National Efficiency Adjustment Clause Samples

National Efficiency Adjustment. The national efficiency adjustment to the Medicare savings requirement ranges from -0.5% to 0.5%. If the national efficiency ratio is: • Less than 0.9, then the national efficiency adjustment is +0.5%; • Between 0.9 and 1.0, then the national efficiency adjustment is between 0.0% and +0.5%; • Between 1.0 and 1.1, then the national efficiency adjustment is between 0.0% and -0.5%; • Greater than 1.1, then the national efficiency adjustment is -0.5%. 11 The national risk- and GAF-adjusted baseline expenditure PBPM will, because of the steps taken to ensure that the standardization process neither increases nor decreases total expenditures, will equal the incurredexpenditure PBPM of the reference population. The floor (and ceiling) for the risk adjusted, geographically price adjusted national efficiency ratio that an ACO must attain to receive the “maximum” (or “minimum”) national efficiency adjustment is thus 10% below or above average, respectively. Between the minimum and maximum efficiency ratios, the adjustment is a simple linear interpolation based on the national efficiency ratio. Table 8.3.2 shows the national efficiency adjustment that will be applied at selected national efficiency ratios.