Actuary’s assessment. As required by Actuarial Standard of Practice (ASOP) No. 23, Data Quality, we disclose that Milliman has relied upon certain data and information provided by the ODM and its vendors, primarily the MCOPs. The values presented in this letter are dependent upon this reliance. We find the encounter data used as the base data source for the development of the 2022 capitation rates to be of appropriate quality and suitable for the purpose of developing actuarially sound rates (subject to the data concerns and resolutions indicated in the Data concerns section below). The resulting base data PMPM expenditures for CY 2019, after the application of the adjustments, is within approximately 1.3% of the MCOP survey updated CY 2019 experience PMPM expenditures. The encounter data additionally appears reasonable in relation to Medicaid dual eligible managed care industry experience.
Actuary’s assessment. As required by Actuarial Standard of Practice No. 23, Data Quality, we disclose that we have relied upon certain data and information provided by ODM and their vendors, primarily the MCOPs and ODM’s fiscal agent. The certification is dependent upon this reliance. We find the cost report data used to develop the 2017 capitation rates to be of appropriate quality and suitable for the purpose of developing actuarially sound rates (subject to the data concerns and resolutions indicated in the Data concerns section below). The resulting base data PMPM expenditures for CY 2015, after adjustments for data quality, is approximately 1.9% greater than the PMPM expenditures submitted by the MCOPs. The cost report data additionally appears reasonable in relation to Medicaid dual eligible managed care industry experience. We believe developing the Opt-Out capitation rates from a blend of Opt-Out and Opt-In experience, with appropriate adjustments, represents the most reasonable usage of available base experience data. We believe this methodology provides greater stability to capitation rates on a year to year basis. The MCOP encounter data is not of sufficient quality to be relied upon for development of the majority of adjustments for reimbursement or policy changes that will impact MyCare expenditures during the rate period beginning January 1, 2017. Adjustments for reimbursement or policy changes were primarily developed from a combination of May 1, 2013 through April 30, 2014 FFS data for the MyCare eligible population located in participating counties, along with CY 2015 FFS data for beneficiaries who would otherwise be eligible for MyCare, but reside in non-participating counties. We believe the historical FFS data corresponding to the MyCare eligible population to be the most appropriate data for development of the majority of program and policy change adjustments. The specified FFS data was used in the development of the CY 2016 MyCare capitation rates and has been reviewed for reasonableness and completeness.
Actuary’s assessment. As required by Actuarial Standard of Practice No. 23, Data Quality, we disclose that we have relied upon certain data and information provided by ODM and their vendors, primarily the MCOPs and ODM’s fiscal agent. The certification is dependent upon this reliance. The FFS data represents the most appropriate data to be used for developing the actuarially sound capitation rates for the CY 2016 MyCare program. The MCOP cost reports are believed to be useful for reference purposes only as opposed to explicit base data. The cost reports contain indications of MCOP costs and are used to inform assumptions used to adjust the FFS data. The MCOP encounter data is not of sufficient quantity or quality to be relied upon for the development of actuarially sound capitation rates.
Actuary’s assessment. As required by Actuarial Standard of Practice (ASOP) No. 23, Data Quality, we disclose that Milliman has relied upon certain data and information provided by the Ohio Department of Medicaid and their vendors, primarily the MCOs. The values presented in this letter are dependent upon this reliance. While there are areas for data improvement, as detailed in the Data concerns section below, we found the encounter data to be of appropriate quality for developing the July 2022 capitation rates.
