Substantial Financial Risk definition

Substantial Financial Risk means a physician or physician group as defined in this Section is at substantial financial risk when more than twenty-five percent (25%) of the total maximum potential payments to the physician or physician group depend on the use of referral services. When the panel size is fewer than 25,000 enrollees’ arrangements that cause substantial financial risk include, but are not limited to, the following:
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Substantial Financial Risk means a financial risk set at greater than twenty-five percent (25%) of potential payments for Covered Services, regardless of the frequency of assessment (i.e., collection) or distribution of payments. The term “potential payments” means simply the maximum anticipated total payments that the physician or physician group could receive if the use or cost of referral services were significantly low. 42 CFR §§438.3(i), 422.208, 422.210.
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Substantial Financial Risk has the meaning specified in 42 C.F.R. (S)417.479, -------------------------- as amended from time to time.
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Examples of Substantial Financial Risk in a sentence

  • Provider or provider groups are subject to requirements outlined in the Final Rule if determined to be at Substantial Financial Risk (SFR).

  • As required by Exhibit H of the OHP Contract, if Subcontractor participates in a Practitioner Incentive Plan under the Agreement that places Subcontractor at Substantial Financial Risk, Subcontractor shall maintain PIP Stop-Loss Protection.

  • Provider must disclose annually to Health Plan and Subcontractor any PIP or risk arrangements Provider may have with physicians either within its group practice or other physicians not associated with the group practice even if there is no Substantial Financial Risk between Health Plan or Subcontractor and the physician or physician group.

  • For any subcontractor at financial risk, as defined in the Substantial Financial Risk provision, or of the Risk provision found in the Definitions Section of this Contract, the Contractor shall establish, enforce and monitor solvency requirements that provide assurance of the subcontractor's ability to meet its obligations.

  • DOH shall provide eye and face protection devices at no cost to all employees whose work requires such protection.

  • THE ONE CONSTANTIn all this change that so surrounds every aspect of our lives, we often long for something constant.

  • Substantial Financial Risk – An incentive arrangement based on referral services that place the physician or physician group at risk for amounts beyond the risk threshold.

  • An arrangement is at Substantial Financial Risk when the incentive arrangements place the physician or physician group at risk for services beyond those provided directly by the physician or physician group for amounts beyond the risk threshold of 25 percent of potential payments for covered services.

  • If Provider has agreed to provide medical service to a Member for a capitation payment, fixed fee, or other arrangement that imposes Substantial Financial Risk on Provider, Provider must protect itself against loss by maintaining a stop loss protection as required by 42 CFR 422.208 and 422.210 (“Physician Incentive Plan Regulations”) and the CCO Contract.

  • If CCO Provider participates in a Practitioner Incentive Plan under the Agreement that places CCO Provider at Substantial Financial Risk, CCO Provider shall submit stop-loss documentation to WVCH in accordance with WVCH’s policies and procedures.


More Definitions of Substantial Financial Risk

Substantial Financial Risk means financial risk such as that achieved when an organization receives revenue through capitation or payment of insurance premiums, or when the organization creates significant financial incentives for providers to achieve specific cost containment goals, such as withholding a substantial amount of their compensation, with distribution of that amount made only if the cost-containment goals are met.
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Substantial Financial Risk means financial risk achieved through capitation or the creation of significant financial incentives for the group to achieve specified cost- containment goals, such as withholding from all members or owners of a qualified managed care plan a substantial amount of the compensation due to them, with distribution of that amount to the members or owners only if the cost-containment goals are met.
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Substantial Financial Risk means a physician or Physician Group at Substantial Financial Risk when more than twenty-five percent (25%) of the total maximum potential payments to the physician or Physician Group depend on the use of referral services. When the panel size is fewer than 25,000 Enrollees’ arrangements that cause Substantial Financial Risk include, but are not limited to the following:
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Related to Substantial Financial Risk

  • Material Financial Relationship means a relationship in which one person is a recipient of any kind of payment such as by way of a loan or gift during the immediately preceding twelve months, equivalent to at least 25% of such payer’s annual income but shall exclude relationships in which the payment is based on arm’s length transactions.

  • high risk breach means that the threshold for notifying the individual is higher than that for notifying the relevant supervisory authority.

  • Substantial U.S. Market Interest means “substantial U.S. market interest” as that term is defined in Regulation S;

  • Minimal risk means that the probability and magnitude of harm or discomfort anticipated in the research are not greater in and of themselves than those ordinarily encountered in daily life or during the performance of routine physical or psychological examinations or tests.

  • Substantial disruption means without limitation that any one or more of the following occur as a result of the bullying:

  • Substantial Change means a change to the terms of this Agreement that reduces your rights or increases your responsibilities.

  • fall risk means any potential exposure to falling either from, off or into;

  • operational risk means the risk of loss for the individual portfolio resulting from inadequate internal processes and failures in relation to people and systems of the investment service provider or from external events, and includes legal and documentation risk and risk resulting from the trading, settlement and valuation procedures operated on behalf of the individual portfolio;

  • Material and substantial disruption of a normal school activity means:

  • Business User means a Signing Officer, Delegate or Non-Signer.

  • Substantial Block means a number of shares of the Voting Stock which has 15% or more of the aggregate voting power of all outstanding shares of Voting Stock.

  • Business Critical means any function identified in any Statement of Work as Business Critical.

  • Substantial Amount means, at the time of determination thereof, an amount in excess of 30.0% of total consolidated assets (exclusive of depreciation) at such time of the Borrower and its Subsidiaries determined on a consolidated basis.

  • commercial fishing means to take, harvest, hold, transport, or off-load marine species for sale or intended sale (R.I. Gen. Laws § 20-1-3).

  • Substantial governmental relationship means the extent of a governmental relationship necessary under Ohio law to make an added guarantee contract issued incident to that relationship valid and enforceable. A guarantee contract is issued "incident to that relationship" if it arises from a clear commonality of interest in the event of an UST release such as conterminous boundaries, overlapping constituencies, common groundwater aquifer, or other relationship other than monetary compensation that provides a motivation for the guarantor to provide a guarantee.

  • Substantially limits means the extent to which the impairment limits an individual’s ability to perform a major life activity as compared to most people in the general population, whether or not an individual chooses to forgo mitigating measures. 42 U.S.C. 126 §12102(4); 28 CFR §35.108(d); 28 CFR §35.105(d) The rules of construction when determining whether an impairment substantially limits performance of a major life activity include:

  • Substantial means more than minor or trivial

  • Business Week means five consecutive Business Days, excluding Public Holidays as defined in the Public Holidays Act;

  • Disadvantaged Business means a small business concern: (a) which is at least 51 percent owned by one or more socially and economically disadvantaged individual(s) or in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more socially and economically disadvantaged individual(s); and (b) whose management and daily business operations are controlled by one or more of the socially and economically disadvantaged individual(s) who own it. It is important to note that the business owners themselves must control the operations of the business. Absentee ownership or title ownership by an individual who does not take an active role in controlling the business is not consistent with eligibility as a DBE under CFR 49 Part 26.71.

  • Significant means in reference to a net emissions increase or the potential of a source to emit any of the following pollutants, a rate of emissions that would equal or exceed any of the following rates:

  • windstorm means straight line winds of at least 80 miles per

  • Explosion means the sudden release of energy sufficient to cause pressure waves and/or projectiles that may cause structural and/or physical damage to the surrounding of the vehicle."

  • All Risk property insurance on a full replacement cost basis insuring CLEC’s property situated on or within any CenturyLink Premises. CLEC may elect to insure business interruption and contingent business interruption, as it is agreed that CenturyLink has no liability for loss of profit or revenues should an interruption of service occur.

  • Certificate of Substantial Performance means a certificate issued by the NCC when the Work reaches Substantial Performance;

  • COVID-19 Pandemic means the SARS-Cov2 or COVID-19 pandemic, including any future resurgence or evolutions or mutations thereof and/or any related or associated disease outbreaks, epidemics and/or pandemics.

  • Substantial bodily injury means "bodily injury which involves (A) a temporary but substantial disfigurement; or (B) a temporary but substantial loss or impairment of the function of any bodily member, organ, or mental faculty." See 18 U.S.C. § 113(b)(1).