INCENTIVES AND WITHHOLDS. Quality Incentive withholds constitute 3% of the certified rates and are consistent with the Original certification. The certified rates illustrated in this certification represent the full Medicaid rates prior to the application of the withhold.
INCENTIVES AND WITHHOLDS i. Withholds There are no provisions for withholds in the CY 2017 capitation payments.
INCENTIVES AND WITHHOLDS. Effective April 1, 2018, ODM implemented a quality withhold arrangement for the MMC program. The withhold arrangement is measured on a calendar year basis and is consistent with description provided under the Original certification. MEDICAL LOSS RATIO ODM’s provider agreement indicates that ODM will perform medical loss ratio (MLR) calculations for the MMC program, which includes the ABD, CFC, AFK, and Extension populations. ODM is implementing a minimum MLR requirement of 86% for the MMC program. ODM will require remittance in the event a MCP reports a MLR below 86%. The MLR requirement will be implemented for the CY 2019 rating period of January 1, 2019, through December 31, 2019. This represents a change from information included in the Original certification, at which point there were no anticipated financial consequences associated with MLR requirements.
INCENTIVES AND WITHHOLDS i. Withholds Withholds constitute 3% of the certified rates.
INCENTIVES AND WITHHOLDS i. Incentives Incentive payments under this plan are below 105% of the certified rates paid under the contract, as pay-for-performance payments are 1.5% in aggregate. Note, the MCP/Hospital Incentive program is a provider pass-through payment, not an incentive program that potentially provides additional funding to contracted MCPs.
INCENTIVES AND WITHHOLDS. Effective April 1, 2018, ODM implemented a quality withhold arrangement for the MMC program. The withhold arrangement is measured on a calendar year basis. ODM is evaluating the withhold measures in the context of the COVID-19 pandemic and will apply adjustments as appropriate. Based on our discussions with ODM related to this process, we believe that the withhold will remain reasonably achievable by the MCPs. MEDICAL LOSS RATIO The capitation rates were developed such that the MCPs are reasonably expected to achieve a medical loss ratio greater than 85 percent, which includes provisions for non-benefit costs that are appropriate and attainable. ODM’s provider agreement indicates that ODM will perform medical loss ratio (MLR) calculations for the MMC program. ODM has implemented a minimum MLR requirement of 86% for the MMC program. ODM will require remittance in the event an MCP reports an MLR below 86%.
INCENTIVES AND WITHHOLDS
