Common use of Certification of Final Rates Clause in Contracts

Certification of Final Rates.

Certification of Final Rates. The following capitation rates were developed for each of the seven regions for the CY 2007 contract period: • Healthy Families/Healthy Start, Less Than 1, Male & Female, • Healthy Families/Healthy Start, 1 Year Old, Male & Female, • Healthy Families/Healthy Start, 2-13 Years Old, Male & Female, • Healthy Families/Healthy Start, 14-18 Years Old, Female, • Healthy Families/Healthy Start, 14-18 Years Old, Male, • Healthy Families, 19-44 Years Old, Female, • Healthy Families, 19-44 Years Old, Male, • Healthy Families, 45 and Over, Male & Female, • Healthy Start, 19-64 Years Old, Female, and • Delivery Payment. A summary of the rates is included in Appendix X. Xxxxxx certifies the above rates were developed in accordance with generally accepted actuarial practices and principles by actuaries meeting the qualification standards of the American Academy of Actuaries for the populations and services covered under the managed care contract. Rates developed by Xxxxxx are actuarial projections of future contingent events. Actual MCP costs will differ from these projections. Xxxxxx developed these rates on behalf of the State to demonstrate compliance with the CMS requirements under 42 CFR 438.6(c) and to demonstrate that rates are in accordance with applicable law and regulations. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx disclaims any responsibility for the use of these rates by MCPs for any purpose. Xxxxxx recommends any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. Use of these rates for purposes beyond those stated may not be appropriate. XXXXXX Government Human Services Consulting October 20, 2006 Xx. Xxx Xxxxxx Ohio Department of Job and Family Services Sincerely, /s/ Xxxxxx XxxXxxx /s/ Xxxxx Xxxxxx Xxxxxx XxxXxxx, MAAA, ASA Xxxxx Xxxxxx, MAAA, FSA Copy: Xxxxx Xxxxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx - State of Ohio Xxxxx Xxxxxx, Xxx Xxxxxxxxx - Xxxxxx XXXXXX Government Human Services Consulting Appendix A - CY 2007 Rate-Setting Methodology (GRAPH) XXXXXX Government Human Services Consulting Appendix B - Regional Delivery System Definition Regional Delivery System Definitions For regional rate development, counties were bucketed into mandatory. Preferred Option, voluntary, or new as outlined below. The data for all counties within the region was used to develop the regional rate. Please see page B-2 for a map defining the counties within each region. Mandatory and Preferred Option Counties Encounter and cost report data was used for counties that were either mandatory or Preferred Option during the base data period*. These counties include: Mandatory: Preferred Option: Cuyahoga Xxxxxx Xxxxx Xxxxx Xxxxx Xxxxxxxx Summit Xxxxxxxx Xxxxxx Xxxxxxxxxx * Please note Mahoning and Trumbull are not included in the above table due to a lack of credible data. Both counties entered into managed care in October of 2005. Voluntary Counties FFS data was used for voluntary counties during the base period and new counties entering the managed care program since the time of the base data. The voluntary counties include: Voluntary Clermont Xxxxxx Pickaway Xxxxxx Xxxx New counties include all counties that were not mandatory, Preferred Option or voluntary during the base data period. XXXXXX Government Human Services Consulting Medicaid Managed Care Program Regions for the CFC Population (MAP) XXXXXX Government Human Services Consulting Appendix C - FFS Data Adjustments This section lists adjustments made to the FFS claims and eligibility information received from the State. Completion Factors The claims data was adjusted to account for the value of claims incurred but unpaid on a COS basis. Xxxxxx used claims for SPY 2004 and SFY 2005 that reflect payments through the dates included in the following table. SFY Paid Through 2004 03/31/05 2005 12/31/05 The value of the claims incurred during each of these years, but unpaid, was estimated using completion factor analysis. Gross Adjustment File (GAF) To account for gross debit and credit amounts not reflected in the FFS data, adjustments were applied to the FFS paid claims. Historical Policy Changes As part of the rate-setting process, Xxxxxx must account for policy changes that occurred during the base data time period. Changes only reflected in a portion of the data must be applied to the remaining data so that all base data reflects the policy changes. All policy changes implemented during SFY 2004 and SFY 2005 were applied to the FFS data. The following table shows the specific policy changes for which Xxxxxx adjusted the SFY 2004 and SFY 2005 delivery (where applicable) and non-delivery data. Xxxxxx calculated the adjustments based on information supplied by the State.

Certification of Final Rates. The following capitation rates were developed for each of the seven regions for the CY 2007 contract period: • Healthy Families/Healthy Start, Less Than 1, Male & Female, • Healthy Families/Healthy Start, 1 Year Old, Male & Female, • Healthy Families/Healthy Start, 2-13 Years Old, Male & Female, • Healthy Families/Healthy Start, 14-18 Years Old, Female, • Healthy Families/Healthy Start, 14-18 Years Old, Male, • Healthy Families, 19-44 Years Old, Female, • Healthy Families, 19-44 Years Old, Male, • Healthy Families, 45 and Over, Male & Female, • Healthy Start, 19-64 Years Old, Female, and • Delivery Payment. A summary of the rates is included in Appendix X. Xxxxxx certifies the above rates were developed in accordance with generally accepted actuarial practices and principles by actuaries meeting the qualification standards of the American Academy of Actuaries for the populations and services covered under the managed care contract. Rates developed by Xxxxxx are actuarial projections of future contingent events. Actual MCP costs will differ from these projections. Xxxxxx developed these rates on behalf of the State to demonstrate compliance with the CMS requirements under 42 CFR 438.6(c) and to demonstrate that rates are in accordance with applicable law and regulations. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Xxxxxx disclaims any responsibility for the use of these rates by MCPs for any purpose. Xxxxxx recommends any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. Use of these rates for purposes beyond those stated may not be appropriate. October 20, 2006 Xx. Xxx Xxxxxx Ohio Department of Job and Family Services Sincerely, Xxxxxx XxxXxxx, MAAA, ASA Xxxxx Xxxxxx, MAAA, FSA Copy: Xxxxx Xxxxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx – State of Ohio Xxxxx Xxxxxx, Xxx Xxxxxxxxx – Xxxxxx Appendix A – CY 2007 Rate-Setting Methodology Appendix B – Regional Delivery System Definition Regional Delivery System Definitions For regional rate development, counties were bucketed into mandatory, Preferred Option, voluntary, or new as outlined below. The data for all counties within the region was used to develop the regional rate. Please see page B-2 for a map defining the counties within each region. Mandatory and Preferred Option Counties Encounter and cost report data was used for counties that were either mandatory or Preferred Option during the base data period*. These counties include: Mandatory: Preferred Option: Cuyahoga Xxxxxx Xxxxx Xxxxx Xxxxx Xxxxxxxx Summit Xxxxxxxx Xxxxxx Xxxxxxxxxx * Please note Mahoning and Trumbull are not included in the above table due to a lack of credible data. Both counties entered into managed care in October of 2005. Voluntary Counties FFS data was used for voluntary counties during the base period and new counties entering the managed care program since the time of the base data. The voluntary counties include: Voluntary: Clermont Xxxxxx Pickaway Xxxxxx Xxxx New counties include all counties that were not mandatory, Preferred Option or voluntary during the base data period. Appendix C – FFS Data Adjustments This section lists adjustments made to the FFS claims and eligibility information received from the State. Completion Factors The claims data was adjusted to account for the value of claims incurred but unpaid on a COS basis. Xxxxxx used claims for SFY 2004 and SFY 2005 that reflect payments through the dates included in the following table. SFY Paid Through 2004 03/31/05 2005 12/31/05 The value of the claims incurred during each of these years, but unpaid, was estimated using completion factor analysis. Gross Adjustment File (GAF) To account for gross debit and credit amounts not reflected in the FFS data, adjustments were applied to the FFS paid claims. Historical Policy Changes As part of the rate-setting process, Xxxxxx must account for policy changes that occurred during the base data time period. Changes only reflected in a portion of the data must be applied to the remaining data so that all base data reflects the policy changes. All policy changes implemented during SFY 2004 and SFY 2005 were applied to the FFS data. The following table shows the specific policy changes for which Xxxxxx adjusted the SFY 2004 and SFY 2005 delivery (where applicable) and non-delivery data. Xxxxxx calculated the adjustments based on information supplied by the State.

Certification of Final Rates. The following capitation rates were developed for each of the seven regions for the CY 2007 contract period: • Healthy Families/Healthy Start, Less Than 1, Male & Female, " Healthy Families/Healthy Start, 1 Year Old, Male & Female, • Healthy Families/Healthy Start, 2-13 Years Old, Male & Female, " Healthy Families/Healthy Start, 14-18 Years Old, Female, • Healthy Families/Healthy Start, 14-18 Years Old, Male, " Healthy Families, 19-44 Years Old, Female, " Healthy Families, 19-44 Years Old, Male, • Healthy Families, 45 and Over, Male & Female, • Healthy Start, 19-64 Years Old, Female, and • Delivery Payment. A summary of the rates is included in Appendix X. Xxxxxx certifies the above rates were developed in accordance with generally accepted actuarial practices and principles by actuaries meeting the qualification standards of the American Academy of Actuaries for the populations and services covered under the managed care contract. Rates developed by Mercer are actuarial projections of future contingent events. Actual MCP costs will differ from these projections. Mercer developed these rates on behalf of the State to demonstrate compliance with the CMS requirements under 42 CFR 438.6(c) and to demonstrate that rates are in accordance with applicable law and regulations. MCPs are advised that the use of these rates may not be appropriate for their particular circumstance and Mercer disclaims any responsibility for the use of these rates by MCPs for any purpose. Mercer recommends any MCP considering contracting with the State should analyze its own projected medical expense, administrative expense, and any other premium needs for comparison to these rates before deciding whether to contract with the State. Use of these rates for purposes beyond those stated may not be appropriate. MERCER Government Human Services Consulting October 20, 2006 Xx. Xxx Xxxxxx Ohio Department of Job and Family Services Sincerely, /s/ Xxxxxx XxxXxxx Xxxxxx XxxXxxx, MAAA, ASA /s/ Xxxxx Xxxxxx Xxxxx Xxxxxx, MAAA, FSA Copy: Xxxxx Xxxxxx, Xxxxxx Xxxxxx, Xxxxx Xxxxxxxx - State of Ohio Xxxxx Xxxxxx, Xxx Xxxxxxxxx - Xxxxxx MMC Xxxxx & McLennan Companies MERCER Government Human Services Consulting Appendix A - CY 2007 Rate-Setting Methodology [Chart] MERCER Government Human Services Consulting Appendix B - Regional Delivery System Definition Regional Delivery System Definitions For regional rate development, counties were bucketed into mandatory. Preferred Option, voluntary, or new as outlined below. The data for all counties within the region was used to develop the regional rate. Please see page B-2 for a map defining the counties within each region. Mandatory and Preferred Option Counties Encounter and cost report data was used for counties that were either mandatory or Preferred Option during the base data period*. These counties include: Mandatory: Preferred Option: Cuyahoga Xxxxxx Xxxxx Xxxxx Xxxxx Xxxxxxxx Summit Xxxxxxxx Xxxxxx Xxxxxxxxxx * Please note Mahoning and Trumbull are not included in the above table due to a lack of credible data. Both counties entered into managed care in October of 2005. Voluntary Counties FFS data was used for voluntary counties during the base period and new counties entering the managed care program since the time of the base data. The voluntary counties include: Voluntary: Clermont Xxxxxx Pickaway Xxxxxx Xxxx New counties include all counties that were not mandatory. Preferred Option or voluntary during the base data period. MERCER Government Human Services Consulting [Medicaid Managed Care Program Regions for the CFC Population Map] MERCER Government Human Services Consulting Appendix C - FFS Data Adjustments This section lists adjustments made to the FFS claims and eligibility information received from the State. Completion Factors SFY Paid Through 2004 03/31/05 2005 12/31/05 The claims data was adjusted to account for the value of claims incurred but unpaid on a COS basis. Mercer used claims for SFY 2004 and SPY 2005 that reflect payments through the dates included in the following table. The value of the claims incurred during each of these years, but unpaid, was estimated using completion factor analysis. Gross Adjustment File (GAF) To account for gross debit and credit amounts not reflected in the FFS data, adjustments were applied to the FFS paid claims. Historical Policy Changes As part of the rate-setting process, Mercer must account for policy changes that occurred during the base data time period. Changes only reflected in a portion of the data must be applied to the remaining data so that all base data reflects the policy changes. All policy changes implemented during SFY 2004 and SFY 2005 were applied to the FFS data. The following table shows the specific policy changes for which Mercer adjusted the SFY 2004 and SFY 2005 delivery (where applicable) and non-delivery data. Mercer calculated the adjustments based on information supplied by the State.