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12/06/2016 (2)
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12/06/2016 (2)
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Last modified
12/10/2020 1:47:03 PM
Creation date
2/21/2017 1:24:25 PM
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Meetings
Meeting Type
BCC Regular Meeting
Document Type
Agenda Packet
Meeting Date
12/06/2016
Meeting Body
Board of County Commissioners
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(ii) Supplemental Factor: The charge to accounts fo r Value -Based Programs <br />incentives/Shared Savings settlements is a supplemental amount that is included <br />in the claim as an amount based on a specified supplemental factor (e.g., a small <br />percentage increase i n the claim amount). The supplemental factor may be <br />adjusted from time to time. <br />When such amounts are billed separately from the price of the claim, they may be <br />billed as follows: <br />• Per Member Per Month (PMPM) Billings: Per member per month billings for Value - <br />Based Programs incentives/Shared Savings settlements to accounts are outside of the <br />claim system. Florida Blue will pass these Host Blue charges directly through to <br />Employer as a separately identified amount on the group billings; or, <br />• Where Host Blues pass on the costs of Value -Based Programs to Florida Blue as <br />PMPM amounts not attached to specific claims, Florida Blue may elect to pass these <br />amounts to Employer as a claim amount. <br />The amounts used to calculate either the supplemental factors for estimated pricing or <br />PMPM billings are fixed amounts that are estimated to be necessary to finance the cost <br />of a particular Value -Based Program. Because amounts are estimates, there may be <br />positive or negative differences based on actual experience, and such differences will be <br />accounted for in a variance account maintained by the Host Blue (in the same manner as <br />described in the BlueCard claim pricing section above) until the end of the applicable <br />Value -Based Program payment and/or reconciliation measurement period. The amounts <br />needed to fund a Value -Based Program may be changed before the end of the <br />measurement period if it is determined that amounts being collected are projected to <br />exceed the amount necessary to fund the program or if they are projected to be <br />insufficient to fund the program. <br />At the end of the Value -Based Program payment and/or reconciliation measurement <br />period for these arrangements, Host Blues will take one of the following actions: <br />• Use any surplus in funds in the variance account to fund Value -Based Program <br />payments or reconciliation amounts in the next measurement period. <br />• Address any deficit in funds in the variance account through an adjustment to the <br />PMPM billing amount or the reconciliation billing amount for the next <br />measurement period <br />The Host Blue will not receive compensation resulting from how estimated, average or <br />PMPM price methods, described above, are calc ulated. If Employer terminates, you will <br />not receive a refund or charge from the variance account. This is because any resulting <br />surpluses or deficits would be eventually exhausted through prospective adjustment to the <br />settlement billings in the case of Value -Based Programs. The measurement period for <br />determining these surpluses or deficits may differ from the term of this Agreement, <br />Variance account balances are small amounts relative to the overall paid claims amounts <br />and will be liquidated over time. The timeframe for their liquidation depends on variables, <br />including, but not limited to, overall volume/number of claims processed and variance <br />account balance. Variance account balances may earn interest, and interest is earned at <br />the federal funds or similar rate. Host Blues may retain interest earned on funds held in <br />20160629 <br />1`55 <br />
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