Common use of Disability Risk Adjusted Payment System Clause in Contracts

Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see xxxx://xxxx.xxxx.xxx/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees. (A) Risk Adjustment Overview (1) Appendix 2 contains the capitation rates used to calculate the Calendar Year risk adjusted payments to the MCO. The risk adjustment weights are found in Appendix 3. (2) The STATE or its actuarial vendor will use, for Contract Year SNBC risk scores, a prospective risk adjustment model. The average risk score across all MCOs will be normalized to 1.0 for each rate cell. (B) Development of Weights. The risk adjustment method utilizes two sets of weights, one for Medical Assistance only (non-Dual Eligible) Enrollees, and one for Dual Eligible Enrollees. These two models include disease categories and risk factor weights customized separately for non-Dual Eligible and Dual Eligible experience. The weights were developed using constrained linear regression and were based upon the Calendar Years (CYs) 2012 and 2013 experience of individuals enrolled in the SNBC program. Risk factor weights were constrained to be non-negative. The model includes: 1) demographic information; 2) diagnoses from health care claims for services provided to individuals during CY 2012; 3) costs from health care claims for services provided to individuals during CY 2013; and 4) developmental disability (DD) waiver status.

Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see xxxx://xxxx.xxxx.xxx/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees. (A) Enrollees.‌ Risk Adjustment Overview (1) Overview Appendix 2 contains the capitation rates used to calculate the Calendar Year risk adjusted payments to the MCO. The risk adjustment weights are found in Appendix 3. (2) . The STATE or its actuarial vendor will use, for Contract Year SNBC risk scores, a prospective risk adjustment model. The average risk score across all MCOs will be normalized to 1.0 for each rate cell. (B) . Development of Weights. The risk adjustment method utilizes two sets of weights, one for Medical Assistance only (non-Dual Eligible) Enrollees, and one for Dual Eligible Enrollees. These two models include disease categories and risk factor weights customized separately for non-Dual Eligible and Dual Eligible experience. The weights were developed using constrained linear regression and were based upon the Calendar Years (CYs) 2012 2014 and 2013 2015 experience of individuals enrolled in the SNBC program. Risk factor weights were constrained to be non-negative. The model includes: 1) demographic information; 2) diagnoses from health care claims for services provided to individuals during CY 20122014; 3) costs from health care claims for services provided to individuals during CY 20132015; and 4) developmental disability (DD) waiver status.. Base Rates. Based on 2014 health plan experience, the STATE calculated base rates based on the following factors: Dual and non-Dual status, institutional (NF, ICF, ICF/DD) and community status, and rate region (Metro, Non-metro North, or Non- metro South as designated in Appendix 3-B). The STATE agrees not to rebase the base rates for risk adjustment during the term of this Contract. Base rates are provided in Appendix 2. Methodology The MCO will receive an SNBC risk score for each rate cell subject to risk adjustment, based on average risk scores across all the MCO’s Enrollees in that rate cell and enrolled in the MCO during the exposure month in 4.2.6(E)(1)(b) and 4.2.6(E)(2)(b) below. New Enrollees. Each MCO Enrollee with no FFS claim experience or managed care encounters in the assessment period will be assigned a risk score equal to the average risk score for the MCO’s Enrollees in the same rate cell. Enrollees with Claims Experience. Enrollees with at least one FFS claim or managed care encounter during the assessment period will be assigned one risk score. Minnesota-specific weights will be used to determine an Enrollee’s risk score. Individual risk scores for MCO Enrollees will be aggregated by rate cell into MCO aggregate risk scores (normalized to 1.0 for each rate cell). These risk scores will be applied to the appropriate capitation rate for the Contract Year. MCO aggregate risk scores will be set no lower than 0.900 and no higher than

Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see xxxx://xxxx.xxxx.xxx/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees. (A) Enrollees.‌ Risk Adjustment Overview (1) Appendix 2 contains the capitation rates used to calculate the Calendar Year risk adjusted payments to the MCO. The risk adjustment weights are found in Appendix 3. (2) The STATE or its actuarial vendor will use, for Contract Year SNBC risk scores, a prospective risk adjustment model. The average risk score across all MCOs will be normalized to 1.0 for each rate cell. (B) . Development of Weights. The risk adjustment method utilizes two sets of weights, one for Medical Assistance only (non-Dual Eligible) Enrollees, and one for Dual Eligible Enrollees. These two models include disease categories and risk factor weights customized separately for non-Dual Eligible and Dual Eligible experience. The weights were developed using constrained linear regression and were based upon the Calendar Years (CYs) 2012 and 2013 experience of individuals enrolled in the SNBC program. Risk factor weights were constrained to be non-negative. The model includes: 1) demographic information; 2) diagnoses from health care claims for services provided to individuals during CY 2012; 3) costs from health care claims for services provided to individuals during CY 2013; and 4) developmental disability (DD) waiver status.. Base Rates. Based on 2014 health plan experience, the STATE calculated base rates based on the following factors: Dual and non-Dual status, institutional (NF, ICF, ICF/DD) and community status, and rate region (Metro, Non-metro North, or Non- metro South). The STATE agrees not to rebase the base rates for risk adjustment during the term of this Contract. Base rates are provided in Appendix 2. Methodology (1) The MCO will receive an SNBC risk score for each rate cell subject to risk adjustment, based on average risk scores across all the MCO’s Enrollees in that rate cell and enrolled in the MCO during the exposure month in 4.2.6(F)(1)(b) and

Disability Risk Adjusted Payment System. The STATE agrees to apply risk adjustment of capitation rates using the Chronic Disability Payment System (CDPS; see xxxx://xxxx.xxxx.xxx/) and the Medicaid Rx risk adjustment model (collectively, “CDPS+Rx”) with Minnesota-specific custom weights to calculate risk scores. Custom weights are developed separately for Dual Eligible Enrollees and for Medical Assistance only (non-Dual Eligible) Enrollees. (A) . Risk Adjustment Overview (1) Appendix 2 contains the capitation rates used to calculate the Calendar Year risk adjusted payments to the MCO. The risk adjustment weights are found in Appendix 3. (2) The STATE or its actuarial vendor will use, for Contract Year SNBC risk scores, a prospective risk adjustment model. The average risk score across all MCOs will be normalized to 1.0 for each rate cell. (B) . Development of Weights. The risk adjustment method utilizes two sets of weights, one for Medical Assistance only (non-Dual Eligible) Enrollees, and one for Dual Eligible Enrollees. These two models include disease categories and risk factor weights customized separately for non-Dual Eligible and Dual Eligible experience. The weights were developed using constrained linear regression and were based upon the Calendar Years (CYs) 2012 and 2013 experience of individuals enrolled in the SNBC program. Risk factor weights were constrained to be non-negative. The model includes: 1) demographic information; 2) diagnoses from health care claims for services provided to individuals during CY 2012; 3) costs from health care claims for services provided to individuals during CY 2013; and 4) developmental disability (DD) waiver status.. Base Rates. Based on 2014 health plan experience, the STATE calculated base rates based on the following factors: Dual and non-Dual status, institutional (NF, ICF, ICF/DD) and community status, and rate region (Metro, Non-metro North, or Non- metro South as designated in Appendix 3-B). The STATE agrees not to rebase the base rates for risk adjustment during the term of this Contract. Base rates are provided in Appendix 2. Methodology (1) The MCO will receive an SNBC risk score for each rate cell subject to risk adjustment, based on average risk scores across all the MCO’s Enrollees in that rate cell and enrolled in the MCO during the exposure month in 4.2.6(F)(1)(b) and