Experience Rebate Sample Clauses

Experience Rebate. (a) MCO’s duty to pay.
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Experience Rebate. (FSR calculation sheet)
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Experience Rebate. (a) MCO’s duty to pay. At the end of each Rate Period beginning with Rate Period 1, the MCO must pay an Experience Rebate for the STAR and CHIP Programs if the MCO’s Net Income before Taxes is greater than the percentage set forth below of the total Revenue for the period. The Experience Rebate is calculated in accordance with the tiered rebate method set forth below based on the consolidated Net Income before Taxes for all of the MCO’s STAR and CHIP Service Areas included within the scope of the Contract, as measured by the Financial-Statistical Report (FSR) as reviewed and confirmed by HHSC.
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Experience Rebate. The portion of the STAR+PLUS MMP’s Net Income Before Taxes, if any, which is returned to HHSC in accordance with requirements in this Contract. The Experience Rebate calculation under this Contract will be separate and apart from the Experience Rebate calculation done for other contracts with HHSC. This Experience Rebate will not be included in the “consolidated basis” of other HHSC contracts. For the purposes of calculating the Experience Rebate under this Contract, Medicare Part D premium revenues, along with associated Medicare Part D costs, will be excluded. Costs under the Experience Rebate calculation are subject to the Admin Cap and the Reinsurance Cap.
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Experience Rebate. For the Initial Term, CONTRACTOR must pay to HHSC an experience rebate calculated in accordance with the tiered rebate method listed below based on the excess of allowable CHIP HMO revenues over allowable CHIP HMO expenses as measured by any positive amount on Line 7, Net Income Before Taxes, of "Part 1: CHIP Financial Summary, All Coverage Groups Combined" of the annual Financial-Statistical Report contained in Appendix D, as reviewed and confirmed by HHSC. GRADUATED REBATE METHOD -------------------------------------------------------------------------------- Experience Rebate CONTRACTOR Share HHSC Share as a Percentage of Revenues -------------------------------------------------------------------------------- 0% - 3% 100% 0% -------------------------------------------------------------------------------- Over 3% - 7% 75% 25% -------------------------------------------------------------------------------- Over 7% - 10% 50% 50% -------------------------------------------------------------------------------- Over 10% - 15% 25% 75% -------------------------------------------------------------------------------- Over 15% 0% 100% -------------------------------------------------------------------------------- The financial governance document for calculating the experience rebate is the governance document used in the Texas Medicaid STAR program on the Effective Date of this Agreement. Losses incurred for one contract year may be carried forward only to the next contract year. If CONTRACTOR operates in multiple CHIP Service Areas, losses in one CHIP Service Area cannot be used to offset net income before taxes in another CHIP Service Area. CONTRACTOR may subtract from an experience rebate that is owed to HHSC any expenses for population-based health initiatives that have been approved by HHSC. A population-based initiative is a project or program designed to improve some aspect of quality of care, quality of life, or health care knowledge for children and/or their adult caretakers, as a whole. There will be two settlements for payment(s) of the state share of the experience rebate. The first settlement shall equal 100% of the state share of the experience rebate as derived from Line 7, Net Income Before Taxes, of "Part 1: CHIP Financial Summary, All Groups Combined" of the annual CHIP Financial-Statistical (CFS) Report contained in Appendix D and shall be paid on the same day the first annual CFS Report is submitted to the Administrative Services Contractor ...
Sample 1
Experience Rebate. (a) HMO’s duty to pay. At the end of each Rate Year beginning with Rate Year 1, the HMO must pay an Experience Rebate to HHSC if the HMO’s Net Income before Taxes is greater than 3% of the total Revenue for the period. The Experience Rebate is calculated in accordance with the tiered rebate method set forth below based on the consolidated Net Income before Taxes for all of the HMO’s Service Areas and HMO Programs included within the scope of the Contract, as measured by any positive amount on the Financial-Statistical Report (FSR) as reviewed and confirmed by HHSC.
Sample 1
Experience Rebate. For the Initial Term, CONTRACTOR must pay to HHSC an experience rebate calculated in accordance with the tiered rebate method listed below based on the excess of allowable CHIP HMO revenues over allowable CHIP HMO expenses as measured by any positive amount on Line 7, Net Income Before Taxes, of "Part 1: CHIP Financial Summary, All Coverage Groups Combined" of the annual Financial-Statistical Report contained in Appendix D, as reviewed and confirmed by HHSC. GRADUATED REBATE METHOD Experience Rebate as a Percentage of Revenues CONTRACTOR Share HHSC Share ---------------------- ---------------- ---------- 0% - 3% 100% 0% Over 3% - 7% 75% 25% Over 7% - 10% 50% 50% Over 10% - 15% 25% 75% Over 15% 0% 100% The financial governance document for calculating the experience rebate is the governance document used in the Texas Medicaid STAR program on the Effective Date of the Agreement. Losses incurred for one contract year may be carried forward only to the next contract year. If CONTRACTOR operates in multiple CHIP Service Areas, losses in one CHIP Service Area cannot be used to offset net income before taxes in another CHIP Service Area. CONTRACTOR may subtract from an experience rebate that is owed to HHSC any expenses for population-based health initiatives that have been approved by HHSC. A population-based initiative is a project or program designed to improve some aspect of quality of care, quality of life, or health care knowledge for children and/or their adult caretakers, as a whole. There will be two settlements for payment(s) of the state share of the experience rebate. The first settlement shall equal 100% of the state share of the experience rebate as derived from Line 7, Net Income Before Taxes, of "Part 1: CHIP Financial Summary, All Groups Combined" of the annual CHIP Financial- Statistical (CFS) Report contained in Appendix D and shall be paid on the same day the first annual CFS Report is submitted to the Administrative Services Contractor or HHSC. The second settlement shall be an adjustment to the first settlement and shall be paid to HHSC on the same day that the second annual CFS Report is submitted to the Administrative Services Contractor or HHSC if the adjustment is a payment from CONTRACTOR to HHSC. HHSC or its agent may audit or review the CFS reports. If HHSC determines that corrections to the CFS reports are required based on an HHSC audit/review or other documentation acceptable to HHSC, to determine an adjustment to the amount of the...
Sample 1
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Experience Rebate. The Demonstration will utilize a one-sided Experience Rebate, similar to that used in Texas’ STAR+PLUS program. This is separate from the Rebate currently used in the STAR+PLUS Program; for those groups of STAR+PLUS enrollees that are not part of this Demonstration, the previously existing STAR+PLUS Experience Rebate will continue to apply. The Experience Rebate is designed to limit the profits received by STAR+PLUS MMPs to a reasonable percentage of total revenue, and to encourage use of revenues for services rather than administrative expenses by putting a limit (Admin Cap) on the amount of administrative expenses that can be used to calculate Net Income Before Taxes when determining the Experience Rebate. The Experience Rebate will apply for all Demonstration Years and will include all Medicare A/B and Medicaid eligible costs. The Admin Cap will be introduced in Demonstration Year 2. Additional detail on the Experience Rebate will be included in the three-way contract. Under this Demonstration, at an appropriate time after the end of each state fiscal year, the STAR+PLUS MMP must pay to the State an Experience Rebate if the STAR+PLUS MMP’s Net Income Before Taxes is greater than the percentage set forth of the total Revenue for the period. There will be specified time frames for the payment of the Experience Rebates, and interest will be applied for late payment or inappropriate reporting that ultimately results in delayed payment; further details will be included in the three-way contract. The Experience Rebate will be calculated in accordance with a tiered rebate method summarized in Table 6-6, below. The State will remit to CMS a share as described below. Revenue will include capitated payments received by the STAR+PLUS MMP for Medicare A/B services (Medicare A/B Component) and for covered Medicaid services (Medicaid Component). Revenues used in calculating the Experience Rebate reflect capitation rate levels, which include the impact of risk adjustment methodologies and cost reconciliation, if any, as described in Sections V and IX.A, respectively. In calculating the Experience Rebate, Revenues will not be reduced by any quality withhold hereunder, and any such withheld payment will not be an Allowable Expense hereunder. Thus, any payment forfeited under the quality withhold terms will not reduce the Net Income Before Taxes used in the Experience Rebate calculation. The Experience Rebate would be calculated as if the payment had not been withheld. R...
Sample 1

Related to Experience Rebate

  • Investment Experience Holder understands that the purchase of this Warrant and its underlying securities involves substantial risk. Holder has experience as an investor in securities of companies in the development stage and acknowledges that Holder can bear the economic risk of such Holder’s investment in this Warrant and its underlying securities and has such knowledge and experience in financial or business matters that Holder is capable of evaluating the merits and risks of its investment in this Warrant and its underlying securities and/or has a preexisting personal or business relationship with the Company and certain of its officers, directors or controlling persons of a nature and duration that enables Holder to be aware of the character, business acumen and financial circumstances of such persons.

  • Experience of the Purchaser The Purchaser, either alone or together with its representatives, has such knowledge, sophistication and experience in business and financial matters so as to be capable of evaluating the merits and risks of the prospective investment in the Securities, and has so evaluated the merits and risks of such investment. The Purchaser is able to bear the economic risk of an investment in the Securities and, at the present time, is able to afford a complete loss of such investment.

  • Medical Examination Where the Employer requires an employee to submit to a medical examination or medical interview, it shall be at the Employer's expense and on the Employer's time.

  • Health Care Coverage The Company shall continue to provide Executive with medical, dental, vision and mental health care coverage at or equivalent to the level of coverage that the Executive had at the time of the termination of employment (including coverage for the Executive’s dependents to the extent such dependents were covered immediately prior to such termination of employment) for the remainder of the Term of Employment, provided, however that in the event such coverage may no longer be extended to Executive following termination of Executive’s employment either by the terms of the Company’s health care plans or under then applicable law, the Company shall instead reimburse Executive for the amount equivalent to the Company’s cost of substantially equivalent health care coverage to Executive under ERISA Section 601 and thereafter and Section 4980B of the Internal Revenue Code (i.e., COBRA coverage) for a period not to exceed the lesser of (A) 18 months after the termination of Executive’s employment or (B) the remainder of the Term of Employment, and provided further that (1) any such health care coverage or reimbursement for health care coverage shall cease at such time that Executive becomes eligible for health care coverage through another employer and (2) any such reimbursement shall be made no later than the last day of the calendar year following the end of the calendar year with respect to which such coverage or reimbursement is provided. The Company shall have no further obligations to the Executive as a result of termination of employment described in this Section 8(a) except as set forth in Section 12.

  • Management, Ownership The Company shall not materially change its ownership, executive staff or management without the prior written consent of the Secured Party. The ownership, executive staff and management of the Company are material factors in the Secured Party's willingness to institute and maintain a lending relationship with the Company.

  • Institutional and Retail Sales You authorize the Manager to sell to institutions and retail purchasers such Securities purchased by you pursuant to the Underwriting Agreement as the Manager will determine. The Selling Concession on any such sales will be credited to the accounts of the Underwriters as the Manager will determine.

  • BUSINESS CONTINUITY/DISASTER RECOVERY In the event of equipment failure, work stoppage, governmental action, communication disruption or other impossibility of performance beyond State Street’s control, State Street shall take reasonable steps to minimize service interruptions. Specifically, State Street shall implement reasonable procedures to prevent the loss of data and to recover from service interruptions caused by equipment failure or other circumstances with resumption of all substantial elements of services in a timeframe sufficient to meet business requirements. State Street shall enter into and shall maintain in effect at all times during the term of this Agreement with appropriate parties one or more agreements making reasonable provision for (i) periodic back-up of the computer files and data with respect to the Trusts; and (ii) emergency use of electronic data processing equipment to provide services under this Agreement. State Street shall test the ability to recover to alternate data processing equipment in accordance with State Street program standards, and provide a high level summary of business continuity test results to the Trusts upon request. State Street will remedy any material deficiencies in accordance with State Street program standards. Upon reasonable advance notice, and at no cost to State Street, the Trusts retain the right to review State Street’s business continuity, crisis management, disaster recovery, and third-party vendor management processes and programs (including discussions with the relevant subject matter experts and an on-site review of the production facilities used) related to delivery of the service no more frequently than an annual basis. Upon reasonable request, the State Street also shall discuss with senior management of the Trusts any business continuity/disaster recovery plan of the State Street and/or provide a high-level presentation summarizing such plan.”

  • Business Travel, Lodging, etc Employer shall reimburse Executive for reasonable travel, lodging, meal and other reasonable expenses incurred by him/her in connection with his/her performance of services hereunder upon submission of evidence, satisfactory to Employer, of the incurrence and purpose of each such expense and otherwise in accordance with Employer’s business travel reimbursement policy applicable to its senior executives as in effect from time to time.

  • APR The Annual Percentage Rate of such Receivable ranges from 0.00% to 11.90%.

  • Experience A minimum of 1 year of IT work experience in computer systems or support with demonstrated working knowledge of basic hardware and software products and problem solving/troubleshooting skills.

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