2 Up to the maximum Medicare participation described in Section 4.6.B.1. Beyond this point, all remaining risk sharing payments shall be treated as Medicaid expenditures eligible for FMAP. 3 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. b. Demonstration Year 2 Incremental % % EOHHS & % CMS % EOHHS Loss or Risk Contractor CMS Risk Risk Risk Gain (as % Corridor Risk Sharing Sharing Sharing2 of Total Percentage Sharing Adjusted Capitation Rate Revenue)1 Loss >10% >110.0% 100% 0% 0% 0% Loss >3% 103.1% to 50% 50% (50%) * and ≤ 10% 110.0% (Medicare Percent of A/B Rate) Percent of Rate) Loss or 97.0% to 100% 0% 0% 0% Gain ≤ 3% 103.0% Gain >3% 96.9% to 50% 50% (50%) * and ≤ 10% 90.0% (Medicare Percent of A/B Rate) Percent of Rate) Gain >10% < 90.0% 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 >10.0% still results in risk sharing reconciliation for the loss or gain between 3.1% and 10.0%. 2 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. c. Demonstration Year 3 Incremental % % EOHHS & % CMS % EOHHS Loss or Risk Contractor CMS Risk Risk Risk Gain (as % Corridor Risk Sharing Sharing Sharing2
2 Up to the maximum Medicare participation described in Section 4.6.B.1. Beyond this point, all remaining risk sharing payments shall be treated as Medicaid expenditures eligible for FMAP. 3 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. b. Demonstration Year 2 Incremental Loss or Gain (as % of Total Adjusted Capitation Rate Revenue)1 Risk Corridor Percentage % Contractor Risk Sharing % EOHHS & CMS Risk Sharing % CMS Risk Sharing % EOHHS Risk Sharing2 Loss >10% >110.0% 100% 0% 0% 0% Loss >3% and ≤ 10% 103.1% to 110.0% 50% 50% (50%) * (Medicare A/B Percent of Rate) Percent of Rate) Loss or Gain ≤ 3% 97.0% to 103.0% 100% 0% 0% 0% Gain >3% and ≤ 10% 96.9% to 90.0% 50% 50% (50%) * (Medicare A/B Percent of Rate) Percent of Rate) Gain >10% < 90.0% 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 >10.0% still results in risk sharing reconciliation for the loss or gain between 3.1% and 10.0%. 2 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. c. Demonstration Year 3 Incremental Loss or Gain (as % Risk Corridor % Contractor Risk % EOHHS & CMS Risk Sharing % CMS Risk Sharing % EOHHS Risk Sharing2
1409-one-care-contract-addendum.docx