Risk corridor definition

Risk corridor means payment limits to prevent immediate large financial gains or losses for Iowa hospitals due to APG implementation.

Risk corridor means a risk sharing mechanism in which OHA and Contractor share in both higher and lower than adjusted expenses under the Contract outside of the predetermined target amount so that if Contractor’s adjusted expenses are outside the corridor in which Contractor is responsible for all adjusted expenses, OHA contributes a portion toward additional adjusted expenses, or receives a portion of lower adjusted expenses.

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State contributes a portion toward any addi- tional losses, and receives a portion of any additional profits.(2) Basic requirements. (i) All pay- ments under risk contracts and all risk-sharing mechanisms in contracts must be actuarially sound.(ii) The contract must specify the payment rates and any risk-sharing mechanisms, and the actuarial basis for computation of those rates and mechanisms.(3) Requirements for actuarially sound rates. In setting actuarially sound capi- tation rates, the State must apply the following elements, or explain why they are not applicable:(i) Base utilization and cost data that are derived from the Medicaid popu- lation, or if not, are adjusted to make them comparable to the Medicaid pop- ulation.(ii) Adjustments made to smooth data and adjustments to account for factors such as medical trend inflation, incomplete data, MCO, PIHP, or PAHP administration (subject to the limits in paragraph (c)(4)(ii) of this section), and utilization;

Examples of Risk corridor in a sentence

• The reconciliation process is outlined in Attachment 6: Reconciliations and Risk Corridor Evaluation Methodologies.

• Insurers relied on the terms of the ACA, including the risk corridor program, in setting their premiums.” The Operation of the Affordable Care Act’s Risk Corridor Program, Testimony by Timothy Stolzfus Jost to House Committee on Oversight and Government Reform, Feb.

• Members and their costs must meet certain criteria to be considered in the HCRP Premium and Reconciliation, outlined in Attachment 6: Reconciliations and Risk Corridor Evaluation Methodologies.

• Medicaid line of business Underwriting Gain: Underwriting Gain equals Net Capitation Revenue less Total Net Medical Expense less Administrative Expense and includes the effect of MLR remittance owed to the State as specified in Section 7.2.10.3 of this Agreement and the effect of reconciliations as specified in Attachment 6: Reconciliations and Risk Corridor Evaluation Methodologies.

More Definitions of Risk corridor

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State contributes a portion toward any addi- tional losses, and receives a portion of any additional profits.(2) Basic requirements. (i) All pay- ments under risk contracts and all risk-sharing mechanisms in contracts must be actuarially sound.(ii) The contract must specify the payment rates and any risk-sharing mechanisms, and the actuarial basis for computation of those rates and mechanisms.

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State

Risk corridor means a risk sharing mechanism in which States and con- tractors share in both profits and losses under the contract outside of predetermined threshold amount, so that after an initial corridor in which the contractor is responsible for all losses or retains all profits, the State contributes a portion toward any addi- tional losses, and receives a portion of any additional profits.

Risk corridor means a percentage of financial gain or loss, calculated on the medical services portion of the capitation payment only, for which the MCP and ODJFS agree to share liability.

Risk corridor. A risk sharing mechanism in which States and MCOs, PIHPs, or PAHPs may share in profits and losses under the contract outside of a predetermined threshold amount.