PMPM Sample Clauses

The PMPM (Per Member Per Month) clause defines a payment structure where fees are calculated based on the number of members covered each month. In practice, this means that the total payment due is determined by multiplying the agreed-upon rate by the number of eligible individuals for each month of service. This approach is commonly used in healthcare and insurance contracts to align costs with actual enrollment levels. The core function of the PMPM clause is to ensure that payments scale appropriately with usage, providing predictability and fairness for both parties.
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PMPM. This is not an inclusive list. OptumRx may charge for any products or services not specifically represented herein.
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PMPM. For purposes of this Addendum, any per Member per month ("PMPM") calculation shall be based on Medicare HMO Members only.
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PMPM. For purposes of this Addendum, any per Member per month ("PMPM") calculation shall be based on HMO Commercial Members only.
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PMPM. An illustrative example of the calculation for (B) is shown below, with the “Hypothetical SFY20 MMs Estimate” being based on statewide SFY18 MMs for illustrative purposes: llustrative Example COA Hypothetica l SFY20 MMs NF CRR PMPM Estimate Total Expenditur e Estimate Custodial Care Nursing Facility <65 20,704 $40.77 $844,102 Custodial Care Nursing Facility 65+ 119,686 $40.77 $4,879,598 Non-Dual Skilled Nursing Facility 1,786 $40.77 $72,815 $5,796,516 In this example, (B) would be $5,796,516; this total dollar amount will vary depending upon the actual SFY20 MMs for these cohorts for each of the MCOs. The State will calculate a value (C) = (A) – (B), which represents how much more or less was paid for the NF CRR payments than originally estimated. If the amount (C) is within a +/-1% band of the original estimate (B) then no risk corridor payment will be made. In this example, the band for which (C) must fall in order for no risk corridor payment to take place is a value of (C) that is between -$57,965 and $57,965. MED-20-001 Any difference (C) in costs between actual utilization (A) and the original estimate (B) outside the 1% band would result in a payment to or from the State of the amount by which (C) exceeds 1% of (B) or falls below -1% of (B). The reconciliation will consist of the State paying the MCO a risk corridor settlement in the case of actual utilization (A) exceeding the original estimates
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PMPM. No reconciliations will occur for expenditures within a +/- 10% corridor of the target, or between $0.86 and $1.05.
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PMPM. For any Assigned Life whose coverage ends mid-month and who is dropped from the Program as a result, ACO will cease to pay the $3.25 PMPM as of the month in which the Assigned Life did not complete the full month of coverage within the Program.
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PMPM. When both parties have signed this Amendment 1, the Agreement and this Amendment 1 together constitute the Agreement.
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PMPM. The $ .09 PMPM fee will be assessed when scanning functionality is utilized by CLIENT. - Provide an allowance of up to $25,000 for license, implementation, integration, conversion and support fees for a CLIENT selected accounting package. - QCSI has provided an estimate of communication costs and incorporated these costs into the PMPM fee. If at a future date, significant cost savings are realized due to CLIENT's ability to contract for such services locally and/or newer technology is utilized which provides significant cost savings, such savings will be passed on to CLIENT. CLIENT will be required to use the communication lines as outlined in this Agreement until QCSI's contract for such lines expires and the lines can be converted. - QCSI will facilitate the ability of CLIENT to retrieve IVR information from the QMACS(TM) database. Quality Care Solutions, Inc. Rev. 02/16/99 10 EXHIBIT C IMPLEMENTATION SERVICES PROGRAM DATA CENTER ASSESSMENT AND IMPLEMENTATION FEE [Confidential treatment has been requested] CLIENT agrees to pay QCSI [****] for assessment, implementation, QCSI purchase of hardware and communications link, set-up and training. The Assessment and Implementation fee is payable as follows: [****] Execution of Software License [****] Remaining four (4) payments due on the first (1st) day of each month following execution of the Software License.
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PMPM a. The Contractor shall receive an actuarially-determined, capitated per member per month (PMPM) payment to provide NET services covered under this Scope of Work. Experience data used to establish rates may be adjusted to reflect only allowable services. A percentage of the PMPM payment shall be contingent on meeting Value-Based Purchasing performance measures, as described in Section
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Related to PMPM

  • Salary Scale The salary scale applicable to Employees shall be set out hereinafter in the Wage Schedule.

  • Step 4 In the event the dispute is not resolved at Step 3 above, either party may serve upon the other and the COORDINATOR written notice by certified mail, within five (5) working days, requesting that the dispute be resolved by arbitration. If such a written notice is served, the parties shall jointly request the Federal Mediation and Conciliation Service to submit the names of five (5) qualified arbitrators, from which list the UNION and the EMPLOYER shall alternately strike names until only one name is left, which person shall hear and resolve the dispute. A hearing shall be conducted by the arbitrator, at which time the parties to the dispute shall be given the opportunity to appear and offer evidence in support of their positions. A decision by the arbitrator shall be rendered in writing within a reasonable time, not to exceed ten (10) days after the conclusion of the hearing. The decision by the arbitrator shall be final and binding upon the parties; provided, however, that the arbitrator shall not have the authority to alter or amend the provisions of this AGREEMENT in any way. The reasonable expenses and fees of the arbitrator shall be borne equally by the parties.

  • Step 3 i. The employer shall review the particulars of the complaint as provided by the complainant pursuant to Article E.2.3.b. i. The employer may request further particulars from the complainant. Upon the conclusion of such a review, the employer shall: (1) initiate an investigation of the complaint and appoint an investigator pursuant to Article E.2.3.c.iii below, or; (2) recommend mediation or other alternative disputes resolution processes to resolve the complaint. ii. Should the complainant not agree with the process described in Article E.2.3.c.i(2), the employer shall initiate an investigation. The employer shall provide notice of investigation. iii. The investigation shall be conducted by a person who shall have training and/or experience in investigating complaints of harassment. iv. The complainant may request: (1) that the investigator shall be of the same gender as the complainant; and/or (2) an investigator who has Aboriginal ancestry, and/or cultural knowledge and sensitivity if a complainant self-identifies as Aboriginal. Where practicable the request(s) will not be denied. v. The investigation shall be conducted as soon as is reasonably possible and shall be completed in twenty (20) working days unless otherwise agreed to by the parties, such agreement not to be unreasonably withheld.

  • Adjustment of Grievance The School Board and the employee will attempt to adjust all grievances which may arise during the course of employment of any employee within the School District in the following manner:

  • Baseline For purposes of measuring a reduction in net tax revenue, the interim final rule measures actual changes in tax revenue relative to a revenue baseline (baseline). The baseline will be calculated as fiscal year 2019 (FY 2019) tax revenue indexed for inflation in each year of the covered period, with inflation calculated using the Bureau of Economic Analysis’s Implicit Price Deflator.163 FY 2019 was chosen as the starting year for the baseline because it is the last full fiscal year prior to the COVID– 162 See, e.g., Tax Policy Center, How do state earned income tax credits work?, https:// ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/▇▇▇▇▇▇▇▇-▇▇▇▇/▇▇▇-▇▇- state-earned-income-tax-credits-work/ (last visited May 9, 2021).