Rate Certification. In preparing the capitation rates for the CY 2014 ABD <21 Risk-Based Managed Care program, Xxxxxx has used and relied upon enrollment, eligibility, encounter, and other information supplied by the State and its vendors. The State and its vendors are responsible for the validity and completeness of this supplied data and information. We have reviewed the data and information for internal consistency and reasonableness, but we did not audit it. If the data and information is incomplete or inaccurate, the values shown in this letter may need to be revised accordingly. Xxxxxx certifies that the rates were developed in accordance with generally accepted actuarial practices and principles and are appropriate for the Medicaid covered populations and services under the managed care contract. The undersigned actuaries are members of the American Academy of Actuaries and meet its qualification standards to certify the actuarial soundness2 of Medicaid managed-care capitation rates. Capitation rates developed by Xxxxxx are actuarial projections of future contingent events. Actual costs will differ from these projections. Xxxxxx has developed these rates on behalf of the State to demonstrate compliance with the Centers for Medicare & Medicaid Services (CMS) requirements under 42 CFR 438.6(c) and in accordance with applicable laws and regulations. Use of these rates for any purpose beyond that stated may not be appropriate. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx disclaims any responsibility for the use of these rates by MCPs for any 2 Medicaid benefit plan premium rates are “actuarially sound” if, for business in the state for which the certification is being prepared and for the period covered by the certification, projected premiums, including expected reinsurance and governmental stop-loss cash flows, governmental risk adjustment cash flows, and investment income, provide for all reasonable, appropriate and attainable costs, including health benefits, health benefit settlement expenses, marketing and administrative expenses, any government mandated assessments, fees, and taxes, and the cost of capital. Note: Please see pages 8-9 of the August 2005, Actuarial Certification of Rates for Medicaid Managed Care Programs, from the American Academy of Actuaries, xxxx://xxx.xxxxxxx.xxx/pdf/practnotes/health_medicaid_05.pdf purpose. Xxxxxx recommends that any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. This certification letter assumes the reader is familiar with the Ohio Medicaid program, Medicaid eligibility rules, and actuarial rating techniques. It is intended for the State and CMS and should not be relied upon by third parties. Other readers should seek the advice of actuaries, or other qualified professionals competent in the area of actuarial rate projections, to understand the technical nature of these results. This document should only be reviewed in its entirety. If you have any questions on any of the above, please feel free to contact Xxxx Xxxxxxxxx at +0 000 000 0000 or Xxxxxx Xxxxxxxxx at +0 000 000 0000. Sincerely, Xxxx Xxxxxxxxx, ASA, MAAA Xxxxxx Xxxxxxxxx, ASA, MAAA Partner Senior Associate DB/jh Attachments Copy: Xxxxxx Xxxxxxxxxx, Xxxx Xxxxxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxxx, Xxxxx Xxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxx Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus A1 - North Central HF/HST <1 M+F 64,590 $ 713.44 $ 46,081,305 $ 8.92 HF/HST 1 M+F 55,600 189.01 10,508,726 2.36 HF/HST 2-13 M+F 589,341 117.90 69,481,832 1.47 HF/HST 14-18 M 88,595 149.00 13,200,733 1.86 HF/HST 14-18 F 92,440 186.28 17,219,766 2.33 HF 19-44 M 93,901 273.63 25,694,247 3.42 HF 19-44 F 285,834 400.39 114,444,836 5.00 HF 45+ M+F 36,980 607.39 22,461,240 7.59 HST 19-64 F 15,448 477.15 7,371,190 5.96 Composite Non-Delivery 1,322,729 $ 246.81 $ 326,463,876 $ 3.09 Delivery CFC 4,262 5,522.04 23,535,500 69.03 CFC Composite 1,322,729 $264.60 $ 349,999,376 $ 3.31 ABD <21 37,301 $ 510.20 $ 19,030,838 $ 6.38 ABD 21 + 107,912 $ 1,358.07 $ 146,552,166 $ 16.98 Composite 1,467,942 $ 351.23 $ 515,582,381 $ 4.39 A2 - Northwest HF/HST <1 M+F 45,870 $ 544.03 $ 24,954,730 $ 6.80 HF/HST 1 M+F 38,775 146.09 5,664,864 1.83 HF/HST 2-13 M+F 423,966 110.28 46,754,603 1.38 HF/HST 14-18 M 62,477 137.80 8,609,530 1.72 HF/HST 14-18 F 63,012 195.68 12,330,429 2.45 HF 19-44 M 66,381 231.33 15,356,256 2.89 HF 19-44 F 180,250 358.87 64,686,070 4.49 HF 45+ M+F 21,927 490.11 10,746,824 6.13 HST 19-64 F 10,438 399.62 4,171,292 5.00 Composite Non-Delivery 913,097 $ 211.67 $ 193,274,599 $ 2.65 Delivery CFC 2,807 5,965.90 16,745,175 74.57 CFC Composite 913,097 $230.01 $ 210,019,774 $ 2.88 ABD <21 9,897 $ 661.06 $ 6,542,856 $ 8.26 ABD 21 + 48,238 $ 1,349.32 $ 65,088,038 $ 16.87 Composite 971,232 $ 289.99 $ 281,650,668 $ 3.62 A3 - Southwest HF/HST <1 M+F 220,889 $ 913.70 $ 201,827,371 $ 11.42 HF/HST 1 M+F 202,819 230.96 46,843,760 2.89 HF/HST 2-13 M+F 2,174,872 142.52 309,970,933 1.78 HF/HST 14-18 M 315,928 177.23 55,992,861 2.22 HF/HST 14-18 F 327,500 215.76 70,662,755 2.70 HF 19-44 M 295,233 265.71 78,445,063 3.32 HF 19-44 F 978,845 374.28 366,360,030 4.68 HF 45+ M+F 130,674 596.31 77,922,936 7.45 HST 19-64 F 56,694 429.35 24,341,933 5.37 Composite Non-Delivery 4,703,455 $ 262.01 $ 1,232,367,642 $ 3.28 Delivery CFC 14,320 5,598.86 80,173,080 69.99 CFC Composite 4,703,455 $279.06 $ 1,312,540,722 $ 3.49 ABD <21 94,936 $ 903.75 $ 85,798,507 $ 11.30 ABD 21 + 338,839 $ 1,424.46 $ 482,661,186 $ 17.81 Composite 5,137,230 $ 366.15 $ 1,881,000,414 $ 4.58 X0 - Xxxxx Xxxxxxx HF/HST <1 M+F 189,729 $ 990.37 $ 187,901,498 $ 12.38 HF/HST 1 M+F 173,861 184.52 32,081,437 2.31 HF/HST 2-13 M+F 1,851,737 126.31 233,900,539 1.58 HF/HST 14-18 M 272,460 150.65 41,045,212 1.88 HF/HST 14-18 F 275,467 198.01 54,545,599 2.48 HF 19-44 M 299,455 277.90 83,217,789 3.47 HF 19-44 F 829,303 396.83 329,096,035 4.96 HF 45+ M+F 121,813 647.79 78,908,569 8.10 HST 19-64 F 45,286 404.76 18,329,780 5.06 Composite Non-Delivery 4,059,110 $ 260.90 $ 1,059,026,459 $ 3.26 Delivery CFC 12,020 5,841.55 70,212,891 73.02 CFC Composite 4,059,110 $278.20 $ 1,129,239,350 $ 3.48 ABD <21 81,133 $ 1,009.73 $ 81,922,435 $ 12.62 ABD 21 + 334,680 $ 1,396.59 $ 467,411,402 $ 17.46 Composite 4,474,924 $ 375.11 $ 1,678,573,187 $ 4.69 Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus B2 - Southeast HF/HST <1 M+F 66,498 $ 825.54 $ 54,897,182 $ 10.32 HF/HST 1 M+F 57,578 154.12 8,874,000 1.93 HF/HST 2-13 M+F 650,716 142.03 92,421,955 1.78 HF/HST 14-18 M 111,097 177.88 19,761,642 2.22 HF/HST 14-18 F 113,426 203.80 23,116,434 2.55 HF 19-44 M 138,200 249.30 34,452,739 3.12 HF 19-44 F 313,522 384.82 120,650,106 4.81 HF 45+ M+F 48,146 577.53 27,805,981 7.22 HST 19-64 F 15,711 449.32 7,059,419 5.62 Composite Non-Delivery 1,514,894 $ 256.81 $ 389,039,458 $ 3.21 Delivery CFC 4,157 5,201.02 21,619,941 65.01 CFC Composite 1,514,894 $271.08 $ 410,659,399 $ 3.39 ABD <21 25,246 $ 773.38 $ 19,524,706 $ 9.67 ABD 21 + 140,097 $ 1,290.99 $ 180,863,503 $ 16.14 Composite 1,680,237 $ 363.67 $ 611,047,608 $ 4.55 C1 - Northeast HF/HST <1 M+F 258,958 $ 1,004.16 $ 260,035,450 $ 12.55 HF/HST 1 M+F 232,433 201.69 46,878,596 2.52 HF/HST 2-13 M+F 2,575,572 124.51 320,672,994 1.56 HF/HST 14-18 M 435,914 153.86 67,068,365 1.92 HF/HST 14-18 F 450,348 195.30 87,952,616 2.44 HF 19-44 M 373,711 243.76 91,094,603 3.05 HF 19-44 F 1,282,288 367.93 471,793,400 4.60 HF 45+ M+F 201,719 542.05 109,341,643 6.78 HST 19-64 F 58,608 535.02 31,356,829 6.69 Composite Non-Delivery 5,869,550 $ 253.20 $ 1,486,194,496 $ 3.17 Delivery CFC 16,820 5,600.65 94,203,856 70.01 CFC Composite 5,869,550 $269.25 $ 1,580,398,352 $ 3.37 ABD <21 170,693 $ 659.93 $ 112,645,168 $ 8.25 ABD 21 + 506,340 $ 1,404.32 $ 711,061,633 $ 17.55 Composite 6,546,583 $ 367.23 $ 2,404,105,153 $ 4.59 C2 - Northeast Central HF/HST <1 M+F 64,414 $ 709.21 $ 45,683,038 $ 8.87 HF/HST 1 M+F 56,193 152.04 8,543,682 1.90 HF/HST 2-13 M+F 628,532 114.68 72,081,154 1.43 HF/HST 14-18 M 102,176 136.81 13,978,513 1.71 HF/HST 14-18 F 103,821 188.24 19,543,278 2.35 HF 19-44 M 108,930 203.52 22,169,466 2.54 HF 19-44 F 296,618 332.66 98,671,767 4.16 HF 45+ M+F 42,280 441.14 18,651,323 5.51 HST 19-64 F 14,971 396.18 5,931,401 4.95 Composite Non-Delivery 1,417,934 $ 215.28 $ 305,253,624 $ 2.69 Delivery CFC 4,173 4,710.04 19,656,341 58.88 CFC Composite 1,417,934 $229.14 $ 324,909,964 $ 2.86 ABD <21 24,691 $ 721.51 $ 17,814,653 $ 9.02 ABD 21 + 91,995 $ 1,156.84 $ 106,423,749 $ 14.46 Composite 1,534,621 $ 292.68 $ 449,148,366 $ 3.66 All Regions HF/HST <1 M+F 910,948 $ 901.68 $ 821,380,575 $ 11.27 HF/HST 1 M+F 817,258 195.04 159,395,066 2.44 HF/HST 2-13 M+F 8,894,735 128.76 1,145,284,012 1.61 HF/HST 14-18 M 1,388,647 158.18 219,656,856 1.98 HF/HST 14-18 F 1,426,015 200.12 285,370,877 2.50 HF 19-44 M 1,375,811 254.71 350,430,162 3.18 HF 19-44 F 4,166,659 375.77 1,565,702,243 4.70 HF 45+ M+F 603,539 573.02 345,838,517 7.16 HST 19-64 F 217,157 453.87 98,561,844 5.67 Composite Non-Delivery 19,800,770 $ 252.09 $ 4,991,620,153 $ 3.15 Delivery CFC 58,558 5,569.60 326,146,784 69.62 CFC Composite 19,800,770 $268.56 $ 5,317,766,937 $ 3.36 ABD <21 443,897 $ 773.33 $ 343,279,163 $ 9.67 ABD 21 + 1,568,102 $ 1,377.50 $ 2,160,061,677 $ 17.22 Composite 21,812,769 $ 358.56 $ 7,821,107,777 $ 4.48 Xxxx Xxxxxxxxx, ASA, MAAA Partner Xxxxxx Xxxxxxxxx, ASA, MAAA Senior Associate 0000 Xxxx Xxxxxxxxx Xxxx, Xxxxx 000 Xxxxxxx, XX 00000 +0 000 000 0000 xxx.xxxxxx.xxx Xx. Xxxxxx Xxxxxx Ohio Department of Medicaid Bureau of Managed Health Care Lazarus Building 00 Xxxx Xxxx Xxxxxx, Xxxxx 000 Xxxxxxxx, Xxxx 00000 December 17, 2013
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
Rate Certification. In preparing the capitation rates for the CY 2014 ABD <21 2015 Extension Risk-Based Managed Care program, Xxxxxx has used and relied upon enrollment, eligibility, claim, encounter, financial and other data, and information supplied by the State and its vendors. The State and its vendors are responsible for the validity and completeness of this supplied data and information. We have Xxxxxx has reviewed the data and information for internal consistency and reasonableness, but we Xxxxxx did not audit it. If the 1 Xxxxxx defines the term “actuarially sound” within the rate certification section of the letter. data and information is incomplete or inaccurate, the values shown in this letter may need to be revised accordingly. Xxxxxx certifies that the rates were developed in accordance with generally accepted actuarial practices and principles and are appropriate for the Medicaid covered populations and services under the managed care contract. The undersigned actuaries are members of the American Academy of Actuaries and meet its qualification standards to certify the actuarial soundness2 of Medicaid managed-managed care capitation rates. Capitation rates developed by Xxxxxx are actuarial projections of future contingent events. Actual costs will differ from these projections. Xxxxxx has developed these rates on behalf of the State to demonstrate compliance with the Centers for Medicare & and Medicaid Services (CMS) requirements under 42 CFR 438.6(c) and in accordance with applicable laws and regulations. Use of these rates for any purpose beyond that stated may not be appropriate. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx disclaims any responsibility for the use of these rates by MCPs for any 2 Medicaid benefit plan premium rates are “actuarially sound” if, for business in the state for which the certification is being prepared and for the period covered by the certification, projected premiums, including expected reinsurance and governmental stop-loss cash flows, governmental risk adjustment cash flows, and investment income, provide for all reasonable, appropriate and attainable costs, including health benefits, health benefit settlement expenses, marketing and administrative expenses, any government mandated assessments, fees, and taxes, and the cost of capital. Note: Please see pages 8-9 of the August 2005, Actuarial Certification of Rates for Medicaid Managed Care Programs, from the American Academy of Actuaries, xxxx://xxx.xxxxxxx.xxx/pdf/practnotes/health_medicaid_05.pdf purpose. Xxxxxx recommends that any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. This certification letter assumes the reader is familiar with the Ohio Medicaid program, Medicaid eligibility rules, and actuarial rating techniques. It is intended for the State and CMS and should not be relied upon by third parties. Other readers should seek the advice of actuaries, actuaries or other qualified professionals competent in the area of actuarial rate projections, projections to understand the technical nature of these results. This document should only be reviewed in its entirety. If you have any questions on any of the above, please feel free to contact Xxxx Xxxxxxxxx at +0 000 000 0000 or Xxxxxx Xxxxxxxxx at +0 000 000 0000. Sincerely, Xxxx Xxxxxxxxx, ASA, MAAA Xxxxxx Xxxxxxxxx, ASA, MAAA Partner Senior Associate DB/jh Attachments Copy: Xxxxxx Xxxxxxxxxx, Xxxx Xxxxxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxxx, Xxxxx Xxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxx Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus A1 - North Central HF/HST <1 M+F 64,590 $ 713.44 $ 46,081,305 $ 8.92 HF/HST 1 M+F 55,600 189.01 10,508,726 2.36 HF/HST 2-13 M+F 589,341 117.90 69,481,832 1.47 HF/HST 14-18 M 88,595 149.00 13,200,733 1.86 HF/HST 14-18 F 92,440 186.28 17,219,766 2.33 HF 19-44 M 93,901 273.63 25,694,247 3.42 HF 19-44 F 285,834 400.39 114,444,836 5.00 HF 45+ M+F 36,980 607.39 22,461,240 7.59 HST 19-64 F 15,448 477.15 7,371,190 5.96 Composite Non-Delivery 1,322,729 $ 246.81 $ 326,463,876 $ 3.09 Delivery CFC 4,262 5,522.04 23,535,500 69.03 CFC Composite 1,322,729 $264.60 $ 349,999,376 $ 3.31 ABD <21 37,301 $ 510.20 $ 19,030,838 $ 6.38 ABD 21 + 107,912 $ 1,358.07 $ 146,552,166 $ 16.98 Composite 1,467,942 $ 351.23 $ 515,582,381 $ 4.39 A2 - Northwest HF/HST <1 M+F 45,870 $ 544.03 $ 24,954,730 $ 6.80 HF/HST 1 M+F 38,775 146.09 5,664,864 1.83 HF/HST 2-13 M+F 423,966 110.28 46,754,603 1.38 HF/HST 14-18 M 62,477 137.80 8,609,530 1.72 HF/HST 14-18 F 63,012 195.68 12,330,429 2.45 HF 19-44 M 66,381 231.33 15,356,256 2.89 HF 19-44 F 180,250 358.87 64,686,070 4.49 HF 45+ M+F 21,927 490.11 10,746,824 6.13 HST 19-64 F 10,438 399.62 4,171,292 5.00 Composite Non-Delivery 913,097 $ 211.67 $ 193,274,599 $ 2.65 Delivery CFC 2,807 5,965.90 16,745,175 74.57 CFC Composite 913,097 $230.01 $ 210,019,774 $ 2.88 ABD <21 9,897 $ 661.06 $ 6,542,856 $ 8.26 ABD 21 + 48,238 $ 1,349.32 $ 65,088,038 $ 16.87 Composite 971,232 $ 289.99 $ 281,650,668 $ 3.62 A3 - Southwest HF/HST <1 M+F 220,889 $ 913.70 $ 201,827,371 $ 11.42 HF/HST 1 M+F 202,819 230.96 46,843,760 2.89 HF/HST 2-13 M+F 2,174,872 142.52 309,970,933 1.78 HF/HST 14-18 M 315,928 177.23 55,992,861 2.22 HF/HST 14-18 F 327,500 215.76 70,662,755 2.70 HF 19-44 M 295,233 265.71 78,445,063 3.32 HF 19-44 F 978,845 374.28 366,360,030 4.68 HF 45+ M+F 130,674 596.31 77,922,936 7.45 HST 19-64 F 56,694 429.35 24,341,933 5.37 Composite Non-Delivery 4,703,455 $ 262.01 $ 1,232,367,642 $ 3.28 Delivery CFC 14,320 5,598.86 80,173,080 69.99 CFC Composite 4,703,455 $279.06 $ 1,312,540,722 $ 3.49 ABD <21 94,936 $ 903.75 $ 85,798,507 $ 11.30 ABD 21 + 338,839 $ 1,424.46 $ 482,661,186 $ 17.81 Composite 5,137,230 $ 366.15 $ 1,881,000,414 $ 4.58 X0 - Xxxxx Xxxxxxx HF/HST <1 M+F 189,729 $ 990.37 $ 187,901,498 $ 12.38 HF/HST 1 M+F 173,861 184.52 32,081,437 2.31 HF/HST 2-13 M+F 1,851,737 126.31 233,900,539 1.58 HF/HST 14-18 M 272,460 150.65 41,045,212 1.88 HF/HST 14-18 F 275,467 198.01 54,545,599 2.48 HF 19-44 M 299,455 277.90 83,217,789 3.47 HF 19-44 F 829,303 396.83 329,096,035 4.96 HF 45+ M+F 121,813 647.79 78,908,569 8.10 HST 19-64 F 45,286 404.76 18,329,780 5.06 Composite Non-Delivery 4,059,110 $ 260.90 $ 1,059,026,459 $ 3.26 Delivery CFC 12,020 5,841.55 70,212,891 73.02 CFC Composite 4,059,110 $278.20 $ 1,129,239,350 $ 3.48 ABD <21 81,133 $ 1,009.73 $ 81,922,435 $ 12.62 ABD 21 + 334,680 $ 1,396.59 $ 467,411,402 $ 17.46 Composite 4,474,924 $ 375.11 $ 1,678,573,187 $ 4.69 Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus B2 - Southeast HF/HST <1 M+F 66,498 $ 825.54 $ 54,897,182 $ 10.32 HF/HST 1 M+F 57,578 154.12 8,874,000 1.93 HF/HST 2-13 M+F 650,716 142.03 92,421,955 1.78 HF/HST 14-18 M 111,097 177.88 19,761,642 2.22 HF/HST 14-18 F 113,426 203.80 23,116,434 2.55 HF 19-44 M 138,200 249.30 34,452,739 3.12 HF 19-44 F 313,522 384.82 120,650,106 4.81 HF 45+ M+F 48,146 577.53 27,805,981 7.22 HST 19-64 F 15,711 449.32 7,059,419 5.62 Composite Non-Delivery 1,514,894 $ 256.81 $ 389,039,458 $ 3.21 Delivery CFC 4,157 5,201.02 21,619,941 65.01 CFC Composite 1,514,894 $271.08 $ 410,659,399 $ 3.39 ABD <21 25,246 $ 773.38 $ 19,524,706 $ 9.67 ABD 21 + 140,097 $ 1,290.99 $ 180,863,503 $ 16.14 Composite 1,680,237 $ 363.67 $ 611,047,608 $ 4.55 C1 - Northeast HF/HST <1 M+F 258,958 $ 1,004.16 $ 260,035,450 $ 12.55 HF/HST 1 M+F 232,433 201.69 46,878,596 2.52 HF/HST 2-13 M+F 2,575,572 124.51 320,672,994 1.56 HF/HST 14-18 M 435,914 153.86 67,068,365 1.92 HF/HST 14-18 F 450,348 195.30 87,952,616 2.44 HF 19-44 M 373,711 243.76 91,094,603 3.05 HF 19-44 F 1,282,288 367.93 471,793,400 4.60 HF 45+ M+F 201,719 542.05 109,341,643 6.78 HST 19-64 F 58,608 535.02 31,356,829 6.69 Composite Non-Delivery 5,869,550 $ 253.20 $ 1,486,194,496 $ 3.17 Delivery CFC 16,820 5,600.65 94,203,856 70.01 CFC Composite 5,869,550 $269.25 $ 1,580,398,352 $ 3.37 ABD <21 170,693 $ 659.93 $ 112,645,168 $ 8.25 ABD 21 + 506,340 $ 1,404.32 $ 711,061,633 $ 17.55 Composite 6,546,583 $ 367.23 $ 2,404,105,153 $ 4.59 C2 - Northeast Central HF/HST <1 M+F 64,414 $ 709.21 $ 45,683,038 $ 8.87 HF/HST 1 M+F 56,193 152.04 8,543,682 1.90 HF/HST 2-13 M+F 628,532 114.68 72,081,154 1.43 HF/HST 14-18 M 102,176 136.81 13,978,513 1.71 HF/HST 14-18 F 103,821 188.24 19,543,278 2.35 HF 19-44 M 108,930 203.52 22,169,466 2.54 HF 19-44 F 296,618 332.66 98,671,767 4.16 HF 45+ M+F 42,280 441.14 18,651,323 5.51 HST 19-64 F 14,971 396.18 5,931,401 4.95 Composite Non-Delivery 1,417,934 $ 215.28 $ 305,253,624 $ 2.69 Delivery CFC 4,173 4,710.04 19,656,341 58.88 CFC Composite 1,417,934 $229.14 $ 324,909,964 $ 2.86 ABD <21 24,691 $ 721.51 $ 17,814,653 $ 9.02 ABD 21 + 91,995 $ 1,156.84 $ 106,423,749 $ 14.46 Composite 1,534,621 $ 292.68 $ 449,148,366 $ 3.66 All Regions HF/HST <1 M+F 910,948 $ 901.68 $ 821,380,575 $ 11.27 HF/HST 1 M+F 817,258 195.04 159,395,066 2.44 HF/HST 2-13 M+F 8,894,735 128.76 1,145,284,012 1.61 HF/HST 14-18 M 1,388,647 158.18 219,656,856 1.98 HF/HST 14-18 F 1,426,015 200.12 285,370,877 2.50 HF 19-44 M 1,375,811 254.71 350,430,162 3.18 HF 19-44 F 4,166,659 375.77 1,565,702,243 4.70 HF 45+ M+F 603,539 573.02 345,838,517 7.16 HST 19-64 F 217,157 453.87 98,561,844 5.67 Composite Non-Delivery 19,800,770 $ 252.09 $ 4,991,620,153 $ 3.15 Delivery CFC 58,558 5,569.60 326,146,784 69.62 CFC Composite 19,800,770 $268.56 $ 5,317,766,937 $ 3.36 ABD <21 443,897 $ 773.33 $ 343,279,163 $ 9.67 ABD 21 + 1,568,102 $ 1,377.50 $ 2,160,061,677 $ 17.22 Composite 21,812,769 $ 358.56 $ 7,821,107,777 $ 4.48 Xxxx Xxxxxxxxx, ASA, MAAA Partner Xxxxxx Xxxxxxxxx, ASA, MAAA Senior Associate 0000 Xxxx Xxxxxxxxx Xxxx, Xxxxx 000 Xxxxxxx, XX 00000 +0 000 000 0000 xxx.xxxxxx.xxx Xx. Xxxxxx Xxxxxx Ohio Department of Medicaid Bureau of Managed Health Care Lazarus Building 00 Xxxx Xxxx Xxxxxx, Xxxxx 000 Xxxxxxxx, Xxxx 00000 December 17, 2013.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
Rate Certification. In preparing the capitation rates for the CY 2014 2015 CFC and ABD <21 21+ Risk-Based Managed Care program, Xxxxxx has used and relied upon enrollment, eligibility, claim, encounter, financial and other information supplied by the State and its vendors. The State and its vendors are responsible for the validity and completeness of this supplied data and information. We have Xxxxxx has reviewed the data and information for internal consistency and reasonableness, but we Xxxxxx did not audit it. If the 1 Xxxxxx defines the term “actuarially sound” within the rate certification section of the letter. data and information is incomplete or inaccurate, the values shown in this letter may need to be revised accordingly. Xxxxxx certifies that the rates were developed in accordance with generally accepted actuarial practices and principles and are appropriate for the Medicaid covered populations and services under the managed care contract. The undersigned actuaries are members of the American Academy of Actuaries and meet its qualification standards to certify the actuarial soundness2 of Medicaid managed-managed care capitation rates. Capitation rates developed by Xxxxxx are actuarial projections of future contingent events. Actual costs will differ from these projections. Xxxxxx has developed these rates on behalf of the State to demonstrate compliance with the Centers for Medicare & and Medicaid Services (CMS) requirements under 42 CFR 438.6(c) and in accordance with applicable laws and regulations. Use of these rates for any purpose beyond that stated may not be appropriate. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx disclaims any responsibility for the use of these rates by MCPs for any 2 Medicaid benefit plan premium rates are “actuarially sound” if, for business in the state for which the certification is being prepared and for the period covered by the certification, projected premiums, including expected reinsurance and governmental stop-loss cash flows, governmental risk adjustment cash flows, and investment income, provide for all reasonable, appropriate and attainable costs, including health benefits, health benefit settlement expenses, marketing and administrative expenses, any government mandated assessments, fees, and taxes, and the cost of capital. Note: Please see pages 8-9 of the August 2005, Actuarial Certification of Rates for Medicaid Managed Care Programs, from the American Academy of Actuaries, xxxx://xxx.xxxxxxx.xxx/pdf/practnotes/health_medicaid_05.pdf purpose. Xxxxxx recommends that any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. This certification letter assumes the reader is familiar with the Ohio Medicaid program, Medicaid eligibility rules, and actuarial rating techniques. It is intended for the State and CMS and should not be relied upon by third parties. Other readers should seek the advice of actuaries, actuaries or other qualified professionals competent in the area of actuarial rate projections, projections to understand the technical nature of these results. This document should only be reviewed in its entirety. If you have any questions on any of the above, please feel free to contact Xxxx Xxxxxxxxx at +0 000 000 0000 or Xxxxxx Xxxxxxxxx at +0 000 000 0000. Sincerely, Xxxx Xxxxxxxxx, ASA, MAAA Xxxxxx Xxxxxxxxx, ASA, MAAA Partner Senior Associate DB/jh Attachments Copy: Xxxxxx Xxxxxxxxxx, Xxxx Xxxxxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxxx, Xxxxx Xxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxx Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus A1 - North Central HF/HST <1 M+F 64,590 $ 713.44 $ 46,081,305 $ 8.92 HF/HST 1 M+F 55,600 189.01 10,508,726 2.36 HF/HST 2-13 M+F 589,341 117.90 69,481,832 1.47 HF/HST 14-18 M 88,595 149.00 13,200,733 1.86 HF/HST 14-18 F 92,440 186.28 17,219,766 2.33 HF 19-44 M 93,901 273.63 25,694,247 3.42 HF 19-44 F 285,834 400.39 114,444,836 5.00 HF 45+ M+F 36,980 607.39 22,461,240 7.59 HST 19-64 F 15,448 477.15 7,371,190 5.96 Composite Non-Delivery 1,322,729 $ 246.81 $ 326,463,876 $ 3.09 Delivery CFC 4,262 5,522.04 23,535,500 69.03 CFC Composite 1,322,729 $264.60 $ 349,999,376 $ 3.31 ABD <21 37,301 $ 510.20 $ 19,030,838 $ 6.38 ABD 21 + 107,912 $ 1,358.07 $ 146,552,166 $ 16.98 Composite 1,467,942 $ 351.23 $ 515,582,381 $ 4.39 A2 - Northwest HF/HST <1 M+F 45,870 $ 544.03 $ 24,954,730 $ 6.80 HF/HST 1 M+F 38,775 146.09 5,664,864 1.83 HF/HST 2-13 M+F 423,966 110.28 46,754,603 1.38 HF/HST 14-18 M 62,477 137.80 8,609,530 1.72 HF/HST 14-18 F 63,012 195.68 12,330,429 2.45 HF 19-44 M 66,381 231.33 15,356,256 2.89 HF 19-44 F 180,250 358.87 64,686,070 4.49 HF 45+ M+F 21,927 490.11 10,746,824 6.13 HST 19-64 F 10,438 399.62 4,171,292 5.00 Composite Non-Delivery 913,097 $ 211.67 $ 193,274,599 $ 2.65 Delivery CFC 2,807 5,965.90 16,745,175 74.57 CFC Composite 913,097 $230.01 $ 210,019,774 $ 2.88 ABD <21 9,897 $ 661.06 $ 6,542,856 $ 8.26 ABD 21 + 48,238 $ 1,349.32 $ 65,088,038 $ 16.87 Composite 971,232 $ 289.99 $ 281,650,668 $ 3.62 A3 - Southwest HF/HST <1 M+F 220,889 $ 913.70 $ 201,827,371 $ 11.42 HF/HST 1 M+F 202,819 230.96 46,843,760 2.89 HF/HST 2-13 M+F 2,174,872 142.52 309,970,933 1.78 HF/HST 14-18 M 315,928 177.23 55,992,861 2.22 HF/HST 14-18 F 327,500 215.76 70,662,755 2.70 HF 19-44 M 295,233 265.71 78,445,063 3.32 HF 19-44 F 978,845 374.28 366,360,030 4.68 HF 45+ M+F 130,674 596.31 77,922,936 7.45 HST 19-64 F 56,694 429.35 24,341,933 5.37 Composite Non-Delivery 4,703,455 $ 262.01 $ 1,232,367,642 $ 3.28 Delivery CFC 14,320 5,598.86 80,173,080 69.99 CFC Composite 4,703,455 $279.06 $ 1,312,540,722 $ 3.49 ABD <21 94,936 $ 903.75 $ 85,798,507 $ 11.30 ABD 21 + 338,839 $ 1,424.46 $ 482,661,186 $ 17.81 Composite 5,137,230 $ 366.15 $ 1,881,000,414 $ 4.58 X0 - Xxxxx Xxxxxxx HF/HST <1 M+F 189,729 $ 990.37 $ 187,901,498 $ 12.38 HF/HST 1 M+F 173,861 184.52 32,081,437 2.31 HF/HST 2-13 M+F 1,851,737 126.31 233,900,539 1.58 HF/HST 14-18 M 272,460 150.65 41,045,212 1.88 HF/HST 14-18 F 275,467 198.01 54,545,599 2.48 HF 19-44 M 299,455 277.90 83,217,789 3.47 HF 19-44 F 829,303 396.83 329,096,035 4.96 HF 45+ M+F 121,813 647.79 78,908,569 8.10 HST 19-64 F 45,286 404.76 18,329,780 5.06 Composite Non-Delivery 4,059,110 $ 260.90 $ 1,059,026,459 $ 3.26 Delivery CFC 12,020 5,841.55 70,212,891 73.02 CFC Composite 4,059,110 $278.20 $ 1,129,239,350 $ 3.48 ABD <21 81,133 $ 1,009.73 $ 81,922,435 $ 12.62 ABD 21 + 334,680 $ 1,396.59 $ 467,411,402 $ 17.46 Composite 4,474,924 $ 375.11 $ 1,678,573,187 $ 4.69 Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus B2 - Southeast HF/HST <1 M+F 66,498 $ 825.54 $ 54,897,182 $ 10.32 HF/HST 1 M+F 57,578 154.12 8,874,000 1.93 HF/HST 2-13 M+F 650,716 142.03 92,421,955 1.78 HF/HST 14-18 M 111,097 177.88 19,761,642 2.22 HF/HST 14-18 F 113,426 203.80 23,116,434 2.55 HF 19-44 M 138,200 249.30 34,452,739 3.12 HF 19-44 F 313,522 384.82 120,650,106 4.81 HF 45+ M+F 48,146 577.53 27,805,981 7.22 HST 19-64 F 15,711 449.32 7,059,419 5.62 Composite Non-Delivery 1,514,894 $ 256.81 $ 389,039,458 $ 3.21 Delivery CFC 4,157 5,201.02 21,619,941 65.01 CFC Composite 1,514,894 $271.08 $ 410,659,399 $ 3.39 ABD <21 25,246 $ 773.38 $ 19,524,706 $ 9.67 ABD 21 + 140,097 $ 1,290.99 $ 180,863,503 $ 16.14 Composite 1,680,237 $ 363.67 $ 611,047,608 $ 4.55 C1 - Northeast HF/HST <1 M+F 258,958 $ 1,004.16 $ 260,035,450 $ 12.55 HF/HST 1 M+F 232,433 201.69 46,878,596 2.52 HF/HST 2-13 M+F 2,575,572 124.51 320,672,994 1.56 HF/HST 14-18 M 435,914 153.86 67,068,365 1.92 HF/HST 14-18 F 450,348 195.30 87,952,616 2.44 HF 19-44 M 373,711 243.76 91,094,603 3.05 HF 19-44 F 1,282,288 367.93 471,793,400 4.60 HF 45+ M+F 201,719 542.05 109,341,643 6.78 HST 19-64 F 58,608 535.02 31,356,829 6.69 Composite Non-Delivery 5,869,550 $ 253.20 $ 1,486,194,496 $ 3.17 Delivery CFC 16,820 5,600.65 94,203,856 70.01 CFC Composite 5,869,550 $269.25 $ 1,580,398,352 $ 3.37 ABD <21 170,693 $ 659.93 $ 112,645,168 $ 8.25 ABD 21 + 506,340 $ 1,404.32 $ 711,061,633 $ 17.55 Composite 6,546,583 $ 367.23 $ 2,404,105,153 $ 4.59 C2 - Northeast Central HF/HST <1 M+F 64,414 $ 709.21 $ 45,683,038 $ 8.87 HF/HST 1 M+F 56,193 152.04 8,543,682 1.90 HF/HST 2-13 M+F 628,532 114.68 72,081,154 1.43 HF/HST 14-18 M 102,176 136.81 13,978,513 1.71 HF/HST 14-18 F 103,821 188.24 19,543,278 2.35 HF 19-44 M 108,930 203.52 22,169,466 2.54 HF 19-44 F 296,618 332.66 98,671,767 4.16 HF 45+ M+F 42,280 441.14 18,651,323 5.51 HST 19-64 F 14,971 396.18 5,931,401 4.95 Composite Non-Delivery 1,417,934 $ 215.28 $ 305,253,624 $ 2.69 Delivery CFC 4,173 4,710.04 19,656,341 58.88 CFC Composite 1,417,934 $229.14 $ 324,909,964 $ 2.86 ABD <21 24,691 $ 721.51 $ 17,814,653 $ 9.02 ABD 21 + 91,995 $ 1,156.84 $ 106,423,749 $ 14.46 Composite 1,534,621 $ 292.68 $ 449,148,366 $ 3.66 All Regions HF/HST <1 M+F 910,948 $ 901.68 $ 821,380,575 $ 11.27 HF/HST 1 M+F 817,258 195.04 159,395,066 2.44 HF/HST 2-13 M+F 8,894,735 128.76 1,145,284,012 1.61 HF/HST 14-18 M 1,388,647 158.18 219,656,856 1.98 HF/HST 14-18 F 1,426,015 200.12 285,370,877 2.50 HF 19-44 M 1,375,811 254.71 350,430,162 3.18 HF 19-44 F 4,166,659 375.77 1,565,702,243 4.70 HF 45+ M+F 603,539 573.02 345,838,517 7.16 HST 19-64 F 217,157 453.87 98,561,844 5.67 Composite Non-Delivery 19,800,770 $ 252.09 $ 4,991,620,153 $ 3.15 Delivery CFC 58,558 5,569.60 326,146,784 69.62 CFC Composite 19,800,770 $268.56 $ 5,317,766,937 $ 3.36 ABD <21 443,897 $ 773.33 $ 343,279,163 $ 9.67 ABD 21 + 1,568,102 $ 1,377.50 $ 2,160,061,677 $ 17.22 Composite 21,812,769 $ 358.56 $ 7,821,107,777 $ 4.48 Xxxx Xxxxxxxxx, ASA, MAAA Partner Xxxxxx Xxxxxxxxx, ASA, MAAA Senior Associate 0000 Xxxx Xxxxxxxxx Xxxx, Xxxxx 000 Xxxxxxx, XX 00000 +0 000 000 0000 xxx.xxxxxx.xxx Xx. Xxxxxx Xxxxxx Ohio Department of Medicaid Bureau of Managed Health Care Lazarus Building 00 Xxxx Xxxx Xxxxxx, Xxxxx 000 Xxxxxxxx, Xxxx 00000 December 17, 2013.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
Rate Certification. In preparing the capitation rates for the CY 2014 ABD <21 2015 Extension Risk-Based Managed Care program, Xxxxxx Mercer has used and relied upon enrollment, eligibility, claim, encounter, financial and other data, and information supplied by the State and its vendors. The State and its vendors are responsible for the validity and completeness of this supplied data and information. We have Mercer has reviewed the data and information for internal consistency and reasonableness, but we Mercer did not audit it. If the 1 Mercer defines the term “actuarially sound” within the rate certification section of the letter. data and information is incomplete or inaccurate, the values shown in this letter may need to be revised accordingly. Xxxxxx Mercer certifies that the rates were developed in accordance with generally accepted actuarial practices and principles and are appropriate for the Medicaid covered populations and services under the managed care contract. The undersigned actuaries are members of the American Academy of Actuaries and meet its qualification standards to certify the actuarial soundness2 of Medicaid managed-managed care capitation rates. Capitation rates developed by Xxxxxx Mercer are actuarial projections of future contingent events. Actual costs will differ from these projections. Xxxxxx Mercer has developed these rates on behalf of the State to demonstrate compliance with the Centers for Medicare & and Medicaid Services (CMS) requirements under 42 CFR 438.6(c) and in accordance with applicable laws and regulations. Use of these rates for any purpose beyond that stated may not be appropriate. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx Mercer disclaims any responsibility for the use of these rates by MCPs for any 2 Medicaid benefit plan premium rates are “actuarially sound” if, for business in the state for which the certification is being prepared and for the period covered by the certification, projected premiums, including expected reinsurance and governmental stop-loss cash flows, governmental risk adjustment cash flows, and investment income, provide for all reasonable, appropriate and attainable costs, including health benefits, health benefit settlement expenses, marketing and administrative expenses, any government mandated assessments, fees, and taxes, and the cost of capital. Note: Please see pages 8-9 of the August 2005, Actuarial Certification of Rates for Medicaid Managed Care Programs, from the American Academy of Actuaries, xxxx://xxx.xxxxxxx.xxx/pdf/practnotes/health_medicaid_05.pdf purpose. Xxxxxx Mercer recommends that any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. This certification letter assumes the reader is familiar with the Ohio Medicaid program, Medicaid eligibility rules, and actuarial rating techniques. It is intended for the State and CMS and should not be relied upon by third parties. Other readers should seek the advice of actuaries, actuaries or other qualified professionals competent in the area of actuarial rate projections, projections to understand the technical nature of these results. This document should only be reviewed in its entirety. If you have any questions on any of the above, please feel free to contact Xxxx Xxxxxxxxx at +0 000 000 0000 or Xxxxxx Xxxxxxxxx at +0 000 000 0000. Sincerely, Xxxx Xxxxxxxxx, ASA, MAAA Xxxxxx Xxxxxxxxx, ASA, MAAA Partner Senior Associate DB/jh Attachments Copy: Xxxxxx Xxxxxxxxxx, Xxxx Xxxxxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxxx, Xxxxx Xxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxx Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus A1 - North Central HF/HST <1 M+F 64,590 $ 713.44 $ 46,081,305 $ 8.92 HF/HST 1 M+F 55,600 189.01 10,508,726 2.36 HF/HST 2-13 M+F 589,341 117.90 69,481,832 1.47 HF/HST 14-18 M 88,595 149.00 13,200,733 1.86 HF/HST 14-18 F 92,440 186.28 17,219,766 2.33 HF 19-44 M 93,901 273.63 25,694,247 3.42 HF 19-44 F 285,834 400.39 114,444,836 5.00 HF 45+ M+F 36,980 607.39 22,461,240 7.59 HST 19-64 F 15,448 477.15 7,371,190 5.96 Composite Non-Delivery 1,322,729 $ 246.81 $ 326,463,876 $ 3.09 Delivery CFC 4,262 5,522.04 23,535,500 69.03 CFC Composite 1,322,729 $264.60 $ 349,999,376 $ 3.31 ABD <21 37,301 $ 510.20 $ 19,030,838 $ 6.38 ABD 21 + 107,912 $ 1,358.07 $ 146,552,166 $ 16.98 Composite 1,467,942 $ 351.23 $ 515,582,381 $ 4.39 A2 - Northwest HF/HST <1 M+F 45,870 $ 544.03 $ 24,954,730 $ 6.80 HF/HST 1 M+F 38,775 146.09 5,664,864 1.83 HF/HST 2-13 M+F 423,966 110.28 46,754,603 1.38 HF/HST 14-18 M 62,477 137.80 8,609,530 1.72 HF/HST 14-18 F 63,012 195.68 12,330,429 2.45 HF 19-44 M 66,381 231.33 15,356,256 2.89 HF 19-44 F 180,250 358.87 64,686,070 4.49 HF 45+ M+F 21,927 490.11 10,746,824 6.13 HST 19-64 F 10,438 399.62 4,171,292 5.00 Composite Non-Delivery 913,097 $ 211.67 $ 193,274,599 $ 2.65 Delivery CFC 2,807 5,965.90 16,745,175 74.57 CFC Composite 913,097 $230.01 $ 210,019,774 $ 2.88 ABD <21 9,897 $ 661.06 $ 6,542,856 $ 8.26 ABD 21 + 48,238 $ 1,349.32 $ 65,088,038 $ 16.87 Composite 971,232 $ 289.99 $ 281,650,668 $ 3.62 A3 - Southwest HF/HST <1 M+F 220,889 $ 913.70 $ 201,827,371 $ 11.42 HF/HST 1 M+F 202,819 230.96 46,843,760 2.89 HF/HST 2-13 M+F 2,174,872 142.52 309,970,933 1.78 HF/HST 14-18 M 315,928 177.23 55,992,861 2.22 HF/HST 14-18 F 327,500 215.76 70,662,755 2.70 HF 19-44 M 295,233 265.71 78,445,063 3.32 HF 19-44 F 978,845 374.28 366,360,030 4.68 HF 45+ M+F 130,674 596.31 77,922,936 7.45 HST 19-64 F 56,694 429.35 24,341,933 5.37 Composite Non-Delivery 4,703,455 $ 262.01 $ 1,232,367,642 $ 3.28 Delivery CFC 14,320 5,598.86 80,173,080 69.99 CFC Composite 4,703,455 $279.06 $ 1,312,540,722 $ 3.49 ABD <21 94,936 $ 903.75 $ 85,798,507 $ 11.30 ABD 21 + 338,839 $ 1,424.46 $ 482,661,186 $ 17.81 Composite 5,137,230 $ 366.15 $ 1,881,000,414 $ 4.58 X0 - Xxxxx Xxxxxxx HF/HST <1 M+F 189,729 $ 990.37 $ 187,901,498 $ 12.38 HF/HST 1 M+F 173,861 184.52 32,081,437 2.31 HF/HST 2-13 M+F 1,851,737 126.31 233,900,539 1.58 HF/HST 14-18 M 272,460 150.65 41,045,212 1.88 HF/HST 14-18 F 275,467 198.01 54,545,599 2.48 HF 19-44 M 299,455 277.90 83,217,789 3.47 HF 19-44 F 829,303 396.83 329,096,035 4.96 HF 45+ M+F 121,813 647.79 78,908,569 8.10 HST 19-64 F 45,286 404.76 18,329,780 5.06 Composite Non-Delivery 4,059,110 $ 260.90 $ 1,059,026,459 $ 3.26 Delivery CFC 12,020 5,841.55 70,212,891 73.02 CFC Composite 4,059,110 $278.20 $ 1,129,239,350 $ 3.48 ABD <21 81,133 $ 1,009.73 $ 81,922,435 $ 12.62 ABD 21 + 334,680 $ 1,396.59 $ 467,411,402 $ 17.46 Composite 4,474,924 $ 375.11 $ 1,678,573,187 $ 4.69 Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus B2 - Southeast HF/HST <1 M+F 66,498 $ 825.54 $ 54,897,182 $ 10.32 HF/HST 1 M+F 57,578 154.12 8,874,000 1.93 HF/HST 2-13 M+F 650,716 142.03 92,421,955 1.78 HF/HST 14-18 M 111,097 177.88 19,761,642 2.22 HF/HST 14-18 F 113,426 203.80 23,116,434 2.55 HF 19-44 M 138,200 249.30 34,452,739 3.12 HF 19-44 F 313,522 384.82 120,650,106 4.81 HF 45+ M+F 48,146 577.53 27,805,981 7.22 HST 19-64 F 15,711 449.32 7,059,419 5.62 Composite Non-Delivery 1,514,894 $ 256.81 $ 389,039,458 $ 3.21 Delivery CFC 4,157 5,201.02 21,619,941 65.01 CFC Composite 1,514,894 $271.08 $ 410,659,399 $ 3.39 ABD <21 25,246 $ 773.38 $ 19,524,706 $ 9.67 ABD 21 + 140,097 $ 1,290.99 $ 180,863,503 $ 16.14 Composite 1,680,237 $ 363.67 $ 611,047,608 $ 4.55 C1 - Northeast HF/HST <1 M+F 258,958 $ 1,004.16 $ 260,035,450 $ 12.55 HF/HST 1 M+F 232,433 201.69 46,878,596 2.52 HF/HST 2-13 M+F 2,575,572 124.51 320,672,994 1.56 HF/HST 14-18 M 435,914 153.86 67,068,365 1.92 HF/HST 14-18 F 450,348 195.30 87,952,616 2.44 HF 19-44 M 373,711 243.76 91,094,603 3.05 HF 19-44 F 1,282,288 367.93 471,793,400 4.60 HF 45+ M+F 201,719 542.05 109,341,643 6.78 HST 19-64 F 58,608 535.02 31,356,829 6.69 Composite Non-Delivery 5,869,550 $ 253.20 $ 1,486,194,496 $ 3.17 Delivery CFC 16,820 5,600.65 94,203,856 70.01 CFC Composite 5,869,550 $269.25 $ 1,580,398,352 $ 3.37 ABD <21 170,693 $ 659.93 $ 112,645,168 $ 8.25 ABD 21 + 506,340 $ 1,404.32 $ 711,061,633 $ 17.55 Composite 6,546,583 $ 367.23 $ 2,404,105,153 $ 4.59 C2 - Northeast Central HF/HST <1 M+F 64,414 $ 709.21 $ 45,683,038 $ 8.87 HF/HST 1 M+F 56,193 152.04 8,543,682 1.90 HF/HST 2-13 M+F 628,532 114.68 72,081,154 1.43 HF/HST 14-18 M 102,176 136.81 13,978,513 1.71 HF/HST 14-18 F 103,821 188.24 19,543,278 2.35 HF 19-44 M 108,930 203.52 22,169,466 2.54 HF 19-44 F 296,618 332.66 98,671,767 4.16 HF 45+ M+F 42,280 441.14 18,651,323 5.51 HST 19-64 F 14,971 396.18 5,931,401 4.95 Composite Non-Delivery 1,417,934 $ 215.28 $ 305,253,624 $ 2.69 Delivery CFC 4,173 4,710.04 19,656,341 58.88 CFC Composite 1,417,934 $229.14 $ 324,909,964 $ 2.86 ABD <21 24,691 $ 721.51 $ 17,814,653 $ 9.02 ABD 21 + 91,995 $ 1,156.84 $ 106,423,749 $ 14.46 Composite 1,534,621 $ 292.68 $ 449,148,366 $ 3.66 All Regions HF/HST <1 M+F 910,948 $ 901.68 $ 821,380,575 $ 11.27 HF/HST 1 M+F 817,258 195.04 159,395,066 2.44 HF/HST 2-13 M+F 8,894,735 128.76 1,145,284,012 1.61 HF/HST 14-18 M 1,388,647 158.18 219,656,856 1.98 HF/HST 14-18 F 1,426,015 200.12 285,370,877 2.50 HF 19-44 M 1,375,811 254.71 350,430,162 3.18 HF 19-44 F 4,166,659 375.77 1,565,702,243 4.70 HF 45+ M+F 603,539 573.02 345,838,517 7.16 HST 19-64 F 217,157 453.87 98,561,844 5.67 Composite Non-Delivery 19,800,770 $ 252.09 $ 4,991,620,153 $ 3.15 Delivery CFC 58,558 5,569.60 326,146,784 69.62 CFC Composite 19,800,770 $268.56 $ 5,317,766,937 $ 3.36 ABD <21 443,897 $ 773.33 $ 343,279,163 $ 9.67 ABD 21 + 1,568,102 $ 1,377.50 $ 2,160,061,677 $ 17.22 Composite 21,812,769 $ 358.56 $ 7,821,107,777 $ 4.48 Xxxx Xxxxxxxxx, ASA, MAAA Partner Xxxxxx Xxxxxxxxx, ASA, MAAA Senior Associate 0000 Xxxx Xxxxxxxxx Xxxx, Xxxxx 000 Xxxxxxx, XX 00000 +0 000 000 0000 xxx.xxxxxx.xxx Xx. Xxxxxx Xxxxxx Ohio Department of Medicaid Bureau of Managed Health Care Lazarus Building 00 Xxxx Xxxx Xxxxxx, Xxxxx 000 Xxxxxxxx, Xxxx 00000 December 17, 2013.
Appears in 1 contract
Samples: Provider Agreement
Rate Certification. In preparing the capitation rates for the CY 2014 2015 CFC and ABD <21 21+ Risk-Based Managed Care program, Xxxxxx Mercer has used and relied upon enrollment, eligibility, claim, encounter, financial and other information supplied by the State and its vendors. The State and its vendors are responsible for the validity and completeness of this supplied data and information. We have Mercer has reviewed the data and information for internal consistency and reasonableness, but we Mercer did not audit it. If the 1 Mercer defines the term “actuarially sound” within the rate certification section of the letter. data and information is incomplete or inaccurate, the values shown in this letter may need to be revised accordingly. Xxxxxx Mercer certifies that the rates were developed in accordance with generally accepted actuarial practices and principles and are appropriate for the Medicaid covered populations and services under the managed care contract. The undersigned actuaries are members of the American Academy of Actuaries and meet its qualification standards to certify the actuarial soundness2 of Medicaid managed-managed care capitation rates. Capitation rates developed by Xxxxxx Mercer are actuarial projections of future contingent events. Actual costs will differ from these projections. Xxxxxx Mercer has developed these rates on behalf of the State to demonstrate compliance with the Centers for Medicare & and Medicaid Services (CMS) requirements under 42 CFR 438.6(c) and in accordance with applicable laws and regulations. Use of these rates for any purpose beyond that stated may not be appropriate. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx Mercer disclaims any responsibility for the use of these rates by MCPs for any 2 Medicaid benefit plan premium rates are “actuarially sound” if, for business in the state for which the certification is being prepared and for the period covered by the certification, projected premiums, including expected reinsurance and governmental stop-loss cash flows, governmental risk adjustment cash flows, and investment income, provide for all reasonable, appropriate and attainable costs, including health benefits, health benefit settlement expenses, marketing and administrative expenses, any government mandated assessments, fees, and taxes, and the cost of capital. Note: Please see pages 8-9 of the August 2005, Actuarial Certification of Rates for Medicaid Managed Care Programs, from the American Academy of Actuaries, xxxx://xxx.xxxxxxx.xxx/pdf/practnotes/health_medicaid_05.pdf purpose. Xxxxxx Mercer recommends that any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. This certification letter assumes the reader is familiar with the Ohio Medicaid program, Medicaid eligibility rules, and actuarial rating techniques. It is intended for the State and CMS and should not be relied upon by third parties. Other readers should seek the advice of actuaries, actuaries or other qualified professionals competent in the area of actuarial rate projections, projections to understand the technical nature of these results. This document should only be reviewed in its entirety. If you have any questions on any of the above, please feel free to contact Xxxx Xxxxxxxxx at +0 000 000 0000 or Xxxxxx Xxxxxxxxx at +0 000 000 0000. Sincerely, Xxxx Xxxxxxxxx, ASA, MAAA Xxxxxx Xxxxxxxxx, ASA, MAAA Partner Senior Associate DB/jh Attachments Copy: Xxxxxx Xxxxxxxxxx, Xxxx Xxxxxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxxx, Xxxxx Xxxxxx, Xxxxx Xxxxxx, Xxxxxx Xxxx Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus A1 - North Central HF/HST <1 M+F 64,590 $ 713.44 $ 46,081,305 $ 8.92 HF/HST 1 M+F 55,600 189.01 10,508,726 2.36 HF/HST 2-13 M+F 589,341 117.90 69,481,832 1.47 HF/HST 14-18 M 88,595 149.00 13,200,733 1.86 HF/HST 14-18 F 92,440 186.28 17,219,766 2.33 HF 19-44 M 93,901 273.63 25,694,247 3.42 HF 19-44 F 285,834 400.39 114,444,836 5.00 HF 45+ M+F 36,980 607.39 22,461,240 7.59 HST 19-64 F 15,448 477.15 7,371,190 5.96 Composite Non-Delivery 1,322,729 $ 246.81 $ 326,463,876 $ 3.09 Delivery CFC 4,262 5,522.04 23,535,500 69.03 CFC Composite 1,322,729 $264.60 $ 349,999,376 $ 3.31 ABD <21 37,301 $ 510.20 $ 19,030,838 $ 6.38 ABD 21 + 107,912 $ 1,358.07 $ 146,552,166 $ 16.98 Composite 1,467,942 $ 351.23 $ 515,582,381 $ 4.39 A2 - Northwest HF/HST <1 M+F 45,870 $ 544.03 $ 24,954,730 $ 6.80 HF/HST 1 M+F 38,775 146.09 5,664,864 1.83 HF/HST 2-13 M+F 423,966 110.28 46,754,603 1.38 HF/HST 14-18 M 62,477 137.80 8,609,530 1.72 HF/HST 14-18 F 63,012 195.68 12,330,429 2.45 HF 19-44 M 66,381 231.33 15,356,256 2.89 HF 19-44 F 180,250 358.87 64,686,070 4.49 HF 45+ M+F 21,927 490.11 10,746,824 6.13 HST 19-64 F 10,438 399.62 4,171,292 5.00 Composite Non-Delivery 913,097 $ 211.67 $ 193,274,599 $ 2.65 Delivery CFC 2,807 5,965.90 16,745,175 74.57 CFC Composite 913,097 $230.01 $ 210,019,774 $ 2.88 ABD <21 9,897 $ 661.06 $ 6,542,856 $ 8.26 ABD 21 + 48,238 $ 1,349.32 $ 65,088,038 $ 16.87 Composite 971,232 $ 289.99 $ 281,650,668 $ 3.62 A3 - Southwest HF/HST <1 M+F 220,889 $ 913.70 $ 201,827,371 $ 11.42 HF/HST 1 M+F 202,819 230.96 46,843,760 2.89 HF/HST 2-13 M+F 2,174,872 142.52 309,970,933 1.78 HF/HST 14-18 M 315,928 177.23 55,992,861 2.22 HF/HST 14-18 F 327,500 215.76 70,662,755 2.70 HF 19-44 M 295,233 265.71 78,445,063 3.32 HF 19-44 F 978,845 374.28 366,360,030 4.68 HF 45+ M+F 130,674 596.31 77,922,936 7.45 HST 19-64 F 56,694 429.35 24,341,933 5.37 Composite Non-Delivery 4,703,455 $ 262.01 $ 1,232,367,642 $ 3.28 Delivery CFC 14,320 5,598.86 80,173,080 69.99 CFC Composite 4,703,455 $279.06 $ 1,312,540,722 $ 3.49 ABD <21 94,936 $ 903.75 $ 85,798,507 $ 11.30 ABD 21 + 338,839 $ 1,424.46 $ 482,661,186 $ 17.81 Composite 5,137,230 $ 366.15 $ 1,881,000,414 $ 4.58 X0 - Xxxxx Xxxxxxx HF/HST <1 M+F 189,729 $ 990.37 $ 187,901,498 $ 12.38 HF/HST 1 M+F 173,861 184.52 32,081,437 2.31 HF/HST 2-13 M+F 1,851,737 126.31 233,900,539 1.58 HF/HST 14-18 M 272,460 150.65 41,045,212 1.88 HF/HST 14-18 F 275,467 198.01 54,545,599 2.48 HF 19-44 M 299,455 277.90 83,217,789 3.47 HF 19-44 F 829,303 396.83 329,096,035 4.96 HF 45+ M+F 121,813 647.79 78,908,569 8.10 HST 19-64 F 45,286 404.76 18,329,780 5.06 Composite Non-Delivery 4,059,110 $ 260.90 $ 1,059,026,459 $ 3.26 Delivery CFC 12,020 5,841.55 70,212,891 73.02 CFC Composite 4,059,110 $278.20 $ 1,129,239,350 $ 3.48 ABD <21 81,133 $ 1,009.73 $ 81,922,435 $ 12.62 ABD 21 + 334,680 $ 1,396.59 $ 467,411,402 $ 17.46 Composite 4,474,924 $ 375.11 $ 1,678,573,187 $ 4.69 Region Rate Group Projected CY 2014 Member Months Proposed Capitation Rate Proposed Expenditures CY 2014 Eligible P4P 1.25% Bonus B2 - Southeast HF/HST <1 M+F 66,498 $ 825.54 $ 54,897,182 $ 10.32 HF/HST 1 M+F 57,578 154.12 8,874,000 1.93 HF/HST 2-13 M+F 650,716 142.03 92,421,955 1.78 HF/HST 14-18 M 111,097 177.88 19,761,642 2.22 HF/HST 14-18 F 113,426 203.80 23,116,434 2.55 HF 19-44 M 138,200 249.30 34,452,739 3.12 HF 19-44 F 313,522 384.82 120,650,106 4.81 HF 45+ M+F 48,146 577.53 27,805,981 7.22 HST 19-64 F 15,711 449.32 7,059,419 5.62 Composite Non-Delivery 1,514,894 $ 256.81 $ 389,039,458 $ 3.21 Delivery CFC 4,157 5,201.02 21,619,941 65.01 CFC Composite 1,514,894 $271.08 $ 410,659,399 $ 3.39 ABD <21 25,246 $ 773.38 $ 19,524,706 $ 9.67 ABD 21 + 140,097 $ 1,290.99 $ 180,863,503 $ 16.14 Composite 1,680,237 $ 363.67 $ 611,047,608 $ 4.55 C1 - Northeast HF/HST <1 M+F 258,958 $ 1,004.16 $ 260,035,450 $ 12.55 HF/HST 1 M+F 232,433 201.69 46,878,596 2.52 HF/HST 2-13 M+F 2,575,572 124.51 320,672,994 1.56 HF/HST 14-18 M 435,914 153.86 67,068,365 1.92 HF/HST 14-18 F 450,348 195.30 87,952,616 2.44 HF 19-44 M 373,711 243.76 91,094,603 3.05 HF 19-44 F 1,282,288 367.93 471,793,400 4.60 HF 45+ M+F 201,719 542.05 109,341,643 6.78 HST 19-64 F 58,608 535.02 31,356,829 6.69 Composite Non-Delivery 5,869,550 $ 253.20 $ 1,486,194,496 $ 3.17 Delivery CFC 16,820 5,600.65 94,203,856 70.01 CFC Composite 5,869,550 $269.25 $ 1,580,398,352 $ 3.37 ABD <21 170,693 $ 659.93 $ 112,645,168 $ 8.25 ABD 21 + 506,340 $ 1,404.32 $ 711,061,633 $ 17.55 Composite 6,546,583 $ 367.23 $ 2,404,105,153 $ 4.59 C2 - Northeast Central HF/HST <1 M+F 64,414 $ 709.21 $ 45,683,038 $ 8.87 HF/HST 1 M+F 56,193 152.04 8,543,682 1.90 HF/HST 2-13 M+F 628,532 114.68 72,081,154 1.43 HF/HST 14-18 M 102,176 136.81 13,978,513 1.71 HF/HST 14-18 F 103,821 188.24 19,543,278 2.35 HF 19-44 M 108,930 203.52 22,169,466 2.54 HF 19-44 F 296,618 332.66 98,671,767 4.16 HF 45+ M+F 42,280 441.14 18,651,323 5.51 HST 19-64 F 14,971 396.18 5,931,401 4.95 Composite Non-Delivery 1,417,934 $ 215.28 $ 305,253,624 $ 2.69 Delivery CFC 4,173 4,710.04 19,656,341 58.88 CFC Composite 1,417,934 $229.14 $ 324,909,964 $ 2.86 ABD <21 24,691 $ 721.51 $ 17,814,653 $ 9.02 ABD 21 + 91,995 $ 1,156.84 $ 106,423,749 $ 14.46 Composite 1,534,621 $ 292.68 $ 449,148,366 $ 3.66 All Regions HF/HST <1 M+F 910,948 $ 901.68 $ 821,380,575 $ 11.27 HF/HST 1 M+F 817,258 195.04 159,395,066 2.44 HF/HST 2-13 M+F 8,894,735 128.76 1,145,284,012 1.61 HF/HST 14-18 M 1,388,647 158.18 219,656,856 1.98 HF/HST 14-18 F 1,426,015 200.12 285,370,877 2.50 HF 19-44 M 1,375,811 254.71 350,430,162 3.18 HF 19-44 F 4,166,659 375.77 1,565,702,243 4.70 HF 45+ M+F 603,539 573.02 345,838,517 7.16 HST 19-64 F 217,157 453.87 98,561,844 5.67 Composite Non-Delivery 19,800,770 $ 252.09 $ 4,991,620,153 $ 3.15 Delivery CFC 58,558 5,569.60 326,146,784 69.62 CFC Composite 19,800,770 $268.56 $ 5,317,766,937 $ 3.36 ABD <21 443,897 $ 773.33 $ 343,279,163 $ 9.67 ABD 21 + 1,568,102 $ 1,377.50 $ 2,160,061,677 $ 17.22 Composite 21,812,769 $ 358.56 $ 7,821,107,777 $ 4.48 Xxxx Xxxxxxxxx, ASA, MAAA Partner Xxxxxx Xxxxxxxxx, ASA, MAAA Senior Associate 0000 Xxxx Xxxxxxxxx Xxxx, Xxxxx 000 Xxxxxxx, XX 00000 +0 000 000 0000 xxx.xxxxxx.xxx Xx. Xxxxxx Xxxxxx Ohio Department of Medicaid Bureau of Managed Health Care Lazarus Building 00 Xxxx Xxxx Xxxxxx, Xxxxx 000 Xxxxxxxx, Xxxx 00000 December 17, 2013.
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Samples: Provider Agreement
