Common use of Incorporate non-claims items and adjustments Clause in Contracts

Incorporate non-claims items and adjustments. The adjusted claims cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Administrative expense allowances were updated in recognition of program adjustments effective July 1, 2020. In addition, the Health Insuring Corporation (HIC) Franchise Fee amounts were developed by MyCare Ohio plan (MCOP) based on projected Medicaid member months, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment to the CY 2020 capitation rates reflects HIC Franchise Fee amounts applicable from July through December 2020. No other changes were made to non-claims assumptions from the values included in the Original certification.

Incorporate non-claims items and adjustments. The adjusted claims claim cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Administrative expense Care management allowances were updated in recognition of program adjustments effective July 1, 20202019, including additional HUB contracting requirements. In addition, the Health Insuring Corporation (HIC) Franchise Fee amounts were developed by MyCare Ohio managed care plan (MCOPMCP) based on projected Medicaid member months, and then weighted based on regional enrollment by MCOPMCP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment to the CY 2020 2019 capitation rates reflects HIC Franchise Fee amounts applicable from to July through December 20202019. No other changes were made to non-claims assumptions from the values included in the Original certification.

Incorporate non-claims items and adjustments. The adjusted claims cost is modified to include the impact of certain non-benefit items, such as an administrative allowance. Administrative expense allowances were updated in recognition of program adjustments effective July 1, 20202019. In addition, the Health Insuring Corporation (HIC) Franchise Fee amounts were developed by MyCare Ohio plan (MCOP) based on projected Medicaid member months, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, this amendment to the CY 2020 2019 capitation rates reflects HIC Franchise Fee amounts applicable from July through December 20202019. No other changes were made to non-claims assumptions from the values included in the Original certification.