Risk Adjustments Sample Clauses

Risk Adjustments. 43 12.1 Purpose for Risk Adjustments 43 12.2 Risk Adjustment Method 44 13.0 CONTRACTOR’S FINANCIAL SECURITY OBLIGATIONS 45 13.1 Solvency Requirements and Protections 45 13.2 Contractor Indemnity 46 13.3 Insurance 47 13.4 Advances and Loans 47 13.5 Provider Risks 48 14.0 THIRD PARTY RESOURCES 48 14.1 Coordination of Benefits (COB) 48 14.2 Third Party Liability 48 15.0 MANAGEMENT INFORMATION SYSTEM 50 15.1 Contractor MIS 50 15.2 Contractor MIS Requirements 50 15.3 Interface Capability 51 15.4 Access to Contractor’s MIS 51 16.0 ENCOUNTER DATA 52 16.1 Encounter Data Submission 52 16.2 Technical Workgroup 53 17.0 KENTUCKY HEALTH INFORMATION EXCHANGE (KHIE) 54 18.0 ELECTRONIC HEALTH RECORDS 54 19.0 QUALITY ASSESSMENT/PERFORMANCE IMPROVEMENT (QAPI) 54 19.1 QAPI Program 54 19.2 Annual QAPI Review 55 19.3 QAPI Plan 56 19.4 QAPI Monitoring and Evaluation 57 20.0 KENTUCKY HEALTHCARE OUTCOMES 58
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Risk Adjustments. Risk adjustment shall be applied Contractor’s rates. The methods used to determine the risk assessment and risk adjustment amount will be designed to be budget neutral to the Commonwealth. The latest version of the Chronic Illness Disability Payment System (CPDS) available at the time of execution of this Contract shall be used; future updated versions of CPDS will be used as deemed appropriate. An initial meeting between the Contractor, the Department, and the Department’s actuary to discuss the technical characteristics of the model shall occur no later than sixty (60) days after contract execution. Upon agreement by all participating MCOs regarding a specified component(s) of a budget neutral risk adjust methodology; the Department shall adopt those recommended components as part of the risk adjustment process. For components of the risk adjustment methodology upon which all participating MCO’s cannot agree, the Department in consultation with its Actuary shall determine the method used for that component (s) of the risk adjustment process. Final recommendations of the group shall be provided to the Department no later than 90 days subsequent to contract execution.
Sample 1
Risk Adjustments. Contractor payments will be adjusted for differences in Member health status. Risk adjustment helps ensure payments to MCOs are more equitable and mitigates the impact of selection bias, thus protecting MCO solvency and reducing incentives for plans to avoid high-risk individuals. Risk adjustment is designed to be revenue neutral to the Commonwealth. Health-based risk adjustment uses information on Member’s medical conditions, as reported in claim and encounter data to predict prospective or concurrent health care costs and adjustment payments to MCOs. The payment rates for all Eligibility Categories will be risk adjusted with the exception of Dual Eligibles. The following are descriptions of the risk assessment methodologies that will be employed to adjust payments to the Contractor. The newly eligible Members due to expansion under the ACA will be risk adjusted separately from the Members eligible under the traditional Medicaid.
Sample 1

Related to Risk Adjustments

  • True-Up Adjustments From time to time, until the Retirement of the Recovery Bonds, the Servicer shall identify the need for True-Up Adjustments and shall take all reasonable action to obtain and implement such True-Up Adjustments, all in accordance with the following:

  • Price Adjustments 17.1 Prices for Goods/Services supplied in terms of this Agreement shall be subject to review as indicated in the Schedule of Requirements/Works Order annexed hereto.

  • Stock Adjustments In the event that during the term of the pledge any stock dividend, reclassification, readjustment or other changes are declared or made in the capital structure of Pledgee, all new, substituted and additional shares or other securities issued by reason of any such change shall be delivered to and held by the Pledgee under the terms of this Security Agreement in the same manner as the Shares originally pledged hereunder. In the event of substitution of such securities, Pledgor, Pledgee and Pledgeholder shall cooperate and execute such documents as are reasonable so as to provide for the substitution of such Collateral and, upon such substitution, references to "Shares" in this Security Agreement shall include the substituted shares of capital stock of Pledgor as a result thereof.

  • Downward Adjustments The Purchase Price shall be adjusted downward by the following:

  • Multiple Adjustments For the avoidance of doubt, if an event occurs that would trigger an adjustment to the Conversion Rate pursuant to this Section 11 under more than one subsection hereof, such event, to the extent fully taken into account in a single adjustment, shall not result in multiple adjustments hereunder; provided, however, that if more than one subsection of this Section 11 is applicable to a single event, the subsection shall be applied that produces the largest adjustment.

  • Share Adjustments If the Company's outstanding shares of Common Stock are increased or decreased or changed into or exchanged for a different number or kind of shares or other securities of the Company by reason of any recapitalization, reclassification, stock split, combination of shares, stock dividend, or transaction having similar effect, the Board shall proportionately and appropriately adjust the number and kind of shares that are subject to this Option and the Exercise Price Per Share, without any change in the aggregate price to be paid therefor upon exercise of this Option.

  • Tax Adjustments The Company may make such reductions in the Purchase Price, in addition to those required by Sections 3, 4, 5, 6, 7 and 8, as the Board of Directors considers to be advisable to avoid or diminish any income tax to holders of Common Stock or rights to purchase Common Stock resulting from any dividend or distribution of stock (or rights to acquire stock) or from any event treated as such for income tax purposes.

  • Adjustments Notwithstanding anything to the contrary contained in this Agreement, if any Lender becomes a Defaulting Lender, then, until such time as that Lender is no longer a Defaulting Lender, to the extent permitted by applicable Law:

  • Upward Adjustments The Purchase Price shall be adjusted upward by the following:

  • Base Price Adjustments The base aircraft price (pursuant to Article 3 of the Agreement) of the Option Aircraft will be adjusted to Boeing's and the engine manufacturer's then-current prices as of the date of execution of the Option Aircraft Supplemental Agreement.

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