DATA RELIANCE. In developing the CY 2008 ABD capitation rates, we have relied upon certain data and information from ODJFS. While limited review was performed for reasonableness, the data and information was accepted without audit. To the extent that the data and information was not accurate or complete, the values shown in this letter will need to be revised. u u u u If you have any questions regarding the enclosed information, please do not hesitate to contact me at (▇▇▇) ▇▇▇-▇▇▇▇. Sincerely, R▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA, MAAA Principal and Consulting Actuary RMD/mle cc: D▇▇ ▇▇▇▇▇ (ODJFS) M▇▇▇▇▇ ▇▇▇▇▇▇ (ODJFS) R▇▇▇▇▇ ▇▇▇▇▇ (ODJFS) Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented.
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DATA RELIANCE. In developing the CY 2008 ABD CFC capitation rates, we have relied upon certain data and information from ODJFS. While limited review was performed for reasonableness, the data and information was accepted without audit. To the extent that the data and information was not accurate or complete, the values shown in this letter will need to be revised. u u u u w w w w If you have any questions regarding the enclosed information, please do not hesitate to contact me at (3▇▇▇) -▇▇▇-▇▇▇▇. Sincerely, R▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA, MAAA Principal and Consulting Actuary RMD/mle cc: D▇▇ ▇▇▇▇▇ (ODJFS) M▇▇▇▇▇ ▇▇▇▇▇▇ (ODJFS) R▇▇▇▇▇ ▇▇▇▇▇ (ODJFS) Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented.. Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. I, R▇▇▇▇▇ ▇. ▇▇▇▇▇▇, am a Principal and Consulting Actuary with the firm of M▇▇▇▇▇▇▇. Inc. I am a Fellow of the Society of Actuaries and a Member of the American Academy of Actuaries. I was retained by the State of Ohio, Department of Job and Family Services to perform an actuarial review and certification regarding the development of the capitation rates to be effective for calendar year 2008. The capitation rates were developed for the Covered Families and Children managed care eligible populations. I have experience in the examination of financial calculations for Medicaid programs and meet the qualification standards for rendering this opinion. I reviewed the historical claims experience for reasonableness and consistency. I have developed certain actuarial assumptions and actuarial methodologies regarding the projection of healthcare expenditures into future periods. I have complied with the elements of the rate setting checklist CMS developed for its Regional Offices regarding 42 CFR 438.6(c) for capitated Medicaid managed care plans. The capitation rates provided with this certification are effective for a one-year rating period beginning January 1, 2008 through December 31, 2008. At the end of the one-year period, the capitation rates will be updated for calendar year 2009. The update may be based on fee-for-service experience, managed care utilization and trend experience, policy and procedure changes, and other changes in the health care market. A separate certification will be provided with the updated rates. The capitation rates provided with this certification are considered actuarially sound, defined as: • the capitation rates have been developed in accordance with generally accepted actuarial principles and practices; • the capitation rates are appropriate for the populations to be covered, and the services to be furnished under the contract; and, • the capitation rates meet the requirements of 42 CFR 438.6(c). This actuarial certification has been based on the actuarial methods, considerations, and analyses promulgated from time to time through the Actuarial Standards of Practice by the Actuarial Standards Board. R▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA Member, American Academy of Actuaries Date Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. Region Rate Group MMs/Deliveries %of MMs Rate Risk Rate CY 2008 Rate Central HF/HST <1 M+F 203,519 7.4 % $ 562.74 $ 5.43 $ 568.17 Central HF/HST 1 M+F 158,456 5.8 % 145.11 1.40 146.51 Central HF/HST 2-13 M+F 1,226,460 44.7 % 98.15 0.95 99.10 Central HF/HST 14-18 F 163,216 5.9 % 163.61 1.58 165.19 Central HF/HST 14-18 M 146,796 5.3 % 117.41 1.13 118.54 Central HF 19-44 F 550,237 20.1 % 301.40 2.91 304.31 Central HF 19-44 M 168,204 6.1 % 196.85 1.90 198.75 Central HF 45+ M+F 65,409 2.4 % 481.13 4.64 485.77 Central HST 19-64 F 61,713 2.2 % 372.66 3.59 376.25 Central Composite Non-Delivery 2,744,010 $ 202.36 $ 1.95 $ 204.31 Central Delivery CFC 10,854 3,718.41 35.85 3,754.26 Central Composite with Delivery 2,744,010 $ 217.07 $ 2.09 $ 219.16 East Central HF/HST <1 M+F 100,943 6.7 % $ 548.66 $ 5.29 $ 553.95 East Central HF/HST 1 M+F 75,476 5.0 % 141.49 1.36 142.85 East Central HF/HST 2-13 M+F 669,784 44.2 % 95.70 0.92 96.62 East Central HF/HST 14-18 F 96,465 6.4 % 159.52 1.54 161.06 East Central HF/HST 14-18 M 88,374 5.8 % 114.47 1.10 115.57 East Central HF I9-44 F 320,982 21.2 % 293.86 2.83 296.69 East Central HF 19-44 M 90,883 6.0 % 191.93 1.85 193.78 East Central HF 45+ M+F 39,563 2.6 % 469.08 4.52 473.60 East Central HST 19-64 F 33,888 2.2 % 363.34 3.50 366.84 East Central Composite Non-Delivery 1,516,358 $ 196.72 $ 1.90 $ 198.62 East Central Delivery CFC 6,386 3,952.33 38.11 3,990.44 East Central Composite with Delivery 1,516,358 $ 213.36 $ 2.06 $ 215.42 Northeast HF/HST <1 M+F 162,387 6.2 % $ 532.52 $ 5.13 $ 537.65 Northeast HF/HST 1 M+F 130,937 5.0 % 137.33 1.32 138.65 Northeast HF/HST 2-13 M+F 1,160,029 44.5 % 92.88 0.90 93.78 Northeast HF/HST 14-18 F 180,843 6.9 % 154.83 1.49 156.32 Northeast HF/HST 14-18 M 164,388 6.3 % 111.11 1.07 112.18 Northeast HF 19-44 F 561,019 21.5 % 285.22 2.75 287.97 Northeast HF 19-44 M 119,830 4.6 % 186.28 1.80 188.08 Northeast HF 45+ M+F 78,748 3.0 % 455.29 4.39 459.68 N▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇-▇▇ F 50,934 2.0 % 352.64 3.40 356.04 Northeast Composite Non-Delivery 2,609,115 $ 189.57 $ 1.83 $ 191.40 Northeast Delivery CFC 9,871 4,066.54 39.21 4,105.75 Northeast Composite with Delivery 2,609,115 $ 204.96 $ 1.98 $ 206.93 Northeast Central HF/HST <1 M+F 42,798 6.2 % $ 575.16 $ 5.55 $ 580.71 Northeast Central HF/HST 1 M+F 32,550 4.7 % 148.33 1.43 149.76 Northeast Central HF/HST 2-13 M+F 306,477 44.2 % 100.32 0.97 101.29 Northeast Central HF/HST 14-18 F 47,853 6.9 % 167.23 1.61 168.84 Northeast Central HF/HST 14-18 M 44,376 6.4 % 120.00 1.16 121.16 Northeast Central HF 19-44 F 145,323 20.9 % 308.07 2.97 311.04 Northeast Central HF 19-44 M 41,692 6.0 % 201.20 1.94 203.14 Northeast Central HF 45+ M+F 18,583 2.7 % 491.75 4.74 496.49 Northeast Central HST 19-64 F 14,085 2.0 % 380.88 3.67 384.55 Northeast Central Composite Non-Delivery 693,737 $ 203.51 $ 1.96 $ 205.47 Northeast Central Delivery CFC 2,683 4,074.59 39.29 4,113.88 Northeast Central Composite with Delivery 693,737 $ 219.27 $ 2.11 $ 221.38 Northwest hf/hst <1 M+F 103,070 7.2 % $ 560.41 $ 5.40 $ 565.81 Northwest HF/HST 1 M+F 76,773 5.4 % 144.52 1.39 145.91 Northwest HF/HST 2-13 M+F 627,854 44.0 % 97.75 0.94 98.69 Northwest HF/HST 14-18 F 91,028 6.4 % 162.94 1.57 164.51 Northwest HF/HST 14-18 M 82,247 5.8 % 116.91 1.13 118.04 Northwest HF 19-44 F 290,044 20.3 % 300.16 2.89 303.05 Northwest HF 19-44 M 88,010 6.2 % 196.05 1.89 197.94 Northwest HF 45+ M+F 32,963 2.3 % 479.14 4.62 483.76 N▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇-▇▇ F 36,142 2.5 % 371.11 3.58 374.69 Northwest Composite Non-Delivery 1,428,131 $ 201.79 $ 1.95 $ 203.74 Northwest Delivery CFC 6,080 3,732.40 35.99 3,768.39 Northwest Composite with Delivery 1,428,131 $ 217.69 $ 2.10 $ 219.79 Southeast HF/HST<1 M+F 54,113 5.6 % $ 569.55 $ 5.49 $ 575.04 Southeast HF/HST 1 M+F 44,355 4.6 % 146.87 1.42 148.29 Southeast HF/HST 2 -13 M+F 405,711 42.2 % 99.34 0.96 100.30 Southeast HF/HST 14-18 F 60,544 6.3 % 165.59 1.60 167.19 Southeast HF/HST 14-18 M 56,221 5.8 % 118.83 1.15 119.98 Southeast HF 19-44 F 205,174 21.3 % 305.06 2.94 308.00 Southeast HF 19-44 M 90,312 9.4 % 199.24 1.92 201.16 Southeast HF 45+ M+F 27,036 2.8 % 486.93 4.70 491.63 S▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇-▇▇ F 18,943 2.0 % 377.17 3.64 380.81 Southeast Composite Non-Delivery 962,409 $ 202.86 $ 1.96 $ 204.82 Southeast Delivery CFC 3,528 3,523.18 33.97 3,557.15 Southeast Composite with Delivery 962,409 $ 215.78 $ 2.08 $ 217.86 Southwest HF/HST <1 M+F 136,292 8.2 % $ 601.16 $ 5.80 $ 606.96 Southwest HF/HST 1 M+F 98,401 5.9 % 155.03 1.49 156.52 Southwest HF/HST 2-13 M+F 761,118 45.6 % 104.86 1.01 105.87 Southwest HF/HST 14-18 F 102,994 6.2 % 174.78 1.69 176.47 Southwest HF/HST 14-18 M 88,400 5.3 % 125.43 1.21 126.64 Southwest HF 19-44F 321,176 19.2 % 321.99 3.10 325.09 Southwest HF 19-44 M 84,540 5.1 % 210.31 2.03 212.34 Southwest HF 45+ M+F 34,189 2.0 % 513.98 4.96 518.94 S▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇-▇▇ F 42,884 2.6 % 398.11 3.84 401.95 Southwest Composite Non-Delivery 1,669,994 $ 216.72 $ 2.09 $ 218.81 Southwest Delivery CFC 7,350 3,973.57 38.31 4,011.88 Southwest Composite with Delivery 1,669,994 $ 234.21 $ 2.26 $ 236.47 West Central HF/HST < 1M+F 88,254 7.5 % $ 567.07 $ 5.47 $ 572.54 West Central HF/HST 1 M+F 65,856 5.6 % 146.24 1.41 147.65 West Central HF/HST 2-13 M+F 528,534 44.7 % 98.91 0.95 99,86 West Central HF/HST 14-18 F 77,143 6.5 % 164.88 1.59 166.47 West Central HF/HST 14-18 M 67,395 5.7 % 118.32 1.14 119.46 West Central HF 19-44 F 234,878 19.9 % 303.73 2.93 306.66 West Central HF-19-44 M 66,482 5.6 % 198.38 1.91 200.29 West Central HF 45+ M+F 27,032 2.3 % 484.84 4.67 489.51 West Centra! HST 19-64 F 27,422 2.3 % 375.53 3.62 379.15 West Central Composite Non-Delivery 1,182,996 $ 203.36 $ 1.96 $ 205.32 West Central Delivery CFC 4,916 4,301.21 41.47 4,342.68 West Central Composite with Delivery 1,182,996 $ 221.24 $ 2.13 $ 223.37 Statewide HF/HST <1 M+F 891,376 7.0 % $ 562.68 $ 5.43 $ 568.11 Statewide HF/HST 1 M+F 682,804 5.3 % 144.95 1.40 146.35 Statewide HF/HST 2- 13 M+F 5,685,967 44.4 % 97.92 0.94 98.86 Statewide HF/HST 14-18F 820,086 6.4 % 163.00 1.57 164.57 Statewide HF/HST 14-18 M 738,197 5.8 % 116.90 1.13 118.03 Statewide HF 19-44 F 2,628,833 20.5 % 300.26 2.90 303.16 Statewide HF 19-44 M 749,953 5.9 % 196.65 1.90 198.55 Statewide HF 45 + M+F 323,523 2.5 % 478.04 4.61 482.65 Statewide HST 19-64 F 286,011 2.2 % 372.59 3.59 376.18 Statewide Composite Non-Delivery 12,806,750 100.0 % $ 201.09 $ 1.94 203.03 Statewide Delivery CFC 51,668 0.4 % 3,91.39 37.72 3,950.11 Statewide Composite with Delivery 12,806,750 $ 100.0 % $ 216.87 $ 2.09 $ 218.96
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