Historical Data Summaries Sample Clauses

Historical Data Summaries. The CY 2008 ABD capitation rates were developed using FFS claims for two state fiscal year (SFY) periods: § SFY 2005 (Incurred during the 12 months ending June 30, 2005 paid through May 31, 2007). § SFY 2006 (Incurred during the 12 months ending June 30, 2006 paid through May 31, 2007). The claims data was provided by ODJFS from the data warehouse. The experience was stratified into geographic region based on the member’s county of residence. The reimbursement amounts captured on the FFS actuarial models reflect the amount paid by ODJFS, net of third party liability recoveries and member co-payment amounts. The reimbursement amounts have not been adjusted for payments made outside the claims processing system. These amounts are discussed later in the documentation. The FFS historical experience was adjusted to include only those services that are included in the capitation payment. Services that are not covered under the capitation payment have been excluded from the experience. The excluded services were identified by the state-assigned Category of Service field, as shown in Table 3. Milliman makes no representations or warranties regarding the contents of this letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this letter prepared for ODJFS by Milliman that would result in the creation of any duty or liability under any theory of law by Milliman or its employees to third parties. Other parties receiving this letter must rely upon their own experts in drawing conclusions about the information presented. FINAL and CONFIDENTIAL Table 3 STATE OF OHIO DEPARTMENT OF JOB AND FAMILY SERVICES FFS Claim Exclusions COS Field Value Description 08 PACE 13 ICF/MR Public 18 ICF/MR Private 35 Core Services 36 Home Care Facilitator Services 41 Mental Health Services 42 Mental Retardation 46 Model 50 Waiver Services 58 HMO Services 59 Mental Health Support Services 60 Mental Retardation Support Services 63 PPO Services 64 Passport 66 Passport Waiver III 67 OBRA MR/DD Waiver 80 Alcohol and Drug Abuse 82 Department of Education 84 ODADAS