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 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 of Total Percentage Sharing Adjusted Capitation Rate Revenue)1 Loss >8% >108.0% 100% 0% 0% 0% Loss >4% 104.1% to 50% 50% (50%) * (50%)* and 8% 108.0% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Loss or 96.0% to 100% 0% 0% 0% Gain 4% 104.0% ≤ Gain >4% 95.9% to 50% 50% (50%) * (50%)* and 8% 92.0% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Gain >8% < 92.0% 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 >8.0% still results in risk sharing reconciliation for the loss or gain between 4.1% and 8.0%. 2 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. d. Demonstration Year 1, if the Contract is terminated prior to June 30, 2015: Incremental % % & % CMS % EOHHS Loss or Risk Contractor CMS Risk Risk Risk Gain (as % Sharing Sharing Sharing2
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 Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. c. Demonstration Year 3 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 >8% >108.0% 100% 0% 0% 0% Loss >4% and ≤ 8% 104.1% to 108.0% 50% 50% (50%) * (Medicare A/B Percent of Rate) (50%)* (Medicaid Percent of Rate) Loss or Gain ≤ 4% 96.0% to 104.0% 100% 0% 0% 0% Gain >4% and ≤ 8% 95.9% to 92.0% 50% 50% (50%) * (Medicare A/B Percent of Rate) (50%)* (Medicaid Percent of Rate) Gain >8% < 92.0% 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 >8.0% still results in risk sharing reconciliation for the loss or gain between 4.1% and 8.0%. 2 All EOHHS Risk Sharing shall be treated as Medicaid expenditures eligible for FMAP. d. Demonstration Year 1, if the Contract is terminated prior to June 30, 2015: Incremental Loss or Gain (as % Risk % Contractor % & CMS Risk Sharing % CMS Risk Sharing % EOHHS Risk Sharing2
contract-addendum-jan-2015.docx