Common use of Risk Mitigation Strategies Clause in Contracts

Risk Mitigation Strategies. ● The Commonwealth will establish High Cost Risk Pools (HCRP) to account for enrollment of high cost members, defined based on spending for select Medicaid long- term supports and services above a defined threshold within Medicaid rating categories across ICOs. For each rating category with a HCRP, a portion of the base Medicaid capitation rate will be withheld from all ICOs into a risk pool. The risk pool will be divided across ICOs based on their percent of total costs above the threshold amount associated with the high cost members. A. Applicable Medicaid rating categories: a. F1- Facility-based Care b. C3- Community Tier 3 - High Community Needs