Incorporate non-claims items and adjustments. The adjusted claims cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Administrative expense allowances were updated in recognition of program adjustments effective July 1, 2020. In addition, the Health Insuring Corporation (HIC) Franchise Fee amounts were developed by MyCare Ohio plan (MCOP) based on projected Medicaid member months, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment to the CY 2020 capitation rates reflects HIC Franchise Fee amounts applicable from July through December 2020. No other changes were made to non-claims assumptions from the values included in the Original certification.
Incorporate non-claims items and adjustments. The adjusted claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Health Insuring Corporation (HIC) Franchise Fee amounts were developed by MCOP based on projected Medicaid member months, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment to the CY 2019 capitation rates reflects HIC Franchise Fee amounts applicable from July through December 2019. All other non-claims items, including the 4% joint savings, have not been revised from the Original certification.
Incorporate non-claims items and adjustments. The adjusted claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. The July 2016 capitation rate amendment includes an annualized amount of $26.8 million across four female CFC rate cells, before fees and taxes, for the enhanced maternal program. ODM has indicated managed care plans (MCPs) will receive an additional $6.7 million in funding for the enhanced maternal program during the July through December 2016 rate period. For the CY 2016 time period after the July 1st rate amendment, the MMC rates will include $20.1 million for the enhanced maternal program. This amount represents an increase from the $13.4 million annual amount included in the Original certification. Additionally, administrative expense allowance for the ABD <21 and ABD 21+ populations reflects an increase of 0.12% from the Original certification. This increase is intended to provide MCPs with the same aggregate administrative expense allowance as the Original certification after reflecting 1634 conversion population movement. No other changes were made to non-claims assumptions from the values included in the Original certification.
Incorporate non-claims items and adjustments. The adjusted claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Effective July 1, 2017, the Sales and Use tax will no longer be applicable to the MyCare population. This tax will be replaced by the Health Insuring Corporation (HIC) Franchise Fee, which will be collected by ODM. Amounts for Sales and Use tax have been excluded from the July 2017 capitation rate amendment. The July 2017 capitation rate amendment includes a fixed per member per month (PMPM) amount by region for the HIC Franchise Fee. HIC Franchise Fee amounts were developed by MCOP based on projected member months, and then weighted based on regional enrollment by MCOP.
Incorporate non-claims items and adjustments. Administrative expense allowances and Health Insuring Corporation (HIC) Tax percentage amounts were applied consistently with the assumptions documented in the Original certification. No other changes were made to non- claims assumptions from the values included in the Original certification.
Incorporate non-claims items and adjustments. The adjusted claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Effective July 1, 2017, the Sales and Use tax will no longer be applicable to the MMC population. This tax will be replaced by the Health Insuring Corporation (HIC) Franchise Fee, which will be collected by ODM. Amounts for Sales and Use tax have been excluded from the July 2017 capitation rate amendment. The July 2017 capitation rate amendment includes a fixed per member per month (PMPM) amount by region for the HIC Franchise Fee. HIC Franchise Fee amounts were developed by MCP based on projected member months, and then weighted based on regional enrollment by MCP. Additionally, we included care management amounts under the delivery kick payment (DKP) in four regions to account for the Pathways Community HUB (HUB) contracting requirements. Under the Original certification, care management was not included in DKPs. No other changes were made to non-claims assumptions from the values included in the Original certification.
Incorporate non-claims items and adjustments. The adjusted claims cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Administrative expense allowances were updated in recognition of program adjustments not considered in the Original certification. In addition, the Health Insuring Corporation (HIC) Franchise Fee amounts were developed by MyCare Ohio plan (MCOP) based on projected Medicaid member months, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment reflects different HIC Franchise Fee amounts for 1H 2021 and 2H 2021 based on projected fees attributable to each period. No other changes were made to non-claims assumptions from the values included in the Original certification.
Incorporate non-claims items and adjustments. The adjusted claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Administrative expense allowances were updated in recognition of program adjustments effective July 1, 2018. In addition, the Health Insuring Corporation (HIC) Franchise Fee amounts were developed by managed care plan (MCP) based on projected Medicaid member months, and then weighted based on regional enrollment by MCP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment to the CY 2018 capitation rates reflects HIC Franchise Fee amounts applicable to July through December 2018. In addition, we added care management amounts under the delivery kick payment (DKP) in the Northeast region due to the presence of two certified Pathways Community HUBs (HUB). No other changes were made to non-claims assumptions from the values included in the Original certification.
Incorporate non-claims items and adjustments. The adjusted claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Relative to the Original certification, we updated the per member per month (PMPM) add-on amounts attributable to the Enhanced Maternal Program and MCP Hospital Incentive after consideration of increases in enrollment projected to occur during CY 2020. Projected total expenditures included in the MMC capitation rates continue to equal $13.4 million and $162 million, respectively, for these two items. In addition, since the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment reflects HIC Franchise Fee amounts applicable to July through December 2020. No other changes were made to non-claims assumptions from the values included in the Original certification.
