NON-BENEFIT COSTS, BY COST CATEGORY Sample Clauses

NON-BENEFIT COSTS, BY COST CATEGORY. Administrative expenses have not been developed from the ground up (based on individual components). However, individual components were reviewed within MCP cost reports and financial statement data. The components may appropriately interact, and the state does not wish to dictate to the plans how these may be allocated. The calendar year 2016 non-benefit cost allowance is determined as a percentage of the capitation rates before fees and taxes. It is our understanding that ODM has modified the administrative requirements for MCPs. The existing care management program has a required staffing ratio of one care manager for every 25 members in the top 1% of the members being managed. Revised requirements provide a range of 25-50 members for each care manager in the “Intensive” level (1%) and a range of 50-100 members for each care manager in the “High” level of care management (next 2%). We assumed that inactive members will require about half the effort to manage compared to active members. ODM’s implementation of the new care management ratios does not align with the required ramp-up of the new membership requirement for those to be care managed. Rather than reducing administrative costs for part of 2016 and then increasing administrative costs to account for implementation expenses, ODM will pursue an implementation strategy that is budget- neutral over the 2016 transition period. We assumed that changes in care managed requirements effective during calendar year 2016 are budget neutral to the capitation rates. Calendar year 2016 capitation rates include amounts for the following non-benefit expense:  Enhanced Maternal Program: ODM has implemented an enhanced maternal health program to target geographic areas with high infant mortality rates. ODM will provide guidelines to the MCPs for the purposes of developing strategies and systems that will provide enhanced maternal case management and reduce infant mortality rates. Funding to support MCP initiatives for the program is included in the applicable regions and female rate cells. A total of $13.4 million was added to four female CFC rate cells, before fees and taxes, for the enhanced maternal program. The rate cells assumed to be included in the program are HF/HST 14-18 F, HF 19-44 F, HF 45+ M+F, and HST 19-64 F. The total amount of available funding for the enhanced maternal program was allocated based on the assumed percent of targeted membership in each region and rate cell.
Sample 1
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NON-BENEFIT COSTS, BY COST CATEGORY i. Administrative costs For the CY 2017 rate development process, the administrative cost has not been developed from the ground up (based on individual components). However, individual components were reviewed within MCP cost reports and financial statement data. The components may appropriately interact, and ODM does not wish to dictate to the plans how these may be allocated. The CY 2017 administrative cost allowance for MyCare was determined as a percentage of the capitation rates before fees and taxes. CY 2017 administrative cost percentages were developed by trending the CY 2016 administrative costs PMPM by 2.0% for the combined MyCare Opt-In and Opt-Out rates.
Sample 1
NON-BENEFIT COSTS, BY COST CATEGORY. Administrative expenses have not been developed from the ground up (based on individual components). However, individual components were reviewed within MCP cost reports and financial statement data. The components may appropriately interact, and the state does not wish to dictate to the plans how these may be allocated. The CY 2017 non- benefit cost allowance is determined as a percentage of the capitation rates before fees and taxes. CY 2017 capitation rates include amounts for the following non-benefit expense: • Enhanced Maternal Program: ODM has implemented an enhanced maternal health program to target geographic areas with high infant mortality rates. ODM will provide guidelines to the MCPs for the purposes of developing strategies and systems that will provide enhanced maternal case management and reduce infant mortality rates. Funding to support MCP initiatives for the program is included in the applicable regions and female rate cells. A total of $13.4 million was added to four female CFC rate cells, before fees and taxes, for the enhanced maternal program. The rate cells assumed to be included in the program are HF/HST 14-18 F, HF 19-44 F, HF 45+ M+F, and HST 19-64 F. The total amount of available funding for the enhanced maternal program was allocated based on the assumed percent of targeted membership in each region and rate cell..
Sample 1
NON-BENEFIT COSTS, BY COST CATEGORY i. Administrative costs At the present time, the administrative cost has not been developed from the ground up (based on individual components). The components may appropriately interact, and ODM does not wish to dictate to the plans how these may be allocated. The CY 2016 administrative cost allowance for MyCare is determined as a percentage of the capitation rates net of taxes and assessments. Administrative cost percentages have been modified to keep CY 2016 administrative costs consistent with CY 2015 on a PMPM basis for the combined MyCare Opt-In and Opt-Out rates.
Sample 1

Related to NON-BENEFIT COSTS, BY COST CATEGORY

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