RATE DEVELOPMENT STANDARDS i. Final Capitation Rate Compliance The final capitation rates are in compliance with 42 CFR 438.4(b)(6) and are only based on services outlined in 42 CFR 438.3(c)(1)(ii) and 438.3(e). Non-state plan services provided by the MCPs have been excluded from the capitation rate development process. Effective July 1, 2017, ODM began permitting the use of IMDs as an in-lieu-of service for the 21 to 64-year-old population for up to 15 days per month.
RATE DEVELOPMENT STANDARDS i. Overview In accordance with 42 CFR §438.5(g), we will follow the rate development standards related to budget-neutral risk adjustment for the MMC program. The composite rates for the CFC, ABD, Extension, and AFK populations will be prospectively risk adjusted by MCP on a regional basis to reflect estimated prospective morbidity differences in the underlying population enrolling with each MCP.
RATE DEVELOPMENT STANDARDS i. Annual basis The capitation rates are for the one year rate period from January 1, 2018 through December 31, 2018.
RATE DEVELOPMENT STANDARDS i. Overview The MyCare rates have been developed as full risk rates. The MCOPs assume risk for the cost of services covered under the contract and incur losses if the cost of furnishing the services exceeds the payments under the contract. The regional NFLOC rates will be prospectively adjusted by MCOP to reflect mix differences in the enrolling population between nursing facility and Community Waiver setting of care. This adjustment will be made to the rates prospectively. No additional risk adjustment is planned for this population in CY 2022.
RATE DEVELOPMENT STANDARDS i. Rate Ranges The CY 2022 MyCare capitation rate development does not utilize rate ranges.
RATE DEVELOPMENT STANDARDS i. Capitation rate structure The MyCare rate structure for CY 2022 did not change from the 2021 rate structure. Rates continue to vary by region consistent with current geographic definitions. The NFLOC rate cell continues to reflect a composite of the Institutional, Community Waiver 18 – 44, Community Waiver 45 – 64 and Community Waiver 65+ population groups. The NFLOC rate cell will be adjusted by the MEMA on a semi-annual basis. The Community Well population groups includes three separate rate cells: Community Well 18 – 44, Community Well 45 – 64, and Community Well 65+ for a total of four MyCare rate cells.
RATE DEVELOPMENT STANDARDS i. Annual basis The capitation rates are effective for the one year rate period from January 1, 2021 through December 31, 2021.
RATE DEVELOPMENT STANDARDS i. Final Capitation Rate Compliance The final capitation rates are in compliance with 42 CFR 438.4(b)(6) and are only based on services outlined in 42 CFR 438.3(c)(1)(ii) and 438.3(e). Non-state plan services provided by the MCPs have been excluded from the capitation rate development process. During CY 2016, the MCPs did not provide any in-lieu-of services. Effective July 1, 2017, ODM began permitting the use of IMDs as an in-lieu-of service for the 21 to 64-year-old population for up to 15 days per month. We do not anticipate a material amount of additional expenditures due to this change, and have not projected any additional benefit costs.
RATE DEVELOPMENT STANDARDS i. Final Capitation Rate Compliance The final capitation rates are in compliance with 42 CFR 438.4(b)(6) and are only based on services outlined in 42 CFR 438.3(c)(1)(ii) and 438.3(e). During CY 2016, the MCOPs did not provide any in-lieu-of services. Effective July 1, 2017, ODM began permitting the use of IMDs as an in-lieu-of service for the 21 to 64-year-old population for up to 15 days per month. We do not anticipate a material amount of additional expenditures due to this change, and have not projected any additional benefit costs.
RATE DEVELOPMENT STANDARDS i. Rating period The capitation rates are effective for an 18-month rating period from July 1, 2022 through December 31, 2023.
