DESCRIPTION OF KEY ASSUMPTION. Adjustments for pent-up demand – Consistent with the CY 2018 rate setting, it was assumed that the baseline experience data did not require these adjustments. Adjustment for adverse selection – Consistent with the CY 2018 rate setting, it was assumed that the baseline experience data did not require these adjustments. Adjustment for demographics of the new adult group – The current rate cell structure of the Extension population appropriately adjusts capitation payments to the MCPs to the extent the demographic mix of the Extension population changes significantly during the CY 2019 rate period. Differences in provider reimbursement rates or provider networks – MCPs were required to report provider reimbursement relative to ODM’s reimbursement schedule by population group (CFC, ABD <21, ABD 21+, Extension, and AFK) and major service category in the 2017 MCP Survey. Additionally, we received re-priced inpatient and outpatient claims experience from ODM that allowed us to evaluate MCP hospital reimbursement relative to ODM’s reimbursement schedule. We are not aware of any provider network differences between the Extension population and other Medicaid populations. Variations in assumptions by covered population were not based on the rate of Federal financial participation associated with the population.
