DATA ADJUSTMENTS. Capitation rates were developed from a blending of historical calendar year 2014 encounter and cost report data. Adjustments were made to the base experience for data credibility, completion, reimbursement changes, and other program adjustments.
DATA ADJUSTMENTS. Should the MPF Provider make any adjustments to the data pertaining to any of the MPF Xtra Mortgages, such adjustments shall be the responsibility of the PFI just as the PFI would be responsible for adjustments made for Mortgages held by the Bank.
DATA ADJUSTMENTS. The CY 2019 Opt-In capitation rates were developed from the projected benefit expenses underlying the Opt-Out capitation rates (baseline Medicaid data). The baseline Medicaid data was adjusted for the following factors: • Selection adjustments • Application of non-benefit expenses • Application of 4% joint savings as required under demonstration year 5 Selection The baseline Medicaid data was adjusted using selection factors to reflect the estimated health status and corresponding utilization of the Opt-In population relative to the Opt-Out population. The selection factors are consistent with those used in the Original certification III. Non-Benefit Expenses CARE MANAGEMENT AND ADMINISTRATIVE EXPENSE COST ALLOWANCE Care management and administrative expenses have been calculated by rate cell and region for the baseline Medicaid data, and are applied as PMPMs consistent with the PMPMs associated with the baseline Medicaid data. Refer to the Opt-Out rate certification for additional information related to the development of the care management and administrative expenses. The provision for margin includes items such as cost of capital, risk mitigation, contingency, underwriting gain, and profit. Consistent with the Original certification, we applied a 3% margin to the Opt-In capitation rates.
DATA ADJUSTMENTS. Capitation rates were developed from CY 2015 program-wide Opt-In and Opt-Out cost report data with claims runout through March 31, 2016. The base data year adjustments include claims completion adjustments, regional smoothing adjustments, opt-in/opt-out selection adjustments, retrospective program adjustments, and other program adjustments.
DATA ADJUSTMENTS. Capitation rates were developed from historical FFS data, incurred from May 1, 2013 to April 30, 2014, and paid through August 31, 2015. The primary base data year adjustments include completion adjustments, reimbursement adjustments, and other program adjustments.
