AZ
"37. COMPENSATION...
Reconciliation of PPC Costs
to Reimbursement: ...
AHCCCSA will reimburse 100%
of a Contractor’s excess reasonable costs in excess of a 10% limit as determined
by reported encounters. AHCCCS will recoup profit amounts in excess of
a 10% limit.
For contract years beginning with CYE ’00, a full reconciliation to 0% profit or loss will be done by AHCCCSA for the same eligibility time periods and risk groups noted above. AHCCCSA will reimburse the health plans 100% of any excess reasonable costs as determined by reported encounters, and all profits will be recouped…" Arizona Contract, pages 39-40.
AZBH
"ATTACHMENT E
SHARED-RISK METHODOLOGY...
Annual Evaluation and Reconciliation...
Any profits or losses in
excess of 10% for Title XIX and 5% for Title XXI will be returned to AHCCCSA
(profits) or reimbursed to ADHS/DBHS (losses). If a subcontracted
RBHA requests an extension for the submission of its Final Audited financial
Statements, the final determination may be delayed." Arizona Behavioral
Health Contract, Attachment D, page 1.
FLMH
"4.22 Savings
The contractor shall retain
any savings realized under this contract after all bills, charges and fines
are paid, unless a risk corridor has been negotiated pursuant to section
4.17. If a risk corridor has been negotiated, the contractor's retention
of savings shall be as defined in the specified risk corridor." Florida
Mental Health RFP, page 65.
IABH
"Distribution of the Medicaid
Capitation Payment
Mental Health and
Substance Abuse Service
Category***Restrictions, if Any Imposed by DHS*** Bidders Proposals...
3. Percentage of capitation payment required for administrative services including profit, if applicable (Medicaid Administrative Fund)***Shall not exceed 15% of the total capitation payment…***5.00%
6. Percentage of Medicaid
Administrative Fund allocated to administrative services and costs
located outside Iowa (#4)
allocated to corporate overhead and profit***Shall not exceed 15% of the
total capitation payment***45.54%…" Iowa Behavioral Health Contract,
page 61.
"Distribution of Funds for
the administration of Substance Abuse Services provided through
The Iowa Department of Public
Health
Category***Restrictions, if Any Imposed by DHS*** Bidders Proposals...
1. Percentage required
for administrative services including profit, if applicable DPH
Administrative Fund)***
Shall not exceed 5% of the total monthly payment***5.00%
2. Percentage of DPH
Administrative Fund (#1) which will be allocated to corporate overhead
including profit if applicable or other services provided outside Iowa***Shall
not exceed 5% of the total monthly payment***7.83%."
Iowa Behavioral Health Contract, page 72.
NE
"8.43 Risk Contract: The plan shall report annually to the Department how it is reinvesting profits into improved services for clients." Nebraska Contract, page 29.
NEBH
"8.42 Profit Reinvestment: PHP Profits (Capitation payments minus the sum of actual claim cost, a 12.5% projected administrative cost), and a 5% shall be reinvested into local community based mental health/substance abuse programs. Determination of the community based mental health and substance abuse programs targeted for reinvestment shall be mutually agreed upon between the PHP and the Department. Profit Reinvestment shall be assessed every six months of the contract period, with the final assessment occurring six (6) months following the end of the contract period, which would include a final reconciliation of the entire contract period." Nebraska Behavioral Health Contract, page 29.
PABH
"10. Performance Standards
and Damages...
c. Profit and
Reinvestment Arrangement
1) A predetermined
profit and reinvestment allowance has been incorporated into the actuarially
sound rate ranges that the MCO will be bidding upon in the Cost Proposals.
The Department intends to use this profit and reinvestment allowance as
a benchmark in conjunction with its review of the MCO's ability to meet
and/or exceed performance standards and health outcomes.
2) Counties
as primary contractors are not permitted to retain any discretionary funds.
After the closure of each contract year, any county discretionary funds
must be returned to DPW.
3) Private
MCOs as primary contractors to DPW are permitted to retain profit.
Profit will be monitored by DPW and will be factor in future rate negotiations."
Pennsylvania Behavioral Health RFP, page 48.
"E. Requirements...
d. Counties
and private MCOs as primary contractors to DPW must have prior approval
from DPW to carryover reinvestment funds from one contract year into a
subsequent contract year. The county/MCO reinvestment spending plans
for carryover funds are due to DPW three months prior to the closure of
each contract year. Any funds remaining in the reinvestment account
at the time of the contract termination must be returned to DPW."
Pennsylvania Behavioral Health RFP, pages 57-58.