XXX’x Review Process. Notwithstanding anything in this addendum to the contrary, PAI has no obligation to provide any Services to you unless and until PAI approves your use. You shall provide PAI with any and all information and documentation (financial or otherwise) that PAI reasonably requires to conduct its review. XXX’s review process will begin upon its receipt of such information and documentation. You certify that the information it has provided or will provide to PAI is true, accurate and complete.
XXX’x Review Process. CMS and MDCH will review ICO financial reports, encounter data, and other information to assess the ongoing financial stability of the ICOs and the appropriateness of capitation payments. At any point, the MDCH may request that CMS staff review documentation from specific plans to assess the appropriateness of capitation rates and identify any potential prospective adjustments that would ensure the rate-setting process is meeting the objective of Medicare and Medicaid jointly financing the costs and sharing in the savings. In Demonstration Years 2 and 3, CMS and the MDCH will review the rates and payment parameters if two or more ICOs show MLRs below 90% over all regions in which those plans participate, or in the event that two or more ICOs show annual losses exceeding 5% over all regions in which those plans participate.
