Common use of RATE DEVELOPMENT STANDARDS Clause in Contracts

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. ii. Differences among capitation rates Any proposed differences among capitation rates according to covered populations are based on valid rate development standards and are not based on the rate of federal financial participation associated with the covered populations. iii. Cross-subsidization of rate cell payment The capitation rates were developed at the rate cell level and neither cross-subsidize nor are cross-subsidized by payments from any other rate cell. iv. Minimum medical loss ratio The capitation rates were developed such that the MCPs are reasonably expected to achieve a medical loss ratio greater than 85 percent, which includes provisions for non-benefit costs that are appropriate and attainable. ODM’s provider agreement indicates that ODM will perform medical loss ratio (MLR) calculations for the MMC program. ODM has implemented a minimum MLR requirement of 86% for the MMC program. ODM will require remittance in the event a MCP reports a MLR below 86%.