Disability Risk Adjusted Payment System Sample Clauses

The Disability Risk Adjusted Payment System is a mechanism used to modify payments based on the assessed risk or cost associated with individuals who have disabilities. In practice, this system evaluates the expected healthcare or service needs of disabled individuals and adjusts funding or reimbursement rates accordingly, often using statistical models or risk categories. Its core function is to ensure that organizations or providers receive fair compensation that reflects the higher costs of serving populations with greater needs, thereby promoting equitable access and reducing financial disincentives to serve disabled individuals.
Disability Risk Adjusted Payment System. ‌ The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see ▇▇▇▇://▇▇▇▇.▇▇▇▇.▇▇▇/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees.
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Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see ▇▇▇▇://▇▇▇▇.▇▇▇▇.▇▇▇/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees.‌ Risk Adjustment Overview Appendix 2 contains the capitation rates used to calculate the Calendar Year risk adjusted payments to the MCO. The risk adjustment weights are found in Appendix 3. The STATE or its actuarial vendor will use, for Contract Year SNBC risk scores, a prospective risk adjustment model. The average risk score across all MCOs will be normalized to 1.0 for each rate cell. Development of Weights. The risk adjustment method utilizes two sets of weights, one for Medical Assistance only (non-Dual Eligible) Enrollees, and one for Dual Eligible Enrollees. These two models include disease categories and risk factor weights customized separately for non-Dual Eligible and Dual Eligible experience. The weights were developed using constrained linear regression and were based upon the Calendar Years (CYs) 2014 and 2015 experience of individuals enrolled in the SNBC program. Risk factor weights were constrained to be non-negative. The model includes: 1) demographic information; 2) diagnoses from health care claims for services provided to individuals during CY 2014; 3) costs from health care claims for services provided to individuals during CY 2015; and 4) developmental disability (DD) waiver status. Base Rates. Based on 2014 health plan experience, the STATE calculated base rates based on the following factors: Dual and non-Dual status, institutional (NF, ICF, ICF/DD) and community status, and rate region (Metro, Non-metro North, or Non- metro South as designated in Appendix 3-B). The STATE agrees not to rebase the base rates for risk adjustment during the term of this Contract. Base rates are provided in Appendix 2. Methodology The MCO will receive an SNBC risk score for each rate cell subject to risk adjustment, based on average risk scores across all the MCO’s Enrollees in that rate cell and enrolled in the MCO during the exposure month in 4.2.6(E)(1)(b) and 4.2.6(E)(2)(b) below. New Enrollees. Each MCO Enrollee with no FFS claim experience or managed care encounters in the assessment period will be assigned a risk score equal to the average risk sco...
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Disability Risk Adjusted Payment System 
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  • Catastrophic Leave Program Leave credits, as defined below, may be transferred from one (1) or more employees to another employee, on an hour-for-hour basis, in accordance with departmental policies upon the request of both the receiving employee and the transferring employee and upon approval of the employee's appointing authority, under the following conditions: A. The receiving employee is required to be absent from work due to injury or the prolonged illness of the employee, employee's spouse, registered domestic partner, a domestic partner listed on an “Affidavit for Enrollment of Domestic Partners,” submitted to employee benefits, parent or child, has exhausted all earned leave credits, including but not limited to sick leave, compensatory time, holiday credits and disability leave and is therefore facing financial hardship. B. The transfers must be for a minimum of four (4) hours and in whole hour increments thereafter. C. Transfers shall be allowed to cross-departmental lines in accordance with the policies of the receiving department. D. The total maximum leave credits received by an employee shall normally not exceed five hundred twenty (520) hours; however, if approved by his/her appointing authority, the total leave credits may be up to one thousand forty (1,040) hours. Total leave credits in excess of one thousand forty (1,040) hours will be considered on a case-by-case basis by the appointing authority subject to the approval of the Chief Administrative Officer. E. The transfers are irrevocable, and will be indistinguishable from other leave credits belonging to the receiving employee. Transfers will be subject to all taxes required by law. F. Leave credits that may be transferred under this program are defined as the transferring employee’s vacation credits or up to twenty-four (24) hours of sick leave per fiscal year. G. Transfers shall be administered according to the rules and regulations of the Auditor and Controller, and made on a form prescribed by the Auditor and Controller. Approvals of the receiving and donating employee, the donating employee's appointing authority and the receiving employee's appointing authority (in the case of an interdepartmental transfer) will be provided for on such form. H. This program is not subject to the Grievance Procedure of this Agreement.

  • BUSINESS CONTINUITY/DISASTER RECOVERY In the event of equipment failure, work stoppage, governmental action, communication disruption or other impossibility of performance beyond State Street’s control, State Street shall take reasonable steps to minimize service interruptions. Specifically, State Street shall implement reasonable procedures to prevent the loss of data and to recover from service interruptions caused by equipment failure or other circumstances with resumption of all substantial elements of services in a timeframe sufficient to meet business requirements. State Street shall enter into and shall maintain in effect at all times during the term of this Agreement with appropriate parties one or more agreements making reasonable provision for (i) periodic back-up of the computer files and data with respect to the Trusts; and (ii) emergency use of electronic data processing equipment to provide services under this Agreement. State Street shall test the ability to recover to alternate data processing equipment in accordance with State Street program standards, and provide a high level summary of business continuity test results to the Trusts upon request. State Street will remedy any material deficiencies in accordance with State Street program standards. Upon reasonable advance notice, and at no cost to State Street, the Trusts retain the right to review State Street’s business continuity, crisis management, disaster recovery, and third-party vendor management processes and programs (including discussions with the relevant subject matter experts and an on-site review of the production facilities used) related to delivery of the service no more frequently than an annual basis. Upon reasonable request, the State Street also shall discuss with senior management of the Trusts any business continuity/disaster recovery plan of the State Street and/or provide a high-level presentation summarizing such plan.”

  • Special Maternity Allowance for Totally Disabled Employees (a) An employee who: (i) fails to satisfy the eligibility requirement specified in subparagraph 17.02(a)(ii) solely because a concurrent entitlement to benefits under the Disability Insurance (DI) Plan, the Long term Disability (LTD) Insurance portion of the Public Service Management Insurance Plan (PSMIP) or the Government Employees Compensation Act prevents her from receiving Employment Insurance or Québec Parental Insurance Plan maternity benefits, and (ii) has satisfied all of the other eligibility criteria specified in paragraph 17.02(a), other than those specified in sections (A) and (B) of subparagraph 17.02(a)(iii), shall be paid, in respect of each week of maternity allowance not received for the reason described in subparagraph (i), the difference between ninety-three per cent (93%) of her weekly rate of pay and the gross amount of her weekly disability benefit under the DI Plan, the LTD Plan or via the Government Employees Compensation Act. (b) An employee shall be paid an allowance under this clause and under clause 17.02 for a combined period of no more than the number of weeks during which she would have been eligible for maternity benefits under the Employment Insurance or Québec Parental Insurance Plan had she not been disqualified from Employment Insurance or Québec Parental Insurance maternity benefits for the reasons described in subparagraph (a)(i).

  • Long Term Cost Evaluation Criterion # 4 READ CAREFULLY and see in the RFP document under "Proposal Scoring and Evaluation". Points will be assigned to this criterion based on your answer to this Attribute. Points are awarded if you agree not i ncrease your catalog prices (as defined herein) more than X% annually over the previous year for years two and thr ee and potentially year four, unless an exigent circumstance exists in the marketplace and the excess price increase which exceeds X% annually is supported by documentation provided by you and your suppliers and shared with TIP S, if requested. If you agree NOT to increase prices more than 5%, except when justified by supporting documentati on, you are awarded 10 points; if 6% to 14%, except when justified by supporting documentation, you receive 1 to 9 points incrementally. Price increases 14% or greater, except when justified by supporting documentation, receive 0 points. increases will be 5% or less annually per question Required Confidentiality Claim Form This completed form is required by TIPS. By submitting a response to this solicitation you agree to download from th e “Attachments” section, complete according to the instructions on the form, then uploading the completed form, wit h any confidential attachments, if applicable, to the “Response Attachments” section titled “Confidentiality Form” in order to provide to TIPS the completed form titled, “CONFIDENTIALITY CLAIM FORM”. By completing this process, you provide us with the information we require to comply with the open record laws of the State of Texas as they ma y apply to your proposal submission. If you do not provide the form with your proposal, an award will not be made if your proposal is qualified for an award, until TIPS has an accurate, completed form from you. Read the form carefully before completing and if you have any questions, email ▇▇▇▇ ▇▇▇▇▇▇ at TIPS at ▇▇▇▇.▇▇▇▇▇▇@t ▇▇▇-▇▇▇.▇▇▇

  • Special Parental Allowance for Totally Disabled Employees (a) An employee who: (i) fails to satisfy the eligibility requirement specified in subparagraph 17.05(a)(ii) solely because a concurrent entitlement to benefits under the Disability Insurance (DI) Plan, the Long-term Disability (LTD) Insurance portion of the Public Service Management Insurance Plan (PSMIP) or via the Government Employees Compensation Act prevents the employee from receiving Employment Insurance or Québec Parental Insurance Plan benefits, and (ii) has satisfied all of the other eligibility criteria specified in paragraph 17.05(a), other than those specified in sections (A) and (B) of subparagraph 17.05(a)(iii), shall be paid, in respect of each week of benefits under the parental allowance not received for the reason described in subparagraph (i), the difference between ninety-three per cent (93%) of the employee's rate of pay and the gross amount of his or her weekly disability benefit under the DI Plan, the LTD Plan or via the Government Employees Compensation Act. (b) An employee shall be paid an allowance under this clause and under clause 17.05 for a combined period of no more than the number of weeks during which the employee would have been eligible for parental, paternity or adoption benefits under the Employment Insurance or Québec Parental Insurance Plan, had the employee not been disqualified from Employment Insurance or Québec Parental Insurance Plan benefits for the reasons described in subparagraph (a)(i).