Common use of Utilization Risk Corridor Clause in Contracts

Utilization Risk Corridor. The Utilization Risk Corridor is defined as the number of Inpatient Days that wrap around the days that State has committed to purchase on a prospective basis in the APM Year. This corridor will be determined using a percentage threshold above and below the value of prospective purchase days. In APM Year 3, the utilization corridor is 98% to 102% of the total prospective days purchased of 18,615. i. The Utilization Risk Corridor, therefore, shall be applied as follows for APM Year 3 and calculations shall be factored into the Year-End Reconciliation. 1. If the actual number of utilized Inpatient Days is between 18,243 and 18,987 then Contractor shall be liable for the costs to serve patients for these days. 2. If the actual number of utilized Inpatient Days is greater than 18,987 during APM Year 3 then the State will reimburse Contractor an additional amount outside of the APM Payment for each day above 18,987 at a rate of $3,100 per day. 3. If the actual number of utilized Inpatient Days is less than 18,243 during APM Year 3, then Contractor shall reimburse back to the State an amount equivalent to $3,100 per day for each day below 18,243. ii. If during the contract, the State or Contractor determines that the Inpatient Days used are 10% or more under the expected utilization as specified in Table 3 of Attachment B, then the Parties may meet to discuss utilization or costs. Evaluations will occur no less frequently than monthly unless the parties agree to evaluate utilization less frequently.

Utilization Risk Corridor. The Utilization Risk Corridor is defined as the number of Inpatient Days that wrap around the days that State has committed to purchase on a prospective basis in the APM Year. This corridor will be determined using a percentage threshold utilized days thresholds above and below the value of prospective purchase days. In APM Year 3, the utilization corridor is 98% to 102% of the total prospective days purchased of 18,615. i. The Utilization Risk Corridor, therefore, shall be applied as follows for APM Year 3 4 and calculations shall be factored into the Year-End Reconciliation. 1. If the actual number of utilized Inpatient Days is between 18,243 and 18,987 then Contractor shall be liable for the costs to serve patients for these daysbetween 18,616 and 18,988 Inpatient Days. 2. If the actual number of utilized Inpatient Days is greater than 18,987 during APM Year 3 then the The State will reimburse shall pay Contractor an additional amount outside of the APM Payment for each day above 18,987 at a rate of $3,100 per dayday for each Inpatient Day utilized between 18,989 and 20,788. 3. Contractor shall be liable for the costs to serve patients between 20,789 and 21,347 Inpatient Days. 4. The State shall pay Contractor a rate of $3,100 per day for each Inpatient Day utilized above 21,347. 5. If the actual number of utilized Inpatient Days is less than 18,243 during APM Year 34, then Contractor shall reimburse back to the State an amount equivalent to $3,100 per day for each day below 18,243. ii. If during the contract, the State or Contractor determines that the Inpatient Days used are 10% or more under the expected utilization as specified in Table 3 4 of Attachment B, then the Parties may meet to discuss utilization or costs. Evaluations will occur no less frequently than monthly unless the parties agree to evaluate utilization less frequently.

Utilization Risk Corridor. The Utilization Risk Corridor is defined as the number of Inpatient Days that wrap around the days that State has committed to purchase on a prospective basis in the APM Year. This corridor will be determined using a percentage threshold utilized days thresholds above and below the value of prospective purchase days. In APM Year 3, the utilization corridor is 98% to 102% of the total prospective days purchased of 18,615. i. The Utilization Risk Corridor, therefore, shall be applied as follows for APM Year 3 4 and calculations shall be factored into the Year-End Reconciliation. 1. If the actual number of utilized Inpatient Days is between 18,243 and 18,987 then Contractor shall be liable for the costs to serve patients for these daysbetween 18,666 and 19,039 Inpatient Days. 2. If the actual number of utilized Inpatient Days is greater than 18,987 during APM Year 3 then the The State will reimburse shall pay Contractor an additional amount outside of the APM Payment for each day above 18,987 at a rate of $3,100 per dayday for each Inpatient Day utilized between 19,040 and 20,839. 3. Contractor shall be liable for the costs to serve patients between 20,840 and 21,399 Inpatient Days. 4. The State shall pay Contractor a rate of $3,100 per day for each Inpatient Day utilized above 21,399. 5. If the actual number of utilized Inpatient Days is less than 18,243 18,293 during APM Year 34, then Contractor shall reimburse back to the State an amount equivalent to $3,100 per day for each day below 18,24318,293. ii. If during the contract, the State or Contractor determines that the Inpatient Days used are 10% or more under the expected utilization as specified in Table 3 4 of Attachment B, then the Parties may meet to discuss utilization or costs. Evaluations will occur no less frequently than monthly unless the parties agree to evaluate utilization less frequently.