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. If you have any questions regarding the enclosed information, please do not hesitate to contact me at (▇▇▇) ▇▇▇-▇▇▇▇. Sincerely, ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA, MAAA Principal and Consulting Actuary RMD/mle cc: ▇▇▇ ▇▇▇▇▇ (ODJFS) ▇▇▇▇▇▇ ▇▇▇▇▇▇ (ODJFS) ▇▇▇▇▇▇ ▇▇▇▇▇ (ODJFS) FINAL and CONFIDENTIAL I, ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, am a Principal and Consulting Actuary with the firm of ▇▇▇▇▇▇▇▇, 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 Aged, Blind, or Disabled 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. /s/ ▇▇▇▇▇▇ ▇. Dalmer_ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA Member, American Academy of Actuaries Date Central 284,169 $1,101.26 $10.62 $1,111.88 Statewide 1,393,418 $1,092.43 $10.53 $1,102.96 MCP: WellCare of Ohio, Inc. Aged, Blind or Disabled: MA-A Aged MA-B Blind MA-D Disabled 1. Basic Benefit Package Pursuant to OAC rule 5101:3-26-03(A), with limited exclusions (see section G.2 of this appendix), MCPs must ensure that members have access to medically-necessary services covered by the Ohio Medicaid fee-for-service (FFS) program. For information on Medicaid-covered services, MCPs must refer to the ODJFS website. The following is a general list of the benefits pertinent to the ABD population covered by the MCPs: · Inpatient hospital services · Outpatient hospital services · Rural health clinics (RHCs) and Federally qualified health centers (FQHCs) · Physician services whether furnished in the physician’s office, the covered person’s home, a hospital, or elsewhere · Laboratory and x-ray services · Family planning services and supplies · Home health and private duty nursing services · Podiatry · Physical therapy, occupational therapy, and speech therapy · Nurse-midwife, certified family nurse practitioner, and certified pediatric nurse practitioner services · Prescription drugs · Ambulance and ambulette services · Dental services · Durable medical equipment and medical supplies · Vision care services, including eyeglasses · Nursing facility stays as specified in OAC rule 5101:3-26-03 · Hospice care · Behavioral health services (see section G.2.b.iii of this appendix) · Chiropractic services
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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. If you have any questions regarding the enclosed information, please do not hesitate to contact me at (▇▇▇) -▇▇▇-▇▇▇▇. Sincerely, ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA, MAAA Principal and Consulting Actuary RMD/mle cc: ▇▇▇ ▇▇▇▇▇ (ODJFS) ▇▇▇▇▇▇ ▇▇▇▇▇▇ MitaliGhatak (ODJFS) ▇▇▇▇▇▇ ▇▇▇▇▇ (ODJFSODJF1 ) FINAL and CONFIDENTIAL I, ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, am a Principal and Consulting Actuary with the firm of ▇▇▇▇▇▇▇▇, 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 Aged, Blind, or Disabled 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. /s/ ▇▇▇▇▇▇ ▇. Dalmer_ ▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇, FSA Member, American Academy of Actuaries Date Central 284,169 $1,101.26 $10.62 $1,111.88 Statewide 1,393,418 $1,092.43 $10.53 $1,102.96 MCP: WellCare of Ohio, Inc. Aged, Blind or Disabled: MA-A Aged MA-B Blind MA-D Disabled 1. Basic Benefit Package Pursuant to OAC rule 5101:3-26-03(A), with limited exclusions (see section G.2 of this appendix), MCPs must ensure that members have access to medically-necessary services covered by the Ohio Medicaid fee-for-service (FFS) program. For information on Medicaid-covered services, MCPs must refer to the ODJFS website. The following is a general list of the benefits pertinent to the ABD population covered by the MCPs: · Inpatient hospital services · Outpatient hospital services · Rural health clinics (RHCs) and Federally qualified health centers (FQHCs) · Physician services whether furnished in the physician’s office, the covered person’s home, a hospital, or elsewhere · Laboratory and x-ray services · Family planning services and supplies · Home health and private duty nursing services · Podiatry · Physical therapy, occupational therapy, and speech therapy · Nurse-midwife, certified family nurse practitioner, and certified pediatric nurse practitioner services · Prescription drugs · Ambulance and ambulette services · Dental services · Durable medical equipment and medical supplies · Vision care services, including eyeglasses · Nursing facility stays as specified in OAC rule 5101:3-26-03 · Hospice care · Behavioral health services (see section G.2.b.iii of this appendix) · Chiropractic servicesActuaries
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