Common use of Risk Sharing Clause in Contracts

Risk Sharing. In each Arrangement Year that is equivalent to a calendar year, the PH-MCO is responsible for the first $15,000 (Threshold Amount) in paid amounts of Covered Services provided to each Member as identified in Section II above. The Department will reimburse the PH-MCO 75.0 percent (75.0%) of Covered Services (net of third party liability/other insurance) submitted by the PH-MCO that are greater than $15,000. If the Arrangement Year begins after January 31, the Department will provide the PH-MCO with a Threshold Amount that will apply in lieu of $15,000. The Department will provide documentation that its actuarial consultant has determined that the Threshold Amount is actuarially appropriate for the terms of the Home Nursing Risk Sharing Agreement inclusive of the applicable Withhold Amounts.