As used in this subchapter:
(1)“Board” means the Diamond State Hospital Cost Review Board established by § 9952 of this title.
(2)“Core CPI” means as defined in § 2503 of Title 18.
(3)“Hospital” means as defined in § 1001 of this title, except that hospitals that exclusively provide psychiatric services, rehabilitative services, or long-term acute care services are excluded from the application of this subchapter.
(4)“Insurer” means as defined in § 9903 of this title.
(5)“Manual” means the Uniform Reporting Manual for Budget Submissions to be adopted by regulation by the Board to ensure the consistency of information provided by hospitals under this subchapter.
(6)“Meaningful Cost Containment Arrangement” means, with respect to the applicable benchmark compliance plan year, any
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As used in this subchapter:
(1) “Board” means the Diamond State Hospital Cost Review Board established by § 9952 of this title.
(2) “Core CPI” means as defined in § 2503 of Title 18.
(3) “Hospital” means as defined in § 1001 of this title, except that hospitals that exclusively provide psychiatric services, rehabilitative services, or long-term acute care services are excluded from the application of this subchapter.
(4) “Insurer” means as defined in § 9903 of this title.
(5) “Manual” means the Uniform Reporting Manual for Budget Submissions to be adopted by regulation by the Board to ensure the consistency of information provided by hospitals under this subchapter.
(6) “Meaningful Cost Containment Arrangement” means, with respect to the applicable benchmark compliance plan year, any of the following:
a. A Medicare or Medicaid Global Budget Arrangement.
b. A Substantial Financial Downside Risk Arrangement.
c. Any other qualifying written agreement approved by the Board on application of a hospital under § 9953(d)(7)c. of this title.
(7) “Medicare or Medicaid Global Budget Arrangement” means a written agreement among Medicare, Medicaid, or other applicable federal or state governmental payer authorities or public programs; a hospital, health system or affiliate; and, as applicable, any necessary third-party payers that is designed to cover the projected costs of hospital-based care for a defined patient population covering at least 50% of the hospital’s historical patient volumes and representing at least 3% of the hospital’s net patient revenue at risk for the applicable benchmark compliance plan year, reflecting a historical baseline calculation adjusted for inflation, demographic shifts, risk adjustment, and other factors for a defined performance period.
(8) “Payer” means as defined in § 9903 of this title.
(9) “Public programs” means as defined in § 9903 of this title.
(10) “Purchaser” means any governmental entity or unit, which offers coverage on a self-insured basis, or any employer that is self-insured within the definitions of the Employee Retirement Income Security Act (ERISA) [29 U.S.C. § 1001 et seq.].
(11) “Spending benchmark” means as defined in § 9903 of this title.
(12) a. “Substantial Financial Downside Risk Arrangement” means, for the applicable benchmark compliance year, 1 or more written agreements between a payer, purchaser, or insurer and a hospital, health system, or affiliate for providing health-care services to a defined patient population that provide all of the following:
1. That total annual costs are not less than 3% of the hospital’s net patient revenue.
2. That a minimum of 10% of the total annual costs for the defined patient population are at risk to the hospital.
3. That, for any hospital having an annual operating budget greater than $1,000,000,000, a minimum of 5,000 covered patient lives are subject to the agreement.
b. The Board may, by regulation, increase the amounts or percentages set forth in paragraphs (12)a.1., a.2., or a.3. of this section.
(13) “Total annual costs” means the aggregate yearly health-care costs of a defined patient population in a Meaningful Cost Containment Arrangement in the applicable benchmark compliance year.