Rating Regions. Region Rating Region A1 — North Central West A2 — Northwest A3 — Southwest Central/Southeast B1 — South Central B2 — Southeast Northeast C1 — Northeast C2 — Northeast Central Rate Groups For CY 2015, base capitation rates were developed by rating region for ABD <21. These rates will be risk adjusted to account for variations in health risk among the MCPs. This process is described in greater detail in Enclosure 5. ENCLOSURE 2
Rating Regions. Region Rating Region A1 — North Central West A2 — Northwest A3 — Southwest Central/Southeast B1 — South Central B2 — Southeast Northeast C1 — Northeast C2 — Northeast Central Rate Groups For CY 2015, the capitation rates will be developed separately for each rating region and the following eight rate groups. Thus, there are 56 Non-Delivery distinct rate groups developed for the Extension population: Table 1.2 — Rate Groups (Program — Age — Gender) Extension — 19 to 34 M Extension — 19 to 34 F Extension — 35 to 44 M Extension — 35 to 44 F Extension — 45 to 54 M Extension — 45 to 54 F Extension — 55 to 64 M Extension — 55 to 64 F In addition to the above rate groups, MCPs will receive a delivery payment for each Extension member with a qualifying event. The same Delivery rate (given the similar risk) will be used for both Covered Families and Children (CFC) and Extension members. The development of this rate is described in the CFC and Aged, Blind, or Disabled Adults (ABD 21+) CY 2015 Capitation Rate Development Methodology letter. CALENDAR YEAR 2015 CAPITATION RATE CERTIFICATION — EXTENSION OHIO DEPARTMENT OF MEDICAID Subpopulations for Rate Development Support Each Extension rate group is comprised of the following four subgroups that are expected to have different underlying costs and influences on the Extension rates:
Rating Regions. Region Rating Region A1 – North Central West Central/Southeast Northeast A2 – Northwest A3 – Southwest B1 – South Central B2 – Southeast C1 – Northeast C2 – Northeast Central 1 Xxxxxx defines the term “actuarially sound” within the rate certification section of the letter. Table 2 – Rate Groups (Program – Gender – Age) Healthy start/Healthy families male/female < Age 1 (HST/HF M/F <1) HST/HF M/F – 1 HST/HF M/F – 2 to 13 HST/HF M – 14 to 18 HST/HF F – 14 to 18 HF M – 19 to 44 HF F – 19 to 44 HF M/F – 45 to 64 HST F – 19 to 64 CFC Delivery ABD 21+ The goal of capitation rate development is to take experience that is available for a historical period and convert that experience, using actuarial principles, into appropriate baseline data for the contract period. Actuarially sound rate-setting development for the CY 2014 CFC and ABD 21+ programs uses CY 2012 Managed Care Plan (MCP) cost reports as the rate base supplemented with the January through June 2012 encounter data to support member-level rate adjustments, rate group, rating region, and service mix. Both sets of data have been segmented by the rating regions and rate groups noted in Table 2.1 and Table 2.2. Using this information, the rates are developed by accounting for each of the following components: • Base Data Construction • Removal of Non-State Plan Services • Adjustment for Third Party Liability and Fraud and Abuse Recoveries • Completion for Additional Claims Run Out • Addition for Certain Expenditures Not Included in the Data • Application of Historical Program Changes • Trend • Prospective Program Changes • Adult Extension • Affordable Care Act Section 1202 • Managed Care Efficiency Adjustments • Care Coordination Expenses and Non-claim Expense Load • Managed Care Plan Hospital Incentive • Sales and Use Tax and Health Insuring Corporation Tax • Affordable Care Act Health Insurance Providers Fee • Pay for Performance • Risk Adjustment (Aged, Blind, or Disabled Only) Base Data Construction Xxxxxx summarized the MCP cost report data for the time period of January 1, 2012 through December 31, 2012 to serve as the base data. The data was examined for potential outliers or reporting issues at the program, MCP, rating region, rate group, and category of service level; appropriate adjustments were made, as necessary. In addition to any of these outliers, adjustments were made to reflect the new rating regions effective July 2013 with the new provider agreement and known eligibility issues that occur...
