of Total Corridor Risk Adjusted Percentage Sharing Capitation Rate Revenue)1 Loss >20% >120.0% 100% 0% 0% 0% Loss > 3% 103.1% to 50% 50% (50%) * (50%)* and 20% 120.0% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Loss >1% 101.1% to 10% 90% (90%) * (90%)* and 3% 103.0% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Loss or 99.0% to 100% 0% 0% 0% Gain 1% 101.0% ≤ Gain >1% 97.0% to 10% 90% (90%) * (90%)* and 3% 98.9% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Gain > 3% 80.0% to 50% 50% (50%) * (50%)* and 20% 96.9% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Gain >20% < 80.0% 100% 0% 0% 0% 1 Loss and gain reflected on an incremental basis, rounded to the nearest one tenth of a percent. Loss or gain >20.0% still results in risk sharing reconciliation for the loss or gain between 1.1% and 20.0%. 2 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. 4. Risk Sharing Settlement: CMS and EOHHS shall determine interim and final settlements of payments made by the Contractor to CMS and EOHHS or by CMS and EOHHS to the Contractor under this section. Interim and final settlement amounts shall be calculated for each Demonstration Year; however, the Risk Corridor for Demonstration Year 1 as described in Section 4.6.B.2.a shall be contingent upon Contractor participation in the Demonstration at
of Total Adjusted Capitation Rate Revenue)1 Corridor Percentage Risk Sharing Loss >20% >120.0% 100% 0% 0% 0% Loss > 3% and ≤ 20% 103.1% to 120.0% 50% 50% (50%) * (Medicare A/B Percent of Rate) (50%)* (Medicaid Percent of Rate) Loss >1% and ≤ 3% 101.1% to 103.0% 10% 90% (90%) * (Medicare A/B Percent of Rate) (90%)* (Medicaid Percent of Rate) Loss or Gain ≤ 1% 99.0% to 101.0% 100% 0% 0% 0% Gain >1% and ≤ 3% 97.0% to 98.9% 10% 90% (90%) * (Medicare A/B Percent of Rate) (90%)* (Medicaid Percent of Rate) Gain > 3% and ≤ 20% 80.0% to 96.9% 50% 50% (50%) * (Medicare A/B Percent of Rate) (50%)* (Medicaid Percent of Rate) Gain >20% < 80.0% 100% 0% 0% 0% 1 Loss and gain reflected on an incremental basis, rounded to the nearest one tenth of a percent. Loss or gain >20.0% still results in risk sharing reconciliation for the loss or gain between 1.1% and 20.0%. 2 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. 4. Risk Sharing Settlement: CMS and EOHHS shall determine interim and final settlements of payments made by the Contractor to CMS and EOHHS or by CMS and EOHHS to the Contractor under this section. Interim and final settlement amounts shall be calculated for each Demonstration Year; however, the Risk Corridor for Demonstration Year 1 as described in Section 4.6.B.2.a shall be contingent upon Contractor participation in the Demonstration at