Completion for Additional Claims. Run Out The base data includes claims incurred during CY 2012 and paid through June 2013. Xxxxxx analyzed the completeness by rating region and category of service (COS) in order to make the appropriate adjustments to the base data for claims incurred but not paid. Historical Program Changes In order to structure the historical claims data base appropriately, Xxxxxx reviewed prior rate setting documentation and other materials from the State to identify program changes that were implemented during the base data period. No mid-year adjustments were made in CY 2012 that materially impacted the ABD <21. Therefore, no historical program changes were made. ENCLOSURE 3 Projected Cost Development The adjusted base data (described in Enclosure 2) was brought forward to the contract period. The adjustments used to produce the projected costs are described within this section and listed below: • Impact of Medicaid Expansion/Those Eligible But Not Enrolled (EBNE). • Prospective Program Changes. • Trend.
Completion for Additional Claims. Run Out The base data includes plan-reported claims, including incurred but not paid (IBNP) estimates, incurred in CY 2012 as reported in the CY 2012 cost reports. The plan-reported total incurred claims were adjustments based on supplemental IBNP information from the second quarter CY 2013 National Association of Insurance Commissioners financial statements. Addition for Certain Expenditures Not Included in the Data Similar to past years, plan reported non-emergent transportation and nursing facility (NF) (ABD 21+) expenditures from the cost reports were used to estimate the proportion of encounters that are attributable to these respective services. Application of Historical Program Changes In order to structure the historical base data appropriately, Xxxxxx reviewed prior rate-setting documentation and other materials from the State to identify program changes that were implemented during the base data period. To place the entire base period on a consistent basis, adjustments were made to the portion of the base data prior to the implementation of the program change.
