or discrepancies in federal Federal law and/or State law or policy compared to the assumptions about federal Federal law and/or State law or policy used in the development of baseline estimates; and changes in coding intensity. CMS and/or MDCH the State will make changes to baseline estimates within 30 days of after identification of the need for such changes, and changes will be applied applied, if necessary on a retrospective basis, if necessary, to effectuate accurate payment rates for each month. B. Changes to the savings percentages would occur if and when CMS and MDCH the State jointly determine that changes in Medicare Part D spending have resulted in materially higher or lower savings that need to be recouped through higher or lower savings percentages applied to the Medicare A/B baselines.