Methodology to Determine Risk Sharing Withhold Amounts Sample Clauses

Methodology to Determine Risk Sharing Withhold Amounts. The amount that is withheld from the capitation rates to fund the risk sharing program is based on an analysis of data (fee-for-service or managed care) from the population and services covered by the risk sharing program. This data is considered the primary source of information for developing the withhold amounts. Since any one year may reflect unusual occurrences, when available, multiple years of information are reviewed and combined together. Because the data is generally historical in nature and the withholds are applicable to the future capitation rates, the data must be trended and adjusted as necessary to coincide with the time period in which the rates will be paid. These trends are estimates of the future costs of services provided. Given the programs' narrow specificity of risk and high per recipient cost, total risk sharing costs may fluctuate substantially from year to year. However, over a period of several years, the amount withheld from the rates is expected to be equivalent to the amount paid by the Commonwealth in risk sharing claims (i.e., budget neutral).
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