Disability Risk Adjusted Payment System Sample Clauses
The Disability Risk Adjusted Payment System is a mechanism used to modify payments based on the assessed risk or cost associated with individuals who have disabilities. In practice, this system evaluates the expected healthcare or service needs of disabled individuals and adjusts funding or reimbursement rates accordingly, often using statistical models or risk categories. Its core function is to ensure that organizations or providers receive fair compensation that reflects the higher costs of serving populations with greater needs, thereby promoting equitable access and reducing financial disincentives to serve disabled individuals.
Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see ▇▇▇▇://▇▇▇▇.▇▇▇▇.▇▇▇/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees.
Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see ▇▇▇▇://▇▇▇▇.▇▇▇▇.▇▇▇/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees. Risk Adjustment Overview Appendix 2 contains the capitation rates used to calculate the Calendar Year risk adjusted payments to the MCO. The risk adjustment weights are found in Appendix 3. The STATE or its actuarial vendor will use, for Contract Year SNBC risk scores, a prospective risk adjustment model. The average risk score across all MCOs will be normalized to 1.0 for each rate cell. Development of Weights. The risk adjustment method utilizes two sets of weights, one for Medical Assistance only (non-Dual Eligible) Enrollees, and one for Dual Eligible Enrollees. These two models include disease categories and risk factor weights customized separately for non-Dual Eligible and Dual Eligible experience. The weights were developed using constrained linear regression and were based upon the Calendar Years (CYs) 2014 and 2015 experience of individuals enrolled in the SNBC program. Risk factor weights were constrained to be non-negative. The model includes: 1) demographic information; 2) diagnoses from health care claims for services provided to individuals during CY 2014; 3) costs from health care claims for services provided to individuals during CY 2015; and 4) developmental disability (DD) waiver status. Base Rates. Based on 2014 health plan experience, the STATE calculated base rates based on the following factors: Dual and non-Dual status, institutional (NF, ICF, ICF/DD) and community status, and rate region (Metro, Non-metro North, or Non- metro South as designated in Appendix 3-B). The STATE agrees not to rebase the base rates for risk adjustment during the term of this Contract. Base rates are provided in Appendix 2. Methodology The MCO will receive an SNBC risk score for each rate cell subject to risk adjustment, based on average risk scores across all the MCO’s Enrollees in that rate cell and enrolled in the MCO during the exposure month in 4.2.6(E)(1)(b) and 4.2.6(E)(2)(b) below. New Enrollees. Each MCO Enrollee with no FFS claim experience or managed care encounters in the assessment period will be assigned a risk score equal to the average risk sco...
Disability Risk Adjusted Payment System