Trend. Trend is an estimate of the change in the cost of providing a specific set of benefits over time, resulting from both unit cost (price and service mix) and utilization changes. Trend factors are used to estimate the cost of providing services in some future year (contract year) based on the cost incurred in a prior period (base period). Mercer considered several information sources to develop appropriate trend factors to use in the State’s rates. Analysis of MCP encounter and financial data (including the CY 2013 cost reports, first half CY 2014 cost reports, and the first half 2014 Ohio Department of Insurance NAIC financial statements) were primary sources of information that provided insight into particular trend patterns within the ODM environment. MCP encounter and financial experience trends reflect a variety of influences, including potential changes in medical management practices, network construction, and population risk. Some of these influences may be accounted for in other aspects of rate setting, such as program changes, managed care assumptions, or demographic mix, and as such, MCP experience trends must be considered within the broader set of information about underlying trend. Other sources, such as regional and national economic indicators and indices, provide broad perspectives of industry trends in the United States, the Midwest region, and the State. Examples of specific resources reviewed include the Department of Labor Consumer Price Index data (local, regional, and national), federal reports and projections (for example, National Health Expenditures), and other health care industry reports (for example, Health Care Cost Institute). ▇▇▇▇▇▇’▇ proprietary information about other state Medicaid programs provides additional information about Medicaid patterns of care and how they affect trends. As part of the above, information regarding drugs that are moving off patent and those being introduced to the market is also used to inform the pharmacy trends. ENCLOSURE 4 In addition to trending the data forward (described in Enclosure 3), adjustments were made to reflect an efficient managed care environment. These adjustments are described within this section and are summarized below: • Managed Care Efficiency Adjustments. • Provider Pricing Targets. • Care Coordination Expenses and Non-Claim Expense Load. • MCP/Hospital Incentive. • Applicable Taxes. • ACA Section 9010. • Pay for Performance. In alignment with the State’s objective of purchasing more effective, efficient, and innovative managed care, Mercer implemented provider unit cost pricing targets and efficiency adjustments, the latter focusing on non-emergent ED use, potentially preventable inpatient admissions, and increasing pharmacy utilization management and pricing efficiency effectiveness. To ensure that unit cost levels in the MCP experience are appropriate to use as a baseline for the program contract period, the State collects information about MCP provider payment levels. After reviewing the collected information and discussion with the State, the pricing targets used in prior years were retained for CY 2015, except for inpatient services, which were returned to their targeted levels prior to the DRG rebase. In addition, a new pricing target service grouping for Rad/Lab/Path services was added. Since Rad/Lab/Path has a facility and a professional component, this adjustment utilized a combination of the Outpatient and Professional targets. The blend was developed based on the mix of facility and professional Rad/Lab/Path dollars by region and population. Mercer performed a retrospective analysis of the MCPs’ CY 2013 Emergency Room (ER) encounter data to identify ED visits (excludes urgent care visits) that were considered avoidable due to the low-acuity nature of the visit. This analysis is not intended to imply that beneficiaries should be denied access to EDs, nor that the MCPs should deny payment for the ED visits. Instead, the analysis was designed to reflect the State’s objective that more effective, efficient, and innovative managed care could have prevented or preempted the need for some beneficiaries to seek care in the ED. Using Mercer-identified, low-acuity non-emergent (LANE) diagnosis and procedure codes compiled through clinical literature review, Mercer scanned the CY 2013 Ohio Medicaid encounter data for ED visits where ▇▇▇▇ diagnoses appeared as the primary diagnosis on both the facility claim and any associated physician claim. While the relevant literature typically considers all such ED visits as non-emergent and/or emergent but primary care treatable or potentially preventable, Mercer applied additional filters on the data to inform an appropriate rate adjustment. The Mercer clinical team, working with a Mercer subcontracted, practicing ED physician, developed for each diagnosis a target percentage of visits to be considered for adjustment. This target varies by diagnosis, taking into consideration the circumstances under which Medicaid populations present at the ED and ultimately have the LANE diagnosis assigned as their final (primary) diagnosis. Mercer then calculated a “LANE dollars to remove” value by identifying ED visits for removal up to the target percentage, pulling them hierarchically from visits with procedure codes 99281, 99282, 99283, and “unclassified,” until the target percentage of visits was removed. No visits with a 99284 or 99285 procedure code were removed, even if that meant the target visit removal could not be achieved. Only a portion of the LANE adjustment was applied to the laboratory/radiology component of the ER visit, as some of these services would have been appropriate services had they been performed as part of or resulting from a physician office visit. Finally, to produce final rate adjustments for LANE, Mercer offset the “LANE dollars to remove” amount with the value of an average physician office visit for approximately 95% of the visits removed. This replacement cost was determined by adding service units to the Office Visits/Consults COS in direct proportion with those removed from the ER Professional COS. This adjustment was applied at the region and rate cell level. Note: Even though the costs associated with urgent care facilities are included in the ER COS, the services performed in an urgent care facility are excluded from the LANE adjustment. Since hospital expenses represent a significant portion of all health care medical expenditures, Mercer performed a retrospective data analysis of the MCP CY 2013 encounter data using condition indicators developed by the Agency for Healthcare Research and Quality (AHRQ). These conditions are collectively referred to as prevention quality indicators (PQI) and pediatric quality indicators (PDI), respectively. Mercer utilized 13 adult PQIs and five pediatric PDIs as part of the analysis. Evidence suggests that hospital admissions for these conditions could have been avoided through high-quality outpatient care and/or the conditions could have been less severe if treated early and appropriately. AHRQ’s technical specifications provide specific criteria that define each PQI and PDI that Mercer utilized in the analysis of the MCP inpatient hospital encounter data. Although AHRQ acknowledges that there are factors outside of the direct control of the health care system that can result in a hospitalization (for example, environmental and patient compliance), AHRQ does recognize that these types of PDI/PQI analyses can be utilized to benchmark health care system efficiency between facilities and across geographies. In the process of evaluating whether an adjustment was appropriate, Mercer considered the following factors: member health risk and member enrollment duration with a particular MCP. Although the AHRQ technical specifications do not account for enrollment duration, Mercer considered enrollment duration as one of the contributing factors that would be associated with the applicability of a PQI/PDI-based adjustment. Enrollment duration was used as a proxy for issues such as patient compliance, MCP outreach and education, time to intervene, and other related concepts. Mercer clinical and actuarial staff determined that a variable-month enrollment duration ranging from two to 12 months, depending on PQI or PDI condition, would be appropriate for the CY 2015 rates. This assumption meant that an individual had to be enrolled with the same MCP for a minimum amount of consecutive months prior to that individual’s PQI or PDI hospital admission to be considered subject to the adjustment. Only the dollars associated with the PQI and PDI hospital admissions that met this enrollment duration criteria were included in the base data adjustment. Recipient eligibility data supplied by the State was used to determine member duration. While AHRQ technical specifications include exclusionary criteria specific to each PQI and PDI, Mercer additionally considered clinically-based global exclusion criteria that removed a member’s inpatient admission claims from the analysis. The global exclusion criteria developed by the Mercer clinical team was utilized to identify certain conditions and situations (for example, indications of trauma, ▇▇▇▇▇, HIV/AIDS) that may require more complex treatment for members. Based on a review of the CY 2013 inpatient encounter data, any member identified as having indications of any of the qualifying conditions resulted in all of that member’s admissions being removed from the analysis. Only the dollars associated with the PQI or PDI hospital admissions that remain after the application of the duration and clinical exclusions were used to form the potentially preventable admissions (PPA) base data adjustment. The value of the PPA adjustment includes only the facility component of the service. The professional component associated with the PPA remains with the base data because it is expected that in an efficient managed care environment, professional services would need to be provided in order to successfully avoid the PPA. Mercer performed a retrospective data analysis of the MCP pharmacy encounter data to determine if the generic pricing methods used by the MCPs and their pharmacy benefit managers were reasonable and appropriate, given the pricing that has been achieved by other nearby Medicaid programs and by each MCP in the State. Each generic drug claim was re-priced using an industry benchmark Medicaid Administrative Claiming (MAC) list for the same date of service. For each pharmacy claim for which there was a benchmark MAC unit price in place on the claim’s date of service, the claim paid amount was compared to the derived paid amount using the MAC unit price benchmark. Each claim was re-priced regardless of whether the benchmark price was higher or lower than the original amount on the claim line. Mercer performed a retrospective analysis of the MCP pharmacy encounter data to identify inappropriate prescribing and/or dispensing patterns using a customized series of clinical rules-based, pharmacy utilization management edits. These edits were developed by ▇▇▇▇▇▇’▇ Managed Pharmacy Practice based on published literature, industry standard practices, clinical appropriateness review, professional expertise, and information gathered during the review of several Medicaid managed care pharmacy programs across the country. The customized edits reviewed individual pharmacy claims to identify issues related to inappropriate dosage limits and quantity limits, therapeutic duplication issues, excessive opiate use based on morphine equivalent doses per day thresholds, excessive use of acetaminophen, and age, gender, and pregnancy-related issues. A relatively small percentage of the MCPs’ total pharmacy claim volume met the customized edit criteria for inappropriate prescribing and/or dispensing. To accommodate for pharmacy claims that had received clinical prior authorization review by the MCP, Mercer utilized information contained in the prior authorization data field on each pharmacy claim to determine if the claim had an administrative prior authorization value (for example, refilling too soon) or contained a value consistent with a clinical prior authorization (for example, repeating sequence of number per individual recipient or indication of prior authorization in the data request). Based on this determination, Mercer removed from the analysis any pharmacy claim that appeared to have undergone prior authorization review for clinical appropriateness, as well as any claim where the MCP would not have had the opportunity to impose any clinical rules (for example, emergency fill). To ensure that a prescription was only counted once in the analysis, a priority ranking was assigned to each edit. For example, if a pharmacy claim met the criteria for a quantity limit edit, as well as narcotic overutilization edit, the claim and the associated dollars were only counted once for purposes of the rate adjustment. As a result, each customized pharmacy edit was assigned a total dollar figure reflecting the value of all unduplicated pharmacy claims that met the criteria associated with that edit. Although the criteria associated with each edit is clinically sound, it is expected that situations exist in which clinical or operational rationale support the payment of a claim that did not meet the initial criteria, thus, resulting in an adjustment factor that varied by edit. Such rationale includes, but is not limited to, clinical practice guidelines, eligibility data issues, off-label prescribing practices, medication titration issues, individual patient response to therapy, and professional judgment. Finally, the adjustment value for this analysis took into consideration the probability that a certain percentage of the pharmacy claims that met the edit criteria could have been modified and appropriately prescribed in another manner (for example, prescribed as a different medication or as a different dosage strength). Mercer considers these cost offsets, which were directly applied to decrease the final adjustment value. The actuarially sound capitation rates that were developed include provisions for MCP administration and underwriting gain, and risk and contingency, collectively referred to as the “non-claim expense load.” Medicaid managed care administrative costs are higher than State costs to administer FFS or primary care case management-style program, as a result of activities that MCPs undertake to manage care. For instance, Medicaid MCPs incur expenses related to provider contracting and credentialing, developing and implementing medical management protocols, and sponsoring disease management programs. These expenses are included in managed care capitation rates with the expectation that they produce more cost-effective patterns of care that result in improved health outcomes for Medicaid recipients. To develop an appropriate value for the non-claim expense capitation component, Mercer reviewed CY 2013 and later the State’s MCP CFC and ABD 21+ cost reports to identify recent and historical program administrative expenses. Mercer compared trended administrative expenses to other industry benchmarks for reasonableness. Effective July 1, 2011, the State implemented a MCP/Hospital Incentive program under which the MCPs are expected to increase payment levels to hospitals providing services to MCP enrollees. The aggregate $162 million that the MCPs are obligated to pay during the CY 2015 rate period will be distributed to the hospitals at the MCPs' discretion. The cost attributed to this change will be allocated across the various rate group/rating region combinations, based on non-NF inpatient per member per month costs attributable to each rate group. This allocation will be applied to CFC Non-Delivery, ABD 21+, and ABD <21 rate groups. The funding for the MCP/Hospital Incentive has not been authorized by the legislature for the next biennium that starts on July 1, 2015. In the event that the funding for this initiative is repealed, the rates will need to be adjusted. MCPs are required to remit Sales and Use taxes, as well as a Health Insuring Corporation (HIC) tax on the revenue they receive. The HIC tax is 1% of revenue, and the Sales and Use tax varies by county. To determine appropria
Appears in 2 contracts
Sources: Provider Agreement, Provider Agreement
Trend. Trend is an estimate of the change in the cost of providing a specific set of benefits over time, resulting from both unit cost (price and service mix) and utilization changes. Trend factors are used to estimate the cost of providing services in some future year (contract year) based on the cost incurred in a prior period (base period). Mercer ▇▇▇▇▇▇ considered several information sources to develop appropriate trend factors to use in the State’s rates. Analysis of MCP encounter and financial data (including the CY 2013 cost reports, first half CY 2014 cost reports, and the first half 2014 Ohio Department of Insurance NAIC financial statements) were primary sources of information that provided insight into particular trend patterns within the ODM environment. MCP encounter and financial experience trends reflect a variety of influences, including potential changes in medical management practices, network construction, and population risk. Some of these influences may be accounted for in other aspects of rate setting, such as program changes, managed care assumptions, or demographic mix, and as such, MCP experience trends must be considered within the broader set of information about underlying trend. Other sources, such as regional and national economic indicators and indices, provide broad perspectives of industry trends in the United States, the Midwest region, and the State. Examples of specific resources reviewed include the Department of Labor Consumer Price Index data (local, regional, and national), federal reports and projections (for example, National Health Expenditures), and other health care industry reports (for example, Health Care Cost Institute). ▇▇▇▇▇▇’▇ proprietary information about other state Medicaid programs provides additional information about Medicaid patterns of care and how they affect trends. As part of the above, information regarding drugs that are moving off patent and those being introduced to the market is also used to inform the pharmacy trends. ENCLOSURE 4 In addition to trending the data forward (described in Enclosure 3), adjustments were made to reflect an efficient managed care environment. These adjustments are described within this section and are summarized below: • Managed Care Efficiency Adjustments. • Provider Pricing Targets. • Care Coordination Expenses and Non-Claim Expense Load. • MCP/Hospital Incentive. • Applicable Taxes. • ACA Section 9010. • Pay for Performance. In alignment with the State’s objective of purchasing more effective, efficient, and innovative managed care, Mercer ▇▇▇▇▇▇ implemented provider unit cost pricing targets and efficiency adjustments, the latter focusing on non-emergent ED use, potentially preventable inpatient admissions, and increasing pharmacy utilization management and pricing efficiency effectiveness. To ensure that unit cost levels in the MCP experience are appropriate to use as a baseline for the program contract period, the State collects information about MCP provider payment levels. After reviewing the collected information and discussion with the State, the pricing targets used in prior years were retained for CY 2015, except for inpatient services, which were returned to their targeted levels prior to the DRG rebase. In addition, a new pricing target service grouping for Rad/Lab/Path services was added. Since Rad/Lab/Path has a facility and a professional component, this adjustment utilized a combination of the Outpatient and Professional targets. The blend was developed based on the mix of facility and professional Rad/Lab/Path dollars by region and population. Mercer ▇▇▇▇▇▇ performed a retrospective analysis of the MCPs’ CY 2013 Emergency Room (ER) encounter data to identify ED visits (excludes urgent care visits) that were considered avoidable due to the low-acuity nature of the visit. This analysis is not intended to imply that beneficiaries should be denied access to EDs, nor that the MCPs should deny payment for the ED visits. Instead, the analysis was designed to reflect the State’s objective that more effective, efficient, and innovative managed care could have prevented or preempted the need for some beneficiaries to seek care in the ED. Using Mercer-identified▇▇▇▇▇▇-identified, low-acuity non-emergent (LANE) diagnosis and procedure codes compiled through clinical literature review, Mercer ▇▇▇▇▇▇ scanned the CY 2013 Ohio Medicaid encounter data for ED visits where ▇▇▇▇ LANE diagnoses appeared as the primary diagnosis on both the facility claim and any associated physician claim. While the relevant literature typically considers all such ED visits as non-emergent and/or emergent but primary care treatable or potentially preventable, Mercer ▇▇▇▇▇▇ applied additional filters on the data to inform an appropriate rate adjustment. The Mercer ▇▇▇▇▇▇ clinical team, working with a Mercer ▇▇▇▇▇▇ subcontracted, practicing ED physician, developed for each diagnosis a target percentage of visits to be considered for adjustment. This target varies by diagnosis, taking into consideration the circumstances under which Medicaid populations present at the ED and ultimately have the LANE diagnosis assigned as their final (primary) diagnosis. Mercer ▇▇▇▇▇▇ then calculated a “LANE dollars to remove” value by identifying ED visits for removal up to the target percentage, pulling them hierarchically from visits with procedure codes 99281, 99282, 99283, and “unclassified,” until the target percentage of visits was removed. No visits with a 99284 or 99285 procedure code were removed, even if that meant the target visit removal could not be achieved. Only a portion of the LANE adjustment was applied to the laboratory/radiology component of the ER visit, as some of these services would have been appropriate services had they been performed as part of or resulting from a physician office visit. Finally, to produce final rate adjustments for LANE, Mercer ▇▇▇▇▇▇ offset the “LANE dollars to remove” amount with the value of an average physician office visit for approximately 95% of the visits removed. This replacement cost was determined by adding service units to the Office Visits/Consults COS in direct proportion with those removed from the ER Professional COS. This adjustment was applied at the region and rate cell level. Note: Even though the costs associated with urgent care facilities are included in the ER COS, the services performed in an urgent care facility are excluded from the LANE adjustment. Since hospital expenses represent a significant portion of all health care medical expenditures, Mercer ▇▇▇▇▇▇ performed a retrospective data analysis of the MCP CY 2013 encounter data using condition indicators developed by the Agency for Healthcare Research and Quality (AHRQ). These conditions are collectively referred to as prevention quality indicators (PQI) and pediatric quality indicators (PDI), respectively. Mercer ▇▇▇▇▇▇ utilized 13 adult PQIs and five pediatric PDIs as part of the analysis. Evidence suggests that hospital admissions for these conditions could have been avoided through high-quality outpatient care and/or the conditions could have been less severe if treated early and appropriately. AHRQ’s technical specifications provide specific criteria that define each PQI and PDI that Mercer ▇▇▇▇▇▇ utilized in the analysis of the MCP inpatient hospital encounter data. Although AHRQ acknowledges that there are factors outside of the direct control of the health care system that can result in a hospitalization (for example, environmental and patient compliance), AHRQ does recognize that these types of PDI/PQI analyses can be utilized to benchmark health care system efficiency between facilities and across geographies. In the process of evaluating whether an adjustment was appropriate, Mercer ▇▇▇▇▇▇ considered the following factors: member health risk and member enrollment duration with a particular MCP. Although the AHRQ technical specifications do not account for enrollment duration, Mercer ▇▇▇▇▇▇ considered enrollment duration as one of the contributing factors that would be associated with the applicability of a PQI/PDI-based adjustment. Enrollment duration was used as a proxy for issues such as patient compliance, MCP outreach and education, time to intervene, and other related concepts. Mercer ▇▇▇▇▇▇ clinical and actuarial staff determined that a variable-month enrollment duration ranging from two to 12 months, depending on PQI or PDI condition, would be appropriate for the CY 2015 rates. This assumption meant that an individual had to be enrolled with the same MCP for a minimum amount of consecutive months prior to that individual’s PQI or PDI hospital admission to be considered subject to the adjustment. Only the dollars associated with the PQI and PDI hospital admissions that met this enrollment duration criteria were included in the base data adjustment. Recipient eligibility data supplied by the State was used to determine member duration. While AHRQ technical specifications include exclusionary criteria specific to each PQI and PDI, Mercer ▇▇▇▇▇▇ additionally considered clinically-based global exclusion criteria that removed a member’s inpatient admission claims from the analysis. The global exclusion criteria developed by the Mercer ▇▇▇▇▇▇ clinical team was utilized to identify certain conditions and situations (for example, indications of trauma, ▇▇▇▇▇, HIV/AIDS) that may require more complex treatment for members. Based on a review of the CY 2013 inpatient encounter data, any member identified as having indications of any of the qualifying conditions resulted in all of that member’s admissions being removed from the analysis. Only the dollars associated with the PQI or PDI hospital admissions that remain after the application of the duration and clinical exclusions were used to form the potentially preventable admissions (PPA) base data adjustment. The value of the PPA adjustment includes only the facility component of the service. The professional component associated with the PPA remains with the base data because it is expected that in an efficient managed care environment, professional services would need to be provided in order to successfully avoid the PPA. Mercer ▇▇▇▇▇▇ performed a retrospective data analysis of the MCP pharmacy encounter data to determine if the generic pricing methods used by the MCPs and their pharmacy benefit managers were reasonable and appropriate, given the pricing that has been achieved by other nearby Medicaid programs and by each MCP in the State. Each generic drug claim was re-priced using an industry benchmark Medicaid Administrative Claiming (MAC) list for the same date of service. For each pharmacy claim for which there was a benchmark MAC unit price in place on the claim’s date of service, the claim paid amount was compared to the derived paid amount using the MAC unit price benchmark. Each claim was re-priced regardless of whether the benchmark price was higher or lower than the original amount on the claim line. Mercer ▇▇▇▇▇▇ performed a retrospective analysis of the MCP pharmacy encounter data to identify inappropriate prescribing and/or dispensing patterns using a customized series of clinical rules-based, pharmacy utilization management edits. These edits were developed by ▇▇▇▇▇▇’▇ Managed Pharmacy Practice based on published literature, industry standard practices, clinical appropriateness review, professional expertise, and information gathered during the review of several Medicaid managed care pharmacy programs across the country. The customized edits reviewed individual pharmacy claims to identify issues related to inappropriate dosage limits and quantity limits, therapeutic duplication issues, excessive opiate use based on morphine equivalent doses per day thresholds, excessive use of acetaminophen, and age, gender, and pregnancy-related issues. A relatively small percentage of the MCPs’ total pharmacy claim volume met the customized edit criteria for inappropriate prescribing and/or dispensing. To accommodate for pharmacy claims that had received clinical prior authorization review by the MCP, Mercer ▇▇▇▇▇▇ utilized information contained in the prior authorization data field on each pharmacy claim to determine if the claim had an administrative prior authorization value (for example, refilling too soon) or contained a value consistent with a clinical prior authorization (for example, repeating sequence of number per individual recipient or indication of prior authorization in the data request). Based on this determination, Mercer ▇▇▇▇▇▇ removed from the analysis any pharmacy claim that appeared to have undergone prior authorization review for clinical appropriateness, as well as any claim where the MCP would not have had the opportunity to impose any clinical rules (for example, emergency fill). To ensure that a prescription was only counted once in the analysis, a priority ranking was assigned to each edit. For example, if a pharmacy claim met the criteria for a quantity limit edit, as well as narcotic overutilization edit, the claim and the associated dollars were only counted once for purposes of the rate adjustment. As a result, each customized pharmacy edit was assigned a total dollar figure reflecting the value of all unduplicated pharmacy claims that met the criteria associated with that edit. Although the criteria associated with each edit is clinically sound, it is expected that situations exist in which clinical or operational rationale support the payment of a claim that did not meet the initial criteria, thus, resulting in an adjustment factor that varied by edit. Such rationale includes, but is not limited to, clinical practice guidelines, eligibility data issues, off-label prescribing practices, medication titration issues, individual patient response to therapy, and professional judgment. Finally, the adjustment value for this analysis took into consideration the probability that a certain percentage of the pharmacy claims that met the edit criteria could have been modified and appropriately prescribed in another manner (for example, prescribed as a different medication or as a different dosage strength). Mercer ▇▇▇▇▇▇ considers these cost offsets, which were directly applied to decrease the final adjustment value. The actuarially sound capitation rates that were developed include provisions for MCP administration and underwriting gain, and risk and contingency, collectively referred to as the “non-claim expense load.” Medicaid managed care administrative costs are higher than State costs to administer FFS or primary care case management-style program, as a result of activities that MCPs undertake to manage care. For instance, Medicaid MCPs incur expenses related to provider contracting and credentialing, developing and implementing medical management protocols, and sponsoring disease management programs. These expenses are included in managed care capitation rates with the expectation that they produce more cost-effective patterns of care that result in improved health outcomes for Medicaid recipients. To develop an appropriate value for the non-claim expense capitation component, Mercer ▇▇▇▇▇▇ reviewed CY 2013 and later the State’s MCP CFC and ABD 21+ cost reports to identify recent and historical program administrative expenses. Mercer ▇▇▇▇▇▇ compared trended administrative expenses to other industry benchmarks for reasonableness. Effective July 1, 2011, the State implemented a MCP/Hospital Incentive program under which the MCPs are expected to increase payment levels to hospitals providing services to MCP enrollees. The aggregate $162 million that the MCPs are obligated to pay during the CY 2015 rate period will be distributed to the hospitals at the MCPs' discretion. The cost attributed to this change will be allocated across the various rate group/rating region combinations, based on non-NF inpatient per member per month costs attributable to each rate group. This allocation will be applied to CFC Non-Delivery, ABD 21+, and ABD <21 rate groups. The funding for the MCP/Hospital Incentive has not been authorized by the legislature for the next biennium that starts on July 1, 2015. In the event that the funding for this initiative is repealed, the rates will need to be adjusted. MCPs are required to remit Sales and Use taxes, as well as a Health Insuring Corporation (HIC) tax on the revenue they receive. The HIC tax is 1% of revenue, and the Sales and Use tax varies by county. To determine appropria
Appears in 1 contract
Sources: Provider Agreement