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. ii. Risk adjustment model Risk adjustment will be performed using CDPS + Rx risk scoring models. Risk adjustment will be performed on a budget neutral basis at the region and rate cell level. Newborns, one-year-olds, and delivery kick payments will be excluded from the risk adjustment process. iii. Acuity adjustments Acuity adjustments are not applicable to the CY 2020 capitation rates.
Appears in 3 contracts
Sources: Provider Agreement, Provider Agreement, Provider Agreement
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 health plan on a regional basis to reflect estimated prospective morbidity differences in the underlying population enrolling with each MCP.
ii. Risk adjustment model Risk adjustment will be performed using CDPS + Rx risk scoring modelsversion 6.2. Risk adjustment will be performed on a budget neutral basis at the region and rate cell level. Newborns, one-year-one year olds, and delivery kick payments will be excluded from the risk adjustment process.
iii. Acuity adjustments Acuity adjustments are not applicable to the CY 2020 2018 capitation rates.
Appears in 2 contracts
Sources: Provider Agreement, Provider Agreement
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.
ii. Risk adjustment model Risk adjustment will be performed using CDPS + Rx risk scoring modelsversion 6.3. Risk adjustment will be performed on a budget neutral basis at the region and rate cell level. Newborns, one-year-one year olds, and delivery kick payments will be excluded from the risk adjustment process.
iii. Acuity adjustments Acuity adjustments are not applicable to the CY 2020 2019 capitation rates.
Appears in 2 contracts
Sources: Provider Agreement, Provider Agreement
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.
ii. Risk adjustment model Risk adjustment will be performed using CDPS + Rx risk scoring models. Risk adjustment will be performed on a budget neutral basis at the region and rate cell level. Newborns, one-year-olds, and delivery kick payments will be excluded from the risk adjustment process.
iii. Acuity adjustments Acuity adjustments are not applicable to the CY 2020 2021 capitation rates.
Appears in 2 contracts
Sources: Provider Agreement, Provider Agreement