Medical Loss Ratio Calculation Sample Clauses

Medical Loss Ratio Calculation. Within ninety (90) days following the six (6) month claims run-out period following the Coverage Year, the Department shall calculate the Medical Loss Ratio by dividing the Benefit Expense by the Revenue. The Medical Loss Ratio shall be expressed as a percentage rounded to the second decimal point. Contractor shall have sixty (60) days to review the Department’s Medical Loss Ratio Calculation. Each Party shall have the right to review all data and methodologies used to calculate the Medical Loss Ratio.

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Medical Loss Ratio Calculation. Within ninety (90) days following the six (6) month claims run-out period following the coverage year, CMS and NYSDOH shall calculate the MLR by dividing the benefit expense by the revenue. The MLR shall be expressed as a percentage rounded to the second decimal point. The FIDA Plan shall have sixty (60) days to review the Medical Loss Ratio Calculation. Each party shall have the right to review all data and methodologies used to calculate the Medical Loss Ratio.

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Medical Loss Ratio Calculation. Following the submission of the MLR report, MDHHS and CMS will have sixty (60) days to review and finalize the MLR calculation. MDHHS and CMS shall calculate the MLR by dividing the benefit expense by the revenue. The MLR shall be expressed as a percentage rounded to the second decimal point. Subsequently, the ICO shall have sixty (60) calendar days to review the MLR calculation. Each party shall have the right to review all data and methodologies used to calculate the MLR.” 46. This Addendum deletes Subsection 4.4.4.8.2 and replaces it with the following “4.4.4.8.2 Payment will be based on performance on the quality withhold measures listed in Exhibit 7 below. The ICO must report these measures based on the prevailing technical specifications for the applicable measurement year.” 47. The Addendum deletes “Exhibit 7 Quality Withhold Measures for Demonstration Years 2-5” and replaces it with the following: “ Measure Source CMS Core Withhold Measure Michigan Withhold Measure Encounter data CMS/State defined measure X Plan all-cause readmissions NCQA/HEDIS X Annual flu vaccine AHRQ/CAHPS X Follow-up after hospitalization for mental illness NCQA/HEDIS X Reducing the risk of falling NCQA/HEDIS/HOS X Controlling blood pressure NCQA/HEDIS X Part D medication adherence for diabetes medications CMS X Care transition record transmitted to health care professional CMS/State defined measure X Medication review – all populations State-defined (HEDIS-like) X Measure Source CMS Core Withhold Measure Michigan Withhold Measure Documentation of care goals CMS/State defined measure X Urinary tract infection (DY 2-3 only) CMS/State defined measure X Annual dental visit (DY 4-5 only) CMS/State defined measure X ” 48. This Addendum deletes Subsection 4.5.1.3 and amends the numbering of “Subsection 4.5.1.4” by renumbering it to “Subsection 4.5.1.3”. 49. This Addendum deletes Subsection 5.5.7.2.1 and replaces is with the following

Medical Loss Ratio Calculation. Within ninety (90) days following the data submission, SCDHHS and CMS shall calculate the MLR by dividing the benefit expense by the revenue. The MLR shall be expressed as a percentage rounded to the second decimal point. The CICO shall have sixty (60) days to review the MLR calculation. Each party shall have the right to review all data and methodologies used to calculate the MLR.

Medical Loss Ratio Calculation. Within ninety (90) days following the six

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Cash Flow Coverage Ratio The ratio of (a) the Company’s Cash Flow to (b) the sum of (i) the Company’s consolidated Interest Expense plus (ii) the Company’s scheduled payments of principal (including the principal component of Capital Leases) to be paid during the 12 months following any date of determination shall at all times exceed (1) 1.5 to 1.0. Compliance with the ratio will be tested as of the last day of each month, with Cash Flow and Interest Expense being calculated for the twelve months then ended.
Minimum Consolidated Fixed Charge Coverage Ratio The Consolidated Fixed Charge Coverage Ratio shall not be less than 1.50 to 1.00, determined based on information for the most recent fiscal quarter annualized.
Interest Expense Coverage Ratio The Borrower will not permit the ratio of (a) Consolidated EBITDA to (b) Consolidated Interest Expense, in each case for any period of four consecutive fiscal quarters ending after the Effective Date, to be less than 4.0 to 1.0.
Consolidated Excess Cash Flow Subject to Section 2.14(g), if there shall be Consolidated Excess Cash Flow for any Fiscal Year beginning with the Fiscal Year ending December 31, 2018, the Borrowers shall, within ten Business Days of the date on which the Borrowers are required to deliver the financial statements of Holdings and its Restricted Subsidiaries pursuant to Section 5.1(b), prepay the Loans and/or certain other Obligations as set forth in Section 2.15(b) in an aggregate amount equal to (i) 50% of such Consolidated Excess Cash Flow minus (ii) voluntary prepayments of the Loans, First Lien Loans or Refinanced Debt (as defined in the First Lien Credit Agreement) made during such Fiscal Year (excluding repayments of revolving First Lien Loans or Refinanced Debt (as defined in the First Lien Credit Agreement) except to the extent the applicable revolving credit commitments are permanently reduced in connection with such repayments) paid from Internally Generated Cash (provided that such reduction as a result of prepayments made pursuant to Section 10.6(k) shall be limited to the actual amount of cash used to prepay principal of Term Loans, First Lien Loans or Refinanced Debt (as defined in the First Lien Credit Agreement) (as opposed to the face amount thereof)); provided, if, as of the last day of the most recently ended Fiscal Year, the Consolidated Total Net Leverage Ratio (determined for such Fiscal Year by reference to the Compliance Certificate delivered pursuant to Section 5.1(c) calculating the Consolidated Total Net Leverage Ratio as of the last day of such Fiscal Year) shall be (A) less than or equal to 4.50:1.00 but greater than 4.00:1.00, the Borrowers shall only be required to make the prepayments and/or reductions otherwise required hereby in an amount equal to (1) 25% of such Consolidated Excess Cash Flow minus (2) voluntary repayments of the Loans, First Lien Loans or Refinanced Debt (as defined in the First Lien Credit Agreement) made during such Fiscal Year (excluding repayments of revolving First Lien or Refinanced Debt (as defined in the First Lien Credit Agreement) except to the extent the applicable revolving credit commitments are permanently reduced in connection with such repayments) paid from Internally Generated Cash (provided that such reduction as a result of prepayments made pursuant to Section 10.6(k) shall be limited to the actual amount of cash used to prepay principal of Term Loans, First Lien Loans or Refinanced Debt (as defined in the First Lien Credit Agreement) (as opposed to the face amount thereof)) and (B) less than or equal to 4.00:1.00, the Borrowers shall not be required to make the prepayments and/or reductions otherwise required by this Section 2.14(e).
Debt Service Coverage Ratio Calculation: If school owns its facility or if the school leases its facility and the lease is capitalized: (Net Income + Depreciation Expense + Interest Expense) divided by (Principal + Interest + Lease Payments) If school leases its facility and the lease is not capitalized: (Facility Lease Payments + Net Income + Depreciation Expense + Interest Expense) divided by (Principal + Interest + Lease Payments) Data Source: Annual Fiscal Audit Report

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