Gain >1% 90.0% to 10% 90% (90%) * (90%)* and 10% 98.9% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) Rate) Gain 80.0% to 50% 50% (50%) * (50%)* >10% and 89.9% (Medicare (Medicaid 20% A/B Percent of ≤ Percent of Rate) Rate) Gain >20% < 80.0% 100% 0% 0% 0% 1 Loss and gain reflected on an incremental 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. b. Demonstration Year 2 Incremental % % & % CMS % Risk Loss or Risk Contractor CMS Risk Risk Sharing2 Gain (as % Corridor Risk Sharing Sharing 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%) * (50%)* and 10% 110.0% (Medicare (Medicaid ≤ A/B Percent of Percent of Rate) 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%
Gain >1% and ≤ 10% 90.0% to 98.9% 10% 90% (90%) * (Medicare A/B Percent of Rate) (90%)* (Medicaid Percent of Rate) Gain >10% and ≤ 20% 80.0% to 89.9% 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 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. b. Demonstration Year 2 Incremental Loss or Gain (as % of Total Adjusted Capitation Rate Revenue)1 Risk Corridor Percentage % Contractor Risk Sharing % & CMS Risk Sharing % CMS Risk Sharing % 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) (50%)* (Medicaid 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%
contract-addendum-jan-2015.docx