Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an amendment to the certified calendar year (CY) 2021 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendices, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs for this purpose and accepted it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purpose. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 $ 999.86 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.
Appears in 2 contracts
Samples: Provider Agreement, Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an amendment to the certified calendar year (CY) 2021 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the existing participating Medicaid MCPs MyCare Ohio Plans (MCOPs) for this purpose and accepted it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purpose. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 CY 2021 PA Capitation Rate Amendment Summary – MyCare Ohio Opt-Out July 27, 2021 ODM01-94 NFLOC 24,095 $ 999.86 4,020.51 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 3,929.70 (2.3%) HF/HST 2Community Well 18-13 M+F 49,838 194.74 192.69 44 5,262 292.61 292.91 0.1% Community Well 45-64 12,448 336.70 336.73 0.0% Community Well 65+ 11,949 405.27 405.07 (1.10.0%) HF/HST 14NFLOC 2,523 $ 4,581.06 $ 4,535.74 (1.0%) Community Well 18-18 M 8,846 230.65 230.14 44 673 335.35 335.93 0.2% Community Well 45-64 1,517 426.02 426.39 0.1% Community Well 65+ 1,638 521.78 521.32 (0.1%) NFLOC 4,313 $ 3,633.36 $ 3,547.37 (2.4%) Community Well 18-44 728 255.52 256.58 0.4% Community Well 45-64 1,763 303.68 303.80 0.0% Community Well 65+ 1,587 405.74 405.80 0.0% NFLOC 6,506 $ 4,164.32 $ 4,111.87 (1.3%) Community Well 18-44 1,326 287.18 287.46 0.1% Community Well 45-64 3,126 334.82 335.24 0.1% Community Well 65+ 3,859 410.85 410.89 0.0% NFLOC 1,478 $ 3,575.27 $ 3,449.73 (3.5%) Community Well 18-44 492 244.10 244.79 0.3% Community Well 45-64 1,112 276.22 276.05 (0.1%) Community Well 65+ 970 334.78 334.48 (0.1%) NFLOC 1,327 $ 3,939.85 $ 3,844.25 (2.4%) Community Well 18-44 474 325.47 325.12 (0.1%) Community Well 45-64 1,142 330.89 330.54 (0.1%) Community Well 65+ 824 291.37 290.89 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19NFLOC 4,264 $ 4,546.61 $ 4,395.59 (3.3%) Community Well 18-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 926 301.38 301.31 (0.0%) Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 2,158 346.06 345.69 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19Community Well 65+ 1,856 421.95 421.31 (0.2%) NFLOC 3,684 $ 3,434.68 $ 3,324.67 (3.2%) Community Well 18-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 643 301.37 301.26 (0.0%) Community Well 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 1,630 325.80 325.63 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 Community Well 65+ 1,215 337.93 337.91 (0.50.0%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1NFLOC 24,095 $ 3,929.70 $ 4,105.92 4.5% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19Community Well 18-44 M 23,665 349.19 356.00 5,262 292.91 298.16 1.8% Community Well 45-64 12,448 336.73 344.62 2.3% Community Well 65+ 11,949 405.07 421.36 4.0% NFLOC 2,523 $ 4,535.74 $ 4,666.57 2.9% Community Well 18-44 673 335.93 342.43 1.9% Community Well 45-64 1,517 426.39 435.35 2.1% Community Well 65+ 1,638 521.32 538.08 3.2% NFLOC 4,313 $ 3,547.37 $ 3,715.48 4.7% Community Well 18-44 728 256.58 261.31 1.8% Community Well 45-64 1,763 303.80 312.53 2.9% Community Well 65+ 1,587 405.80 427.43 5.3% NFLOC 6,506 $ 4,111.87 $ 4,274.59 4.0% Community Well 18-44 1,326 287.46 291.46 1.4% Community Well 45-64 3,126 335.24 341.72 1.9% Community Well 65+ 3,859 410.89 425.39 3.5% NFLOC 1,478 $ 3,449.73 $ 3,580.11 3.8% Community Well 18-44 492 244.79 248.68 1.6% Community Well 45-64 1,112 276.05 281.59 2.0% HF 19Community Well 65+ 970 334.48 345.47 3.3% NFLOC 1,327 $ 3,844.25 $ 4,069.23 5.9% Community Well 18-44 F 71,281 563.74 580.36 2.9474 325.12 330.85 1.8% HF Community Well 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.81,142 330.54 336.76 1.9% EXT 19Community Well 65+ 824 290.89 299.75 3.0% NFLOC 4,264 $ 4,395.59 $ 4,641.71 5.6% Community Well 18-34 M 33,504 44 926 301.31 308.27 2.3% Community Well 45-64 2,158 345.69 356.73 3.2% Community Well 65+ 1,856 421.31 444.49 5.5% NFLOC 3,684 $ 601.51 3,324.67 $ 615.92 2.43,485.18 4.8% EXT 19Community Well 18-34 F 29,214 603.11 616.40 44 643 301.26 306.60 1.8% Community Well 45-64 1,630 325.63 332.89 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21Community Well 65+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 1,215 337.91 350.99 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% Milliman is among the world’s largest providers of actuarial and related products and services. The following are firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollmentglobe. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.xxxxxxxx.xxx
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2022 amendment to the certified calendar year (CY) 2021 2022 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the existing participating Medicaid MCPs MyCare Ohio Plans (MCOPs) for this purpose and accepted it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purpose. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 27,619 $ 999.86 3,815.78 $ 1,004.70 0.53,945.33 3.4% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.114,578 310.59 317.00 2.1% HF 19Community Well 45-64 20,910 395.79 404.08 2.1% Community Well 65+ 20,201 406.66 419.21 3.1% NFLOC 4,719 $ 4,472.67 $ 4,595.93 2.8% Community Well 18-44 F 24,684 527.73 537.14 2,071 367.04 375.24 2.2% Community Well 45-64 2,945 508.59 519.05 2.1% Community Well 65+ 3,642 551.27 566.81 2.8% NFLOC 4,310 $ 3,335.81 $ 3,439.47 3.1% Community Well 18-44 1,811 268.68 274.87 2.3% Community Well 45-64 2,468 346.45 354.43 2.3% Community Well 65+ 2,176 375.69 386.58 2.9% NFLOC 6,362 $ 3,938.18 $ 4,055.41 3.0% Community Well 18-44 3,933 300.83 305.99 1.7% Community Well 45-64 5,586 386.32 393.44 1.8% HF Community Well 65+ 6,020 386.81 398.42 3.0% NFLOC 2,356 $ 3,380.67 $ 3,537.93 4.7% Community Well 18-44 1,219 255.27 259.99 1.8% Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 1,911 325.54 332.76 2.2% Community Well 65+ 1,696 338.37 349.83 3.4% NFLOC 2,377 $ 3,770.46 $ 3,952.26 4.8% Community Well 18-44 1,500 328.15 333.49 1.6% Community Well 45-64 2,504 380.02 385.97 1.6% Community Well 65+ 1,818 310.19 318.93 2.8% EXT 19-34 M 11,813 NFLOC 4,509 $ 582.92 3,948.37 $ 591.19 1.44,103.23 3.9% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35Community Well 18-44 M 5,909 865.18 878.33 1.52,568 331.01 339.66 2.6% EXT 35Community Well 45-64 3,484 418.91 430.74 2.8% Community Well 65+ 3,237 426.88 443.54 3.9% NFLOC 2,986 $ 3,388.83 $ 3,490.24 3.0% Community Well 18-44 F 4,531 912.74 928.83 1,476 301.14 307.26 2.0% Community Well 45-64 2,012 363.84 370.38 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21Community Well 65+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 1,612 335.87 344.66 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. xxxxxxxx.xxx MILLIMAN CLIENT REPORT July 2022 MyCare Ohio Capitation Provider Agreement Rate Amendment Summary Opt-64 F 7,148 551.47 569.97 3.4% EXT 19Out Capitation Rates June 13, 2022 Xxxxxx X. Xxxxxx, FSA, MAAA Xxxxx X. Xxxxx, FSA, MAAA Principal and Consulting Actuary Consulting Actuary Xxxxxxx X. Xxxxxx, FSA, MAAA Principal and Consulting Actuary Table of Contents BACKGROUND 1 SUMMARY OF METHODOLOGY 2 PROGRAM ADJUSTMENTS: JULY THROUGH DECEMBER 2022 3 CARE MANAGEMENT COSTS 4 ADMINISTRATIVE EXPENSE COST ALLOWANCE 4 STATE TAXES AND FEES 4 WITHHOLDS 5 INCENTIVES 5 XXXX XXXXXXX XXXXXXXXXX 0 July 2022 PA Capitation Rate Amendment – MyCare Ohio Opt-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon requestOut June 13, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.2022
I. Introduction & Executive Summary
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2019 amendment to the certified calendar year (CY) 2021 2019 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2019 amendment to the certified CY 2019 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 19,898 $ 999.86 3,991.69 $ 1,004.70 0.54,076.09 2.1% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 4,113 351.16 $ 356.34 1.5% Community Well 45-64 8,727 402.14 $ 408.90 1.7% Community Well 65+ 7,739 533.22 $ 545.65 2.3% NFLOC 2,228 $ 4,412.37 $ 4,495.10 1.9% Community Well 18-44 524 418.89 423.94 1.2% Community Well 45-64 1,050 525.81 532.04 1.2% Community Well 65+ 1,048 750.48 762.84 1.6% NFLOC 3,246 $ 3,621.70 $ 3,710.99 2.5% Community Well 18-44 570 334.29 340.08 1.7% Community Well 45-64 1,239 413.06 422.57 2.3% Community Well 65+ 1,023 562.80 580.86 3.2% NFLOC 5,220 $ 4,274.13 $ 4,343.90 1.6% Community Well 18-44 973 360.51 365.25 1.3% Community Well 45-64 2,147 408.29 414.26 1.5% Community Well 65+ 2,473 473.90 483.19 2.0% NFLOC 1,158 $ 3,803.53 $ 3,901.20 2.6% Community Well 18-44 386 312.63 317.05 1.4% Community Well 45-64 734 366.58 373.03 1.8% Community Well 65+ 603 555.23 570.06 2.7% NFLOC 1,190 $ 3,997.92 $ 4,049.17 1.3% Community Well 18-44 383 398.84 403.29 1.1% HF 19Community Well 45-64 756 402.86 407.40 1.1% Community Well 65+ 535 412.77 419.05 1.5% NFLOC 3,617 $ 4,256.08 $ 4,361.03 2.5% Community Well 18-44 F 24,684 527.73 537.14 1.8763 321.73 326.72 1.6% HF Community Well 45+ M+F 3,791 764.60 777.49 -64 1,565 376.75 383.29 1.7% HST 19Community Well 65+ 1,271 521.08 532.80 2.2% NFLOC 3,239 $ 3,387.69 $ 3,476.37 2.6% Community Well 18-44 514 320.24 327.11 2.1% Community Well 45-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 1,236 328.29 335.90 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21Community Well 65+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 786 476.42 495.00 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% Milliman is among the world’s largest providers of actuarial and related products and services. 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Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2018 amendment to the certified calendar year (CY) 2021 2018 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this reportletter, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report letter will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report letter prepared for ODM 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 report letter must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2018 amendment to the certified CY 2018 capitation rates capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 2,097 $ 999.86 4,614.29 $ 1,004.70 4,625.28 0.2% Community Well 18-44 403 601.42 604.50 0.5% HF/HST 1 M+F 4,570 206.06 201.25 Community Well 45-64 788 691.93 695.80 0.6% Community Well 65+ 905 934.51 941.97 0.8% NFLOC 2,617 $ 3,465.55 $ 3,471.45 0.2% Community Well 18-44 403 358.02 362.16 1.2% Community Well 45-64 936 444.41 448.87 1.0% Community Well 65+ 787 738.89 744.84 0.8% NFLOC 4,405 $ 3,971.26 $ 3,979.24 0.2% Community Well 18-44 616 368.58 372.76 1.1% Community Well 45-64 1,474 461.45 465.97 1.0% Community Well 65+ 1,824 777.79 783.89 0.8% NFLOC 968 $ 3,911.36 $ 3,932.01 0.5% Community Well 18-44 280 329.60 333.42 1.2% Community Well 45-64 517 423.49 427.54 1.0% Community Well 65+ 446 771.98 777.11 0.7% NFLOC 1,196 $ 4,160.54 $ 4,169.34 0.2% Community Well 18-44 298 443.58 440.82 (2.30.6%) HF/HST 2Community Well 45-13 M+F 49,838 194.74 192.69 64 508 538.16 536.11 (1.10.4%) HF/HST 14-18 M 8,846 230.65 230.14 Community Well 65+ 404 861.59 864.37 0.3% NFLOC 3,466 $ 4,503.63 $ 4,494.64 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.1598 355.22 357.58 0.7% HF 19-44 F 24,684 527.73 537.14 1.8% HF Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.81,220 470.93 472.88 0.4% EXT 19-34 M 11,813 Community Well 65+ 1,023 918.81 922.18 0.4% NFLOC 3,083 $ 582.92 3,406.61 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 3,401.48 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19Community Well 18-44 M 9,424 361.81 368.52 1.9432 360.89 366.91 1.7% HF 19Community Well 45-64 976 439.15 444.56 1.2% Community Well 65+ 627 684.87 687.57 0.4% NFLOC 17,832 $ 3,987.96 $ 3,991.16 0.1% Community Well 18-44 F 25,116 514.02 527.35 2.63,030 398.18 401.40 0.8% HF Community Well 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.96,419 488.68 492.20 0.7% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21Community Well 65+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 6,016 815.77 820.94 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP MCOP’s responsibilities related to communicating with eligible individuals pre-enrollment and MCP MCOP members post-enrollment. Upon request, the MCP shall MCOP will provide both members and eligible individuals with a copy of their practice guidelines.
1. The MyCare Ohio logo shall be on all member communications and marketing materials, excluding nominal gifts.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an amendment to the certified calendar year (CY) 2021 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the existing participating Medicaid MCPs MyCare Ohio Plans (MCOPs) for this purpose and accepted it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purpose. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 CY 2021 PA Capitation Rate Amendment Summary – MyCare Ohio Opt-In July 27, 2021 ODM01-94 NFLOC 29,698 $ 999.86 3,769.24 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 3,745.45 (2.30.6%) HF/HST 2Community Well 18-13 M+F 49,838 194.74 192.69 44 14,589 302.94 303.19 0.1% Community Well 45-64 22,574 390.14 390.19 0.0% Community Well 65+ 20,720 407.01 406.71 (0.1%) NFLOC 4,837 $ 4,384.53 $ 4,377.03 (0.2%) Community Well 18-44 2,038 348.02 347.95 (0.0%) Community Well 45-64 3,174 489.55 489.33 (0.0%) Community Well 65+ 3,586 539.01 538.49 (0.1%) NFLOC 4,930 $ 3,319.81 $ 3,310.25 (0.3%) Community Well 18-44 1,851 264.35 264.92 0.2% Community Well 45-64 2,684 346.27 346.41 0.0% Community Well 65+ 2,260 385.59 385.37 (0.1%) NFLOC 6,894 $ 3,957.68 $ 3,914.82 (1.1%) HF/HST 14Community Well 18-18 M 8,846 230.65 230.14 44 4,026 297.47 297.91 0.1% Community Well 45-64 6,166 386.32 386.56 0.1% Community Well 65+ 6,481 397.67 397.75 0.0% NFLOC 2,542 $ 3,428.88 $ 3,425.66 (0.1%) Community Well 18-44 1,220 252.10 252.63 0.2% Community Well 45-64 2,059 325.38 325.56 0.1% Community Well 65+ 1,731 342.13 341.45 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1NFLOC 2,524 $ 3,609.15 $ 3,624.90 0.4% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 1,492 326.66 326.07 (0.2%) Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 2,550 377.60 377.22 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45Community Well 65+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 1,794 310.94 310.42 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6NFLOC 4,699 $ 3,904.82 $ 3,914.01 0.2% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19Community Well 18-44 M 9,424 361.81 368.52 2,569 315.28 315.36 0.0% Community Well 45-64 3,811 401.98 401.96 (0.0%) Community Well 65+ 3,226 416.37 415.68 (0.2%) NFLOC 3,272 $ 3,333.03 $ 3,209.98 (3.7%) Community Well 18-44 1,393 300.42 301.11 0.2% Community Well 45-64 2,130 364.81 365.04 0.1% Community Well 65+ 1,642 339.99 340.03 0.0% NFLOC 29,698 $ 3,745.45 $ 3,890.41 3.9% Community Well 18-44 14,589 303.19 308.36 1.7% Community Well 45-64 22,574 390.19 397.23 1.8% Community Well 65+ 20,720 406.71 419.70 3.2% NFLOC 4,837 $ 4,377.03 $ 4,497.85 2.8% Community Well 18-44 2,038 347.95 354.31 1.8% Community Well 45-64 3,174 489.33 497.24 1.6% Community Well 65+ 3,586 538.49 551.78 2.5% NFLOC 4,930 $ 3,310.25 $ 3,440.89 3.9% Community Well 18-44 1,851 264.92 269.42 1.7% Community Well 45-64 2,684 346.41 353.01 1.9% HF 19Community Well 65+ 2,260 385.37 398.36 3.4% NFLOC 6,894 $ 3,914.82 $ 4,059.06 3.7% Community Well 18-44 F 25,116 514.02 527.35 2.64,026 297.91 301.88 1.3% HF Community Well 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.96,166 386.56 392.63 1.6% EXT 19-34 M 12,036 Community Well 65+ 6,481 397.75 409.77 3.0% NFLOC 2,542 $ 500.88 3,425.66 $ 511.86 2.23,528.96 3.0% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35Community Well 18-44 M 6,721 683.18 705.15 3.21,220 252.63 256.39 1.5% EXT 35Community Well 45-64 2,059 325.56 330.39 1.5% Community Well 65+ 1,731 341.45 349.84 2.5% NFLOC 2,524 $ 3,624.90 $ 3,790.09 4.6% Community Well 18-44 F 5,793 810.55 830.53 2.51,492 326.07 332.03 1.8% EXT Community Well 45-54 M 5,528 880.19 898.79 64 2,550 377.22 384.24 1.9% Community Well 65+ 1,794 310.42 321.60 3.6% NFLOC 4,699 $ 3,914.01 $ 4,113.15 5.1% Community Well 18-44 2,569 315.36 322.05 2.1% EXT Community Well 45-54 F 6,208 971.78 996.97 2.664 3,811 401.96 411.47 2.4% EXT 55Community Well 65+ 3,226 415.68 434.48 4.5% NFLOC 3,272 $ 3,209.98 $ 3,352.74 4.4% Community Well 18-44 1,393 301.11 306.51 1.8% Community Well 45-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 2,130 365.04 371.97 1.9% ABD 21Community Well 65+ 11,894 1,549.61 1,593.82 2.91,642 340.03 351.64 3.4% HF/HST <Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. xxxxxxxx.xxx MILLIMAN CLIENT REPORT Calendar Year 2021 MyCare Ohio Capitation Provider Agreement Rate Amendment Summary Opt-Out Capitation Rates July 27, 2021 Xxxxxx X. Xxxxxx, FSA, MAAA Xxxxx X. Xxxxx, FSA, MAAA Principal and Consulting Actuary Consulting Actuary Xxxxxxx X. Xxxxxx, FSA, MAAA Principal and Consulting Actuary Table of Contents BACKGROUND 1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.SUMMARY OF METHODOLOGY 2 IMPACT OF DEATHS ON NFLOC ENROLLMENT DISTRIBUTION 3 PROGRAM ADJUSTMENTS 3 CARE MANAGEMENT COSTS 5 ADMINISTRATIVE EXPENSE COST ALLOWANCE 5 STATE TAXES AND FEES 5 WITHHOLDS 5 INCENTIVES 5 RISK SHARING MECHANISMS 6
I. Introduction & Executive Summary
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an amendment to the certified calendar year (CY) 2021 2020 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the amendment to the certified CY 2020 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,852 $ 999.86 $ 1,004.70 0.5% 1,023.94 HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) 4,194 192.77 HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) 44,714 179.48 HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) 7,258 236.08 HF/HST 14-18 F 8,683 289.81 290.04 7,431 306.11 HF 19-44 M 4,578 429.67 HF 19-44 F 19,471 580.12 HF 45+ M+F 2,947 903.08 HST 19-64 F 909 829.21 EXT 19-34 M 6,520 $ 626.46 EXT 19-34 F 6,847 594.42 EXT 35-44 M 3,471 910.52 EXT 35-44 F 3,339 998.31 EXT 45-54 M 3,370 1,062.51 EXT 45-54 F 3,900 1,050.32 EXT 55-64 M 3,251 1,183.86 EXT 55-64 F 3,744 1,151.86 ABD <21 4,059 $ 854.11 ABD 21+ 11,037 1,830.94 HF/HST <1 M+F 3,356 $ 872.18 HF/HST 1 M+F 2,767 181.52 HF/HST 2-13 M+F 29,838 153.58 HF/HST 14-18 M 4,902 263.96 HF/HST 14-18 F 5,100 257.73 HF 19-44 M 2,955 404.81 HF 19-44 F 11,166 516.63 HF 45+ M+F 1,665 867.12 HST 19-64 F 793 588.48 EXT 19-34 M 3,162 $ 640.33 EXT 19-34 F 3,894 554.77 EXT 35-44 M 1,853 797.67 EXT 35-44 F 2,096 819.08 EXT 45-54 M 1,770 1,075.65 EXT 45-54 F 2,341 1,137.13 EXT 55-64 M 1,854 1,288.74 EXT 55-64 F 2,327 1,088.37 ABD <21 1,664 $ 816.68 ABD 21+ 4,770 1,641.20 HF/HST <1 M+F 18,641 $ 1,203.57 HF/HST 1 M+F 15,914 241.32 HF/HST 2-13 M+F 172,423 193.57 HF/HST 14-18 M 27,242 258.30 HF/HST 14-18 F 28,120 312.25 HF 19-44 M 16,101 402.19 HF 19-44 F 69,040 532.41 HF 45+ M+F 10,835 785.23 HST 19-64 F 3,859 746.67 EXT 19-34 M 23,813 $ 580.07 EXT 19-34 F 24,535 585.56 EXT 35-44 M 14,019 799.12 EXT 35-44 F 12,696 869.49 EXT 45-54 M 13,060 1,017.06 EXT 45-54 F 14,279 1,073.02 EXT 55-64 M 12,490 1,192.44 EXT 55-64 F 13,804 1,114.55 ABD <21 12,715 $ 1,128.79 ABD 21+ 34,494 1,734.33 HF/HST <1 M+F 16,138 $ 1,476.52 HF/HST 1 M+F 13,630 263.14 HF/HST 2-13 M+F 149,590 198.26 HF/HST 14-18 M 23,623 270.67 HF/HST 14-18 F 24,157 337.30 HF 19-44 M 16,130 407.76 HF 19-44 F 57,201 603.40 HF 45+ M+F 10,776 800.99 HST 19-64 F 3,200 753.95 EXT 19-34 M 19,712 $ 672.19 EXT 19-34 F 20,320 661.89 EXT 35-44 M 11,215 984.32 EXT 35-44 F 10,558 971.90 EXT 45-54 M 10,446 1,206.57 EXT 45-54 F 11,749 1,118.95 EXT 55-64 M 9,258 1,357.21 EXT 55-64 F 10,575 1,215.55 ABD <21 9,798 $ 1,206.23 ABD 21+ 31,670 1,826.48 HF/HST <1 M+F 5,087 $ 1,190.92 HF/HST 1 M+F 4,363 261.92 HF/HST 2-13 M+F 48,970 191.52 HF/HST 14-18 M 8,426 276.20 HF/HST 14-18 F 8,642 319.47 HF 19-44 M 6,518 444.26 HF 19-44 F 20,734 565.33 HF 45+ M+F 3,531 849.58 HST 19-64 F 1,209 695.97 EXT 19-34 M 7,496 $ 589.06 EXT 19-34 F 7,560 596.36 EXT 35-44 M 4,357 775.90 EXT 35-44 F 4,202 876.69 EXT 45-54 M 4,247 1,018.14 EXT 45-54 F 4,977 1,007.66 EXT 55-64 M 4,158 1,201.48 EXT 55-64 F 4,823 1,136.04 ABD <21 3,221 $ 1,139.72 ABD 21+ 12,387 1,614.53 HF/HST <1 M+F 20,560 $ 1,308.99 HF/HST 1 M+F 18,540 245.93 HF/HST 2-13 M+F 205,406 200.45 HF/HST 14-18 M 34,407 254.00 HF/HST 14-18 F 35,481 303.71 HF 19-44 M 22,346 364.89 HF 19-44 F 92,721 522.02 HF 45+ M+F 16,088 743.05 HST 19-64 F 4,032 826.55 EXT 19-34 M 36,556 $ 539.64 EXT 19-34 F 35,774 533.35 EXT 35-44 M 19,772 727.57 EXT 35-44 F 17,184 756.75 EXT 45-54 M 19,372 958.68 EXT 45-54 F 21,235 968.29 EXT 55-64 M 19,961 1,124.43 EXT 55-64 F 22,180 992.35 ABD <21 18,420 $ 1,071.55 ABD 21+ 52,632 1,720.04 HF/HST <1 M+F 5,277 $ 978.78 HF/HST 1 M+F 4,427 217.53 HF/HST 2-13 M+F 48,701 181.80 HF/HST 14-18 M 7,825 243.10 HF/HST 14-18 F 8,154 293.05 HF 19-44 M 5,006 394.70 HF 19-44 F 20,198 493.24 HF 45+ M+F 3,011 725.63 HST 19-64 F 1,133 635.68 EXT 19-34 M 6,383 $ 555.75 EXT 19-34 F 7,254 532.82 EXT 35-44 M 3,700 743.79 EXT 35-44 F 3,890 810.79 EXT 45-54 M 3,637 935.22 EXT 45-54 F 4,391 950.08 EXT 55-64 M 3,784 1,159.04 EXT 55-64 F 4,416 1,004.56 ABD <21 3,382 $ 1,148.69 ABD 21+ 9,227 1,549.70 HF/HST <1 M+F 73,911 $ 1,248.73 HF/HST 1 M+F 63,835 241.29 HF/HST 2-13 M+F 699,642 193.02 HF/HST 14-18 M 113,683 258.68 HF/HST 14-18 F 117,084 311.26 HF 19-44 M 73,632 397.12 HF 19-44 F 290,530 545.29 HF 45+ M+F 48,854 785.70 HST 19-64 F 15,135 753.81 EXT 19-34 M 103,643 $ 587.24 EXT 19-34 F 106,182 579.19 EXT 35-44 M 58,388 811.80 EXT 35-44 F 53,965 855.97 EXT 45-54 M 55,903 1,031.60 EXT 45-54 F 62,873 1,033.45 EXT 55-64 M 54,755 1,196.64 EXT 55-64 F 61,868 1,083.10 ABD <21 53,259 $ 1,094.48 ABD 21+ 156,216 1,731.78 MILLIMAN CLIENT REPORT HF/HST <1 M+F 4,779 $ 1,031.60 $ 0.63 $ 0.00 $ 1,032.23 0.1% HF/HST 1 M+F 4,200 199.21 0.63 0.01 199.85 0.3% HF/HST 2-13 M+F 49,823 181.45 0.61 0.01 182.07 0.3% HF/HST 14-18 M 7,870 238.09 0.83 0.01 238.93 0.4% HF/HST 14-18 F 7,969 306.11 1.21 0.01 307.33 0.4% HF 19-44 M 6,999 383.79 388.01 1.16,189 409.99 1.54 0.02 411.55 0.4% HF 19-44 F 24,684 527.73 537.14 1.821,343 565.45 2.55 0.03 568.03 0.5% HF 45+ M+F 3,791 764.60 777.49 1.73,356 872.26 5.09 0.05 877.40 0.6% HST 19-64 F 1,784 597.62 614.09 2.81,285 740.91 1.96 0.02 742.89 0.3% EXT 19-34 M 11,813 8,560 $ 582.92 593.85 $ 591.19 1.41.14 $ 0.01 $ 595.00 0.2% EXT 19-34 F 9,772 535.82 542.74 1.38,358 566.81 2.12 0.02 568.95 0.4% EXT 35-44 M 5,909 865.18 878.33 1.54,161 865.11 2.65 0.03 867.79 0.3% EXT 35-44 F 4,531 912.74 928.83 1.83,922 951.14 4.59 0.05 955.78 0.5% EXT 45-54 M 4,670 1,036.30 1,054.49 1.84,107 1,009.02 4.00 0.04 1,013.06 0.4% EXT 45-54 F 5,059 991.99 1,010.62 1.94,493 999.85 6.03 0.06 1,005.94 0.6% EXT 55-64 M 3,741 1,209.84 1,229.68 1.63,826 1,134.78 4.94 0.05 1,139.77 0.4% EXT 55-64 F 4,226 1,067.44 1,087.00 1.84,277 1,105.30 6.48 0.07 1,111.85 0.6% ABD <21 3,848 3,897 $ 943.34 859.57 $ 960.93 1.92.19 $ 0.02 $ 861.78 0.3% ABD 21+ 10,355 1,829.06 1,865.11 2.010,631 1,822.30 10.09 0.10 1,832.49 0.6% HF/HST <1 M+F 3,160 3,342 $ 917.12 880.76 $ 910.53 (0.7%) 0.47 $ 0.00 $ 881.23 0.1% HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) 2,901 186.81 0.50 - 187.31 0.3% HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) 33,461 155.20 0.53 0.01 155.74 0.3% HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) 5,403 264.11 0.75 0.01 264.87 0.3% HF/HST 14-18 F 6,009 252.71 252.85 0.15,544 257.95 1.12 0.01 259.08 0.4% HF 19-44 M 4,690 361.17 366.83 1.64,098 385.55 1.49 0.01 387.05 0.4% HF 19-44 F 14,803 474.99 484.86 2.112,497 503.57 2.30 0.02 505.89 0.5% HF 45+ M+F 2,231 676.02 688.62 1.91,992 837.72 4.38 0.04 842.14 0.5% HST 19-64 F 1,381 427.98 441.58 3.21,014 529.42 1.49 0.02 530.93 0.3% EXT 19-34 M 5,834 4,325 $ 548.84 606.56 $ 561.41 2.31.09 $ 0.01 $ 607.66 0.2% EXT 19-34 F 5,615 497.91 506.20 1.75,074 528.33 1.85 0.02 530.20 0.4% EXT 35-44 M 3,221 708.29 720.92 1.82,354 758.47 2.25 0.03 760.75 0.3% EXT 35-44 F 2,998 712.36 726.39 2.02,551 780.80 3.99 0.04 784.83 0.5% EXT 45-54 M 2,600 989.46 1,014.67 2.52,274 1,018.46 3.73 0.04 1,022.23 0.4% EXT 45-54 F 3,073 1,047.63 1,072.64 2.42,844 1,081.99 5.74 0.06 1,087.79 0.5% EXT 55-64 M 2,266 1,255.99 1,285.03 2.31,233.93 4.62 0.05 1,238.60 0.4% EXT 55-64 F 2,748 1,064.59 1,084.91 1.92,752 1,045.28 5.49 0.06 1,050.83 0.5% ABD <21 1,717 1,668 $ 852.44 819.88 $ 868.45 1.92.52 $ 0.02 $ 822.42 0.3% ABD 21+ 4,617 1,592.24 1,632.60 2.54,580 1,633.30 9.52 0.10 1,642.92 0.6% HF/HST <1 M+F 17,597 18,540 $ 1,262.30 1,207.81 $ 1,265.69 0.30.66 $ 0.00 $ 1,208.47 0.1% HF/HST 1 M+F 18,049 281.37 281.84 16,608 243.66 0.66 - 244.32 0.3% HF/HST 2-13 M+F 193,305 190.89 0.64 0.01 191.54 0.3% HF/HST 14-18 M 29,917 255.31 0.79 0.01 256.11 0.3% HF/HST 14-18 F 31,001 307.83 1.18 0.01 309.02 0.4% HF 19-44 M 22,152 379.44 1.44 0.02 380.90 0.4% HF 19-44 F 76,386 515.57 2.50 0.02 518.09 0.5% HF 45+ M+F 12,545 755.00 4.63 0.05 759.68 0.6% HST 19-64 F 4,958 669.93 1.87 0.02 671.82 0.3% EXT 19-34 M 31,931 $ 546.29 $ 1.02 $ 0.01 $ 547.32 0.2% EXT 19-34 F 30,900 554.61 1.96 0.02 556.59 0.4% EXT 35-44 M 17,533 756.22 2.40 0.03 758.65 0.3% EXT 35-44 F 15,565 825.15 4.27 0.04 829.46 0.5% EXT 45-54 M 16,114 960.10 3.71 0.04 963.85 0.4% EXT 45-54 F 17,024 1,017.32 5.91 0.06 1,023.29 0.6% EXT 55-64 M 14,711 1,139.20 4.56 0.05 1,143.81 0.4% EXT 55-64 F 16,269 1,067.28 6.22 0.07 1,073.57 0.6% ABD <21 12,450 $ 1,129.43 $ 2.83 $ 0.03 $ 1,132.29 0.3% ABD 21+ 33,847 1,723.18 9.33 0.10 1,732.61 0.5% HF/HST <1 M+F 15,710 $ 1,482.60 $ 0.68 $ 0.00 $ 1,483.28 0.0% HF/HST 1 M+F 14,208 264.82 0.66 - 265.48 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6166,896 195.74 0.66 - 196.40 0.3% HF/HST 14-18 M 34,218 244.22 246.87 1.125,723 267.74 0.82 0.01 268.57 0.3% HF/HST 14-18 F 34,248 316.37 321.05 1.526,119 332.70 1.27 0.01 333.98 0.4% HF 19-44 M 25,453 345.00 351.93 2.021,432 385.44 1.63 0.02 387.09 0.4% HF 19-44 F 87,917 494.47 507.49 2.661,624 584.40 2.93 0.03 587.36 0.5% HF 45+ M+F 14,354 677.16 692.62 2.312,378 771.01 5.01 0.05 776.07 0.7% HST 19-64 F 7,148 551.47 569.97 3.44,044 677.40 1.83 0.02 679.25 0.3% EXT 19-34 M 42,323 25,789 $ 516.42 632.64 $ 528.92 2.41.38 $ 0.01 $ 634.03 0.2% EXT 19-34 F 35,855 531.85 543.10 2.125,111 626.69 2.25 0.02 628.96 0.4% EXT 35-44 M 23,577 745.91 763.14 2.313,599 931.04 3.15 0.03 934.22 0.3% EXT 35-44 F 18,522 790.64 810.28 2.512,554 922.92 4.90 0.05 927.87 0.5% EXT 45-54 M 18,469 935.82 957.10 2.312,821 1,138.65 4.85 0.05 1,143.55 0.4% EXT 45-54 F 18,972 1,005.41 1,030.53 2.513,713 1,061.06 6.87 0.07 1,068.00 0.7% EXT 55-64 M 15,046 1,153.35 1,179.15 2.210,752 1,296.19 5.78 0.06 1,302.03 0.5% EXT 55-64 F 16,926 1,041.51 1,065.35 2.312,264 1,161.72 7.47 0.07 1,169.26 0.6% ABD <21 12,397 9,712 $ 1,162.87 1,207.20 $ 1,186.20 2.02.95 $ 0.03 $ 1,210.18 0.2% ABD 21+ 33,463 1,648.92 1,692.23 2.630,651 1,813.17 11.95 0.12 1,825.24 0.7% HF/HST <1 M+F 14,934 5,014 $ 1,631.73 1,194.97 $ 1,629.98 (0.62 $ 0.01 $ 1,195.60 0.1%) % HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) 4,473 264.74 0.65 - 265.39 0.2% HF/HST 2-13 M+F 169,110 208.57 208.76 0.154,654 189.56 0.73 - 190.29 0.4% HF/HST 14-18 M 28,913 254.04 256.54 1.09,176 273.38 0.89 0.01 274.28 0.3% HF/HST 14-18 F 29,231 318.77 322.18 1.19,302 315.78 1.45 0.01 317.24 0.5% HF 19-44 M 23,665 349.19 356.00 2.08,950 419.18 1.73 0.02 420.93 0.4% HF 19-44 F 71,281 563.74 580.36 2.922,848 547.87 2.88 0.03 550.78 0.5% HF 45+ M+F 14,148 708.47 725.94 2.54,142 817.04 4.90 0.05 821.99 0.6% HST 19-64 F 5,883 586.12 608.58 3.81,494 621.57 1.74 0.01 623.32 0.3% EXT 19-34 M 33,504 9,955 $ 601.51 554.77 $ 615.92 2.41.30 $ 0.01 $ 556.08 0.2% EXT 19-34 F 29,214 603.11 616.40 2.29,543 565.16 2.23 0.02 567.41 0.4% EXT 35-44 M 18,111 880.49 903.51 2.65,316 735.83 2.90 0.03 738.76 0.4% EXT 35-44 F 14,846 877.94 899.88 2.55,045 832.72 5.06 0.05 837.83 0.6% EXT 45-54 M 14,468 1,104.90 1,132.14 2.55,151 961.77 4.35 0.04 966.16 0.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.65,941 956.17 6.24 0.06 962.47 0.7% EXT 55-64 M 10,764 1,286.32 1,322.63 2.84,891 1,148.53 5.11 0.05 1,153.69 0.4% EXT 55-64 F 12,385 1,158.77 1,190.11 2.75,695 1,086.82 7.02 0.07 1,093.91 0.7% ABD <21 9,842 3,116 $ 1,232.54 1,141.11 $ 1,259.01 2.13.48 $ 0.04 $ 1,144.63 0.3% ABD 21+ 29,961 1,752.05 1,804.35 3.012,168 1,602.22 11.41 0.12 1,613.75 0.7% HF/HST <1 M+F 4,722 20,391 $ 1,225.57 1,309.35 $ 1,221.70 (0.3%) 0.66 $ 0.01 $ 1,310.02 0.1% HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) 18,714 248.29 0.67 0.01 248.97 0.3% HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) 229,076 198.15 0.60 0.01 198.76 0.3% HF/HST 14-18 M 9,872 264.29 265.91 0.637,192 251.86 0.71 0.01 252.58 0.3% HF/HST 14-18 F 9,973 315.68 318.51 0.938,584 300.33 1.10 0.01 301.44 0.4% HF 19-44 M 9,424 361.81 368.52 1.930,284 345.89 1.24 0.01 347.14 0.4% HF 19-44 F 25,116 514.02 527.35 2.6100,984 506.81 2.23 0.02 509.06 0.4% HF 45+ M+F 4,614 799.91 820.48 2.618,885 716.49 4.07 0.05 720.61 0.6% HST 19-64 F 1,786 561.24 583.02 3.95,149 740.51 1.85 0.01 742.37 0.3% EXT 19-34 M 12,036 49,370 $ 500.88 509.69 $ 511.86 2.20.89 $ 0.01 $ 510.59 0.2% EXT 19-34 F 10,527 567.53 580.47 2.345,315 506.54 1.81 0.01 508.36 0.4% EXT 35-44 M 6,721 683.18 705.15 3.224,482 690.08 2.02 0.02 692.12 0.3% EXT 35-44 F 5,793 810.55 830.53 2.521,055 719.99 3.64 0.04 723.67 0.5% EXT 45-54 M 5,528 880.19 898.79 2.124,253 907.20 3.29 0.04 910.53 0.4% EXT 45-54 F 6,208 971.78 996.97 2.625,228 920.25 4.97 0.05 925.27 0.5% EXT 55-64 M 4,889 1,100.09 1,132.22 2.923,518 1,076.68 3.95 0.04 1,080.67 0.4% EXT 55-64 F 5,633 1,076.35 1,102.72 2.426,356 950.91 5.28 0.05 956.24 0.6% ABD <21 3,162 17,881 $ 1,223.04 1,073.55 $ 1,246.28 1.92.13 $ 0.02 $ 1,075.70 0.2% ABD 21+ 11,894 1,549.61 1,593.82 2.951,605 1,713.42 7.93 0.08 1,721.43 0.5% HF/HST <1 M+F 18,881 5,264 $ 1,375.64 982.35 $ 1,362.27 (1.0%) 0.62 $ 0.01 $ 982.98 0.1% HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) 4,589 220.51 0.64 0.00 221.15 0.3% HF/HST 2-13 M+F 224,655 212.38 213.43 0.554,515 180.39 0.61 0.01 181.01 0.3% HF/HST 14-18 M 40,560 248.78 251.88 1.28,562 241.45 0.77 0.01 242.23 0.3% HF/HST 14-18 F 40,839 304.53 309.14 1.58,878 289.86 1.19 0.01 291.06 0.4% HF 19-44 M 32,969 322.73 327.89 1.66,892 373.57 1.46 0.01 375.04 0.4% HF 19-44 F 112,237 490.07 501.31 2.322,074 478.32 2.53 0.03 480.88 0.5% HF 45+ M+F 20,522 675.31 691.25 2.43,521 698.14 4.62 0.05 702.81 0.7% HST 19-64 F 7,105 638.81 659.09 3.21,498 566.47 1.82 0.02 568.31 0.3% EXT 19-34 M 62,187 8,517 $ 474.15 524.13 $ 482.33 1.71.12 $ 0.01 $ 525.26 0.2% EXT 19-34 F 50,610 473.53 481.26 1.69,179 505.43 2.07 0.03 507.53 0.4% EXT 35-44 M 31,273 671.62 684.60 1.94,520 704.66 2.51 0.02 707.19 0.4% EXT 35-44 F 23,623 695.39 708.63 1.94,703 769.75 4.52 0.04 774.31 0.6% EXT 45-54 M 26,371 869.64 885.73 1.94,496 883.60 3.97 0.04 887.61 0.5% EXT 45-54 F 26,643 904.61 924.19 2.25,235 901.98 5.80 0.06 907.84 0.6% EXT 55-64 M 22,966 1,070.04 1,087.93 1.74,337 1,107.24 4.81 0.05 1,112.10 0.4% EXT 55-64 F 25,852 970.77 989.78 2.05,270 960.08 6.45 0.07 966.60 0.7% ABD <21 17,875 3,374 $ 1,102.71 1,150.70 $ 1,127.93 2.32.75 $ 0.02 $ 1,153.47 0.2% ABD 21+ 50,902 1,677.75 1,716.97 2.39,138 1,538.52 10.53 0.10 1,549.15 0.7% HF/HST <1 M+F 4,852 73,040 $ 943.93 1,251.64 $ 930.70 (1.4%) 0.65 $ 0.00 $ 1,252.29 0.1% HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) 65,692 244.02 0.65 0.00 244.68 0.3% HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) 781,730 191.10 0.63 0.01 191.74 0.3% HF/HST 14-18 M 9,435 232.90 234.29 0.6123,842 256.53 0.78 0.01 257.31 0.3% HF/HST 14-18 F 9,558 286.31 289.76 1.2127,397 307.71 1.19 0.01 308.91 0.4% HF 19-44 M 7,730 320.29 325.64 1.799,996 375.86 1.46 0.02 377.33 0.4% HF 19-44 F 24,818 459.17 470.62 2.5317,756 528.75 2.52 0.02 531.29 0.5% HF 45+ M+F 3,897 666.61 681.52 2.256,818 756.51 4.56 0.05 761.13 0.6% HST 19-64 F 1,881 509.02 531.96 4.519,442 675.85 1.83 0.02 677.70 0.3% EXT 19-34 M 11,012 138,447 $ 477.49 553.39 $ 486.84 2.01.08 $ 0.01 $ 554.48 0.2% EXT 19-34 F 9,978 489.01 497.61 1.8133,480 548.99 2.00 0.02 551.00 0.4% EXT 35-44 M 6,119 674.86 688.08 2.071,964 768.38 2.47 0.03 770.87 0.3% EXT 35-44 F 5,416 753.87 770.48 2.265,394 812.49 4.28 0.04 816.81 0.5% EXT 45-54 M 5,062 909.71 927.27 1.969,215 974.61 3.86 0.04 978.51 0.4% EXT 45-54 F 5,664 935.40 955.98 2.274,477 980.92 5.79 0.06 986.77 0.6% EXT 55-64 M 4,312 1,064.55 1,085.81 2.064,302 1,144.21 4.62 0.05 1,148.89 0.4% EXT 55-64 F 5,244 1,023.93 1,044.55 2.072,884 1,036.27 6.16 0.06 1,042.48 0.6% ABD <21 3,413 52,097 $ 1,161.76 1,096.73 $ 1,180.81 1.62.59 $ 0.03 $ 1,099.34 0.2% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6152,619 1,721.46 9.68 0.10 1,731.24 0.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2020 amendment to the certified calendar year (CY) 2021 2020 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2020 amendment to the certified CY 2020 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 27,421 $ 999.86 3,849.20 $ 1,004.70 3,875.96 0.7% Community Well 18-44 13,687 275.68 280.62 1.8% Community Well 45-64 22,440 363.08 368.27 1.4% Community Well 65+ 19,885 380.59 388.61 2.1% NFLOC 4,444 $ 4,484.97 $ 4,502.90 0.4% Community Well 18-44 1,901 319.88 325.17 1.7% Community Well 45-64 3,122 463.70 469.52 1.3% Community Well 65+ 3,265 502.56 510.95 1.7% NFLOC 4,585 $ 3,322.68 $ 3,348.79 0.8% Community Well 18-44 1,759 256.30 260.65 1.7% Community Well 45-64 2,758 333.62 338.62 1.5% Community Well 65+ 2,339 380.70 389.61 2.3% NFLOC 6,104 $ 4,048.59 $ 4,082.89 0.8% Community Well 18-44 3,743 272.26 276.93 1.7% Community Well 45-64 6,216 360.29 364.64 1.2% Community Well 65+ 6,424 370.13 377.68 2.0% NFLOC 2,382 $ 3,671.65 $ 3,688.20 0.5% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.11,168 244.58 248.37 1.5% HF 19Community Well 45-64 2,033 310.30 314.70 1.4% Community Well 65+ 1,748 338.57 345.31 2.0% NFLOC 2,550 $ 3,709.64 $ 3,725.71 0.4% Community Well 18-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1,467 289.31 294.23 1.7% HST 19Community Well 45-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 2,465 365.23 370.07 1.3% EXT 35Community Well 65+ 1,606 312.34 317.66 1.7% NFLOC 4,296 $ 3,928.49 $ 3,967.61 1.0% Community Well 18-44 M 5,909 865.18 878.33 1.52,402 272.66 278.43 2.1% EXT 35Community Well 45-64 3,776 348.63 355.23 1.9% Community Well 65+ 2,943 365.04 375.55 2.9% NFLOC 3,060 $ 3,460.22 $ 3,485.32 0.7% Community Well 18-44 F 4,531 912.74 928.83 1.81,247 264.81 270.34 2.1% EXT Community Well 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 2,070 334.58 340.21 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 Community Well 65+ 1,560 314.86 322.30 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP MCOP’s responsibilities related to communicating with eligible individuals pre-enrollment and MCP MCOP members post-enrollment. Upon request, the MCP shall MCOP will provide both members and eligible individuals with a copy of their practice guidelines.
1. The MyCare Ohio logo shall be on all member communications and marketing materials, excluding nominal gifts.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2020 amendment to the certified calendar year (CY) 2021 2020 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2020 amendment to the certified CY 2020 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 27,421 $ 999.86 3,849.20 $ 1,004.70 3,875.96 0.7% Community Well 18-44 13,687 275.68 280.62 1.8% Community Well 45-64 22,440 363.08 368.27 1.4% Community Well 65+ 19,885 380.59 388.61 2.1% NFLOC 4,444 $ 4,484.97 $ 4,502.90 0.4% Community Well 18-44 1,901 319.88 325.17 1.7% Community Well 45-64 3,122 463.70 469.52 1.3% Community Well 65+ 3,265 502.56 510.95 1.7% NFLOC 4,585 $ 3,322.68 $ 3,348.79 0.8% Community Well 18-44 1,759 256.30 260.65 1.7% Community Well 45-64 2,758 333.62 338.62 1.5% Community Well 65+ 2,339 380.70 389.61 2.3% NFLOC 6,104 $ 4,048.59 $ 4,082.89 0.8% Community Well 18-44 3,743 272.26 276.93 1.7% Community Well 45-64 6,216 360.29 364.64 1.2% Community Well 65+ 6,424 370.13 377.68 2.0% NFLOC 2,382 $ 3,671.65 $ 3,688.20 0.5% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.11,168 244.58 248.37 1.5% HF 19Community Well 45-64 2,033 310.30 314.70 1.4% Community Well 65+ 1,748 338.57 345.31 2.0% NFLOC 2,550 $ 3,709.64 $ 3,725.71 0.4% Community Well 18-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1,467 289.31 294.23 1.7% HST 19Community Well 45-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 2,465 365.23 370.07 1.3% EXT 35Community Well 65+ 1,606 312.34 317.66 1.7% NFLOC 4,296 $ 3,928.49 $ 3,967.61 1.0% Community Well 18-44 M 5,909 865.18 878.33 1.52,402 272.66 278.43 2.1% EXT 35Community Well 45-64 3,776 348.63 355.23 1.9% Community Well 65+ 2,943 365.04 375.55 2.9% NFLOC 3,060 $ 3,460.22 $ 3,485.32 0.7% Community Well 18-44 F 4,531 912.74 928.83 1.81,247 264.81 270.34 2.1% EXT Community Well 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 2,070 334.58 340.21 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 Community Well 65+ 1,560 314.86 322.30 2.4% EXT 55MILLIMAN CLIENT REPORT July 2020 MyCare Ohio Capitation Provider Agreement Rate Amendment Summary Opt-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55Out Capitation Rates June 17, 2020 Xxxxxx X. Xxxxxx, FSA, MAAA Xxxxx X. Xxxxx, FSA, MAAA Principal and Consulting Actuary Consulting Actuary Xxxxxxx X. Xxxxxx, FSA, MAAA Principal and Consulting Actuary Table of Contents I. INTRODUCTION & EXECUTIVE SUMMARY 2 BACKGROUND 2 SUMMARY OF METHODOLOGY 3 II. PROSPECTIVE DATA ADJUSTMENTS 4 PROGRAM ADJUSTMENTS: JULY THROUGH DECEMBER 2020 4 NURSING FACILITY REIMBURSEMENT CHANGES 4 VENTILATOR-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2DEPENDENT NURSING FACILITY RATE CHANGE 4 OTHER NON-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14FACILITY REIMBURSEMENT CHANGES 4 IMMATERIAL PROGRAM ADJUSTMENTS 4 III. NON-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 BENEFIT EXPENSES 5 CARE MANAGEMENT COSTS 5 ADMINISTRATIVE EXPENSE COST ALLOWANCE 5 STATE TAXES AND FEES 5 HEALTH INSURANCE PROVIDERS FEE (0.1%HIF) HF/HST 1 M+F 15,372 288.51 287.04 5 IV. OTHER ITEMS 6 INCENTIVES AND WITHHOLDS 6 V. MEMBER ENROLLMENT MIX ADJUSTMENT (0.5%MEMA) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment7 VI. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.LIMITATIONS AND DATA RELIANCE 8
I. Introduction & Executive Summary
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an amendment to the certified calendar year (CY) 2021 2020 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of this amendment to the certified CY 2020 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 Region: Statewide Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 22,557 $ 999.86 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 194,099.22 Community Well 18-44 M 6,999 383.79 388.01 1.1% HF 194,878 $ 303.11 Community Well 45-64 10,554 $ 365.42 Community Well 65+ 9,917 $ 435.98 Region: Central / Southeast Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 2,462 $ 4,744.90 Community Well 18-44 F 24,684 527.73 537.14 1.8% HF 643 336.86 Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 1,250 455.96 Community Well 65+ 1,261 582.25 Region: East Central Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 3,898 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 353,623.66 Community Well 18-44 M 5,909 865.18 878.33 1.5% EXT 35656 277.18 Community Well 45-64 1,497 345.67 Community Well 65+ 1,384 452.22 Region: Northeast Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 5,946 $ 4,266.90 Community Well 18-44 F 4,531 912.74 928.83 1.8% EXT 1,179 308.90 Community Well 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 64 2,634 371.28 Community Well 65+ 3,268 434.30 Region: Northeast Central Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 1,340 $ 3,772.36 Community Well 18-44 434 265.47 Community Well 45-54 F 5,059 991.99 1,010.62 1.9% EXT 5564 925 321.03 Community Well 65+ 813 378.38 Region: Northwest Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 1,367 $ 4,123.12 Community Well 18-44 446 328.42 Community Well 45-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55950 373.29 Community Well 65+ 665 345.83 Region: Southwest Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 4,104 $ 4,518.99 Community Well 18-44 913 302.42 Community Well 45-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 1,881 356.57 Community Well 65+ 1,534 422.74 Region: West Central Rate Cell Average Monthly Enrollment January to June 2020Capitation Rate NFLOC 3,440 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 193,503.17 Community Well 18-44 M 4,690 361.17 366.83 1.6% HF 19607 293.46 Community Well 45-64 1,417 330.94 Community Well 65+ 992 361.08 MILLIMAN CLIENT REPORT Region: Statewide Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 22,557 $ 4,127.24 Community Well 18-44 F 14,803 474.99 484.86 2.1% HF 4,878 308.14 Community Well 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 10,554 371.05 Community Well 65+ 9,917 442.91 Region: Central / Southeast Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 2,462 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 354,763.98 Community Well 18-44 M 3,221 708.29 720.92 1.8% EXT 35643 342.46 Community Well 45-64 1,250 461.72 Community Well 65+ 1,261 588.14 Region: East Central Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 3,898 $ 3,641.62 Community Well 18-44 F 2,998 712.36 726.39 2.0% EXT 656 281.75 Community Well 45-54 M 2,600 989.46 1,014.67 2.5% EXT 64 1,497 351.24 Community Well 65+ 1,384 460.01 Region: Northeast Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 5,946 $ 4,296.53 Community Well 18-44 1,179 313.11 Community Well 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 5564 2,634 376.18 Community Well 65+ 3,268 440.84 Region: Northeast Central Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 1,340 $ 3,795.52 Community Well 18-44 434 269.55 Community Well 45-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55925 325.22 Community Well 65+ 813 383.54 Region: Northwest Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 1,367 $ 4,102.09 Community Well 18-44 446 333.55 Community Well 45-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 950 378.30 Community Well 65+ 665 350.35 Region: Southwest Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 4,104 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 194,583.16 Community Well 18-44 M 25,453 345.00 351.93 2.0% HF 19913 308.41 Community Well 45-64 1,881 363.73 Community Well 65+ 1,534 432.11 Region: West Central Rate Cell Average Monthly Enrollment July to December 2020Capitation Rate NFLOC 3,440 $ 3,524.44 Community Well 18-44 F 87,917 494.47 507.49 2.6% HF 607 299.17 Community Well 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 191,417 337.22 Community Well 65+ 992 368.70 MILLIMAN CLIENT REPORT July 2020 MyCare Ohio Capitation Provider Agreement Rate Amendment Summary Opt-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19In Capitation Rates June 17, 2020 Xxxxxx X. Xxxxxx, FSA, MAAA Xxxxx X. Xxxxx, FSA, MAAA Principal and Consulting Actuary Consulting Actuary Xxxxxxx X. Xxxxxx, FSA, MAAA Principal and Consulting Actuary Table of Contents BACKGROUND 2 SUMMARY OF METHODOLOGY 3 PROGRAM ADJUSTMENTS: JULY THROUGH DECEMBER 2020 4 NURSING FACILITY REIMBURSEMENT CHANGES 4 VENTILATOR-34 F 35,855 531.85 543.10 2.1% EXT 35DEPENDENT NURSING FACILITY RATE CHANGE 4 OTHER NON-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 FACILITY REIMBURSEMENT CHANGES 4 IMMATERIAL PROGRAM ADJUSTMENTS 4 CARE MANAGEMENT COSTS 5 ADMINISTRATIVE EXPENSE COST ALLOWANCE 5 STATE TAXES AND FEES 5 HEALTH INSURANCE PROVIDERS FEE (0.1%HIF) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.5 INCENTIVES AND WITHHOLDS 6
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2017 amendment to the certified calendar year (CY) 2021 2017 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Opt-In Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2017 amendment to the certified CY 2017 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 Region: Central / Southeast Projected AverageRate Cell Monthly Members January - December 2017 Capitation Rate July - December 2017 Capitation Rate Total Change NFLOC Total 3,777 1,214 2,034 2,060 9,085 Projected Average Monthly Members $ 999.86 4,321.59 464.67 645.92 799.20 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 2,184.58 January - December 2017 Capitation Rate $ 4,072.49 (2.35.76%) HF/HST 2-13 M+F 49,838 194.74 192.69 Community Well 65+ 789.92 (1.11.16%) HF/HST 14-18 M 8,846 230.65 230.14 NFLOC Total 4,177 1,199 1,907 1,674 8,957 Projected Average Monthly Members $ 3,294.91 292.58 349.28 643.27 $ 1,770.30 January - December 2017 Capitation Rate $ 3,110.44 (0.25.60%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 65+ 634.17 (1.41%) NFLOC Total 6,193 Community Well 18-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 2,754 Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 4,447 Community Well 65+ 4,584 All Populations 17,978 Region: Northeast Central Projected AverageRate Cell Monthly Members $ 582.92 3,922.00 360.49 426.71 565.83 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 1,656.08 January - December 2017 Capitation Rate $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 3,667.79 (0.76.48%) HF/HST 1 M+F 3,252 216.22 213.31 555.67 (1.31.80%) HF/HST 2-13 M+F 33,863 160.73 157.34 NFLOC Total 1,900 946 1,426 1,149 5,421 Projected Average Monthly Members $ 3,598.30 264.43 311.10 614.03 $ 1,519.29 January - December 2017 Capitation Rate $ 3,385.37 (2.15.92%) HF/HST 14-18 M 6,148 240.46 240.31 Community Well 65+ 605.85 (0.11.33%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 NFLOC Total 2,336 1,018 1,469 1,162 5,985 Projected Average Monthly Members $ 548.84 3,764.89 415.29 461.25 511.02 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 1,752.54 January - December 2017 Capitation Rate $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 3,554.30 (0.15.59%) HF/HST 1 M+F 15,372 288.51 287.04 Community Well 65+ 520.40 1.84% NFLOC Total 3,750 1,551 2,406 1,810 9,517 Projected Average Monthly Members $ 4,031.71 325.35 402.82 731.36 $ 1,882.58 January - December 2017 Capitation Rate $ 3,838.78 (0.54.79%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1Community Well 65+ 741.67 1.41% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 NFLOC Total 3,208 897 1,243 702 6,050 Projected Average Monthly Members $ 601.51 3,521.75 366.31 433.69 671.08 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 2,088.68 January - December 2017 Capitation Rate $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 3,294.49 (0.36.45%) HF/HST 1 M+F 4,784 233.22 229.74 Community Well 65+ 662.84 (1.51.23%) HF/HST 2-13 M+F 53,831 194.79 194.39 NFLOC Total 25,341 $ 3,805.01 $ 3,582.65 (0.25.84%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45Community Well 65+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 13,141 640.07 635.00 (1.00.79%) HFAppendix 01 - Rate Change Milliman, Inc. Page 1 of 1 Prepared for: Deputy Director Rate Setting Ohio Department of Medicaid Prepared by: FSA, MAAA Principal and Consulting Actuary ASA, MAAA Associate Actuary Chase Center/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollmentCircle 000 Xxxxxxxx Xxxxxx Suite 601 Indianapolis, IN 46204 USA Tel +0 000 000 0000 Fax +0 000 000 0000 xxxxxxxx.xxx I. BACKGROUND 2 II. Upon request, the MCP shall provide both members and eligible individuals with a copy EXECUTIVE SUMMARY 3 Summary of their practice guidelines.Methodology 3
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2017 amendment to the certified calendar year (CY) 2021 2017 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the July 1, 2017 amendment to the certified CY 2017 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,928 $ 999.86 759.57 $ 1,004.70 0.5760.51 0.12% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.24,626 144.72 169.33 17.01% HF/HST 2-13 M+F 195,275 209.02 210.22 0.647,074 121.37 147.96 21.91% HF/HST 14-18 M 34,218 244.22 246.87 1.17,367 173.57 192.25 10.76% HF/HST 14-18 F 34,248 316.37 321.05 1.57,492 213.59 228.21 6.84% HF 19-44 M 25,453 345.00 351.93 2.06,853 269.75 283.03 4.92% HF 19-44 F 87,917 494.47 507.49 2.620,977 383.77 387.59 1.00% HF 45+ M+F 14,354 677.16 692.62 2.3% 3,353 614.04 591.01 (3.75%) HST 19-64 F 7,148 551.47 569.97 3.42,232 449.10 453.50 0.98% EXT 19-34 M 42,323 9,139 $ 516.42 317.20 $ 528.92 2.4323.82 2.09% EXT 19-34 F 35,855 531.85 543.10 2.18,286 358.38 363.63 1.46% EXT 35-44 M 23,577 745.91 763.14 2.3% 4,423 547.27 544.12 (0.58%) EXT 35-44 F 18,522 790.64 810.28 2.5% 3,621 602.59 584.09 (3.07%) EXT 45-54 M 18,469 935.82 957.10 2.3% 4,334 780.77 741.87 (4.98%) EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% 4,492 838.45 804.61 (4.04%) EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% 3,186 924.23 888.17 (3.90%) EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% 3,530 861.33 824.77 (4.24%) ABD <21 12,397 2,860 $ 1,162.87 784.33 $ 1,186.20 2.0% 708.54 (9.66%) ABD 21+ 33,463 1,648.92 1,692.23 2.6% 8,734 1,595.30 1,503.21 (5.77%) HF/HST <1 M+F 14,934 3,406 $ 1,631.73 708.33 $ 1,629.98 (0.1%) 734.43 3.68% HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) 3,057 127.87 154.09 20.51% HF/HST 2-13 M+F 169,110 208.57 208.76 0.131,881 121.80 148.03 21.54% HF/HST 14-18 M 28,913 254.04 256.54 1.05,083 213.03 230.68 8.29% HF/HST 14-18 F 29,231 318.77 322.18 1.15,178 196.00 211.51 7.91% HF 19-44 M 23,665 349.19 356.00 2.04,295 268.71 277.99 3.45% HF 19-44 F 71,281 563.74 580.36 2.912,371 367.72 375.29 2.06% HF 45+ M+F 14,148 708.47 725.94 2.5% 1,872 613.86 601.49 (2.02%) HST 19-64 F 5,883 586.12 608.58 3.81,865 408.17 426.33 4.45% EXT 19-34 M 33,504 4,242 $ 601.51 294.72 $ 615.92 2.4308.77 4.77% EXT 19-34 F 29,214 603.11 616.40 2.24,543 357.88 363.29 1.51% EXT 35-44 M 18,111 880.49 903.51 2.6% 2,195 524.91 523.52 (0.26%) EXT 35-44 F 14,846 877.94 899.88 2.5% 2,158 672.82 648.84 (3.56%) EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% 2,197 819.85 777.70 (5.14%) EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% 2,562 850.35 824.07 (3.09%) EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% 1,712 847.41 817.07 (3.58%) EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% 2,046 862.59 838.40 (2.80%) ABD <21 9,842 1,012 $ 1,232.54 728.54 $ 1,259.01 2.1% 650.72 (10.68%) ABD 21+ 29,961 1,752.05 1,804.35 3.0% 3,501 1,407.78 1,362.83 (3.19%) HF/HST <1 M+F 4,722 17,670 $ 1,225.57 898.53 $ 1,221.70 (0.3%) 912.79 1.59% HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) 17,320 187.16 203.45 8.70% HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) 178,931 142.39 161.66 13.53% HF/HST 14-18 M 9,872 264.29 265.91 0.628,036 200.02 212.59 6.28% HF/HST 14-18 F 9,973 315.68 318.51 0.928,794 240.43 248.35 3.29% HF 19-44 M 9,424 361.81 368.52 1.923,911 240.61 251.21 4.41% HF 19-44 F 25,116 514.02 527.35 2.674,073 349.20 353.86 1.33% HF 45+ M+F 4,614 799.91 820.48 2.6% 12,502 566.27 552.38 (2.45%) HST 19-64 F 1,786 561.24 583.02 3.98,915 352.92 364.18 3.19% EXT 19-34 M 12,036 31,978 $ 500.88 308.05 $ 511.86 2.2314.84 2.20% EXT 19-34 F 10,527 567.53 580.47 2.327,982 357.90 361.39 0.98% EXT 35-44 M 6,721 683.18 705.15 3.2% 16,499 502.11 494.04 (1.61%) EXT 35-44 F 5,793 810.55 830.53 2.5% 13,307 629.67 619.01 (1.69%) EXT 45-54 M 5,528 880.19 898.79 2.1% 16,256 742.21 716.53 (3.46%) EXT 45-54 F 6,208 971.78 996.97 2.6% 16,605 790.93 769.27 (2.74%) EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% 11,743 864.31 838.06 (3.04%) EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% 13,660 876.70 850.55 (2.98%) ABD <21 3,162 8,415 $ 1,223.04 1,091.48 $ 1,246.28 1.9% 1,063.64 (2.55%) ABD 21+ 11,894 1,549.61 1,593.82 2.9% 25,517 1,530.27 1,438.83 (5.98%) HF/HST <1 M+F 18,881 15,675 $ 1,375.64 1,109.37 $ 1,362.27 (1.0%) 1,139.78 2.74% HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) 15,314 200.53 220.22 9.82% HF/HST 2-13 M+F 224,655 212.38 213.43 0.5153,344 148.50 169.42 14.09% HF/HST 14-18 M 40,560 248.78 251.88 1.224,107 186.30 197.29 5.90% HF/HST 14-18 F 40,839 304.53 309.14 1.524,300 235.59 242.48 2.92% HF 19-44 M 32,969 322.73 327.89 1.623,509 261.50 267.67 2.36% HF 19-44 F 112,237 490.07 501.31 2.3% 61,530 384.62 383.36 (0.33%) HF 45+ M+F 20,522 675.31 691.25 2.4% 11,524 577.08 558.52 (3.22%) HST 19-64 F 7,105 638.81 659.09 3.27,394 376.44 384.76 2.21% EXT 19-34 M 62,187 24,461 $ 474.15 331.98 $ 482.33 1.7333.40 0.43% EXT 19-34 F 50,610 473.53 481.26 1.622,528 381.91 382.06 0.04% EXT 35-44 M 31,273 671.62 684.60 1.9% 12,279 568.63 558.03 (1.86%) EXT 35-44 F 23,623 695.39 708.63 1.9% 10,758 639.73 617.61 (3.46%) EXT 45-54 M 26,371 869.64 885.73 1.9% 11,994 824.51 786.65 (4.59%) EXT 45-54 F 26,643 904.61 924.19 2.2% 12,797 814.04 783.41 (3.76%) EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% 8,432 926.65 900.00 (2.88%) EXT 55-64 F 25,852 970.77 989.78 2.0% 10,049 859.37 829.74 (3.45%) ABD <21 17,875 6,348 $ 1,102.71 1,326.77 $ 1,127.93 2.3% 1,237.29 (6.74%) ABD 21+ 50,902 1,677.75 1,716.97 2.3% 25,104 1,476.86 1,382.19 (6.41%) HF/HST <1 M+F 4,852 5,136 $ 943.93 875.72 $ 930.70 (1.4%) 912.39 4.19% HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) 4,792 194.41 208.18 7.08% HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) 52,033 149.57 168.37 12.57% HF/HST 14-18 M 9,435 232.90 234.29 0.69,112 198.51 213.39 7.50% HF/HST 14-18 F 9,558 286.31 289.76 1.29,072 235.88 243.65 3.29% HF 19-44 M 7,730 320.29 325.64 1.79,800 265.97 277.62 4.38% HF 19-44 F 24,818 459.17 470.62 2.523,088 373.95 377.23 0.88% HF 45+ M+F 3,897 666.61 681.52 2.2% 4,064 563.13 550.65 (2.22%) HST 19-64 F 1,881 509.02 531.96 4.52,551 474.67 484.24 2.02% EXT 19-34 M 11,012 9,937 $ 477.49 277.70 $ 486.84 2.0292.16 5.21% EXT 19-34 F 9,978 489.01 497.61 1.88,503 358.50 364.69 1.73% EXT 35-44 M 6,119 674.86 688.08 2.0% 4,859 551.12 537.38 (2.49%) EXT 35-44 F 5,416 753.87 770.48 2.2% 4,336 581.18 566.30 (2.56%) EXT 45-54 M 5,062 909.71 927.27 1.9% 4,853 702.30 675.71 (3.79%) EXT 45-54 F 5,664 935.40 955.98 2.2% 5,532 752.47 731.29 (2.81%) EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% 3,764 818.89 784.24 (4.23%) EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% 4,463 820.93 793.53 (3.34%) ABD <21 3,413 2,060 $ 1,161.76 1,036.06 $ 1,180.81 1.61,040.69 0.45% ABD 21+ 9,197 1,581.29 1,624.62 2.7% 9,581 1,352.36 1,282.59 (5.16%) HF/HST <1 M+F 68,698 18,988 $ 1,315.48 979.40 $ 1,311.11 (0.3%) 1,016.10 3.75% HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) 19,190 198.09 217.53 9.81% HF/HST 2-13 M+F 780,446 204.79 205.11 0.2204,259 133.27 152.51 14.44% HF/HST 14-18 M 137,992 247.24 249.51 0.935,455 173.09 189.50 9.48% HF/HST 14-18 F 138,541 306.84 310.53 1.236,337 207.12 219.46 5.96% HF 19-44 M 110,930 342.11 348.14 1.829,997 231.97 242.73 4.64% HF 19-44 F 360,856 507.19 519.91 2.594,508 345.96 351.90 1.72% HF 45+ M+F 63,557 696.97 713.12 2.3% 17,329 543.87 530.27 (2.50%) HST 19-64 F 26,968 576.45 596.43 3.58,307 396.58 415.22 4.70% EXT 19-34 M 178,709 44,680 $ 519.67 291.11 $ 530.45 2.1297.86 2.32% EXT 19-34 F 151,571 524.77 534.79 1.938,620 346.76 352.99 1.80% EXT 35-44 M 94,931 744.24 760.84 2.221,557 464.71 459.39 (1.14%) EXT 35-44 F 17,219 552.52 544.00 (1.54%) EXT 45-54 M 22,615 726.31 696.72 (4.07%) EXT 45-54 F 23,281 744.03 718.70 (3.40%) EXT 55-64 M 18,318 866.85 834.65 (3.71%) EXT 55-64 F 20,897 795.47 766.80 (3.60%) ABD <21 12,671 $ 767.27 $ 751.54 (2.05%) ABD 21+ 40,838 1,514.95 1,419.71 (6.29%) HF/HST <1 M+F 5,122 $ 719.61 $ 761.52 5.82% HF/HST 1 M+F 4,907 168.34 191.65 13.85% HF/HST 2-13 M+F 50,487 124.90 149.31 19.54% HF/HST 14-18 M 8,345 196.23 211.01 7.53% HF/HST 14-18 F 8,487 203.89 220.22 8.01% HF 19-44 M 7,375 212.42 226.17 6.47% HF 19-44 F 21,153 331.49 340.73 2.79% HF 45+ M+F 3,431 548.42 537.54 (1.98%) HST 19-64 F 2,754 405.22 423.96 4.62% EXT 19-34 M 8,104 $ 269.22 $ 282.55 4.95% EXT 19-34 F 7,853 322.68 329.75 2.19% EXT 35-44 M 4,181 427.62 414.66 (3.03%) EXT 35-44 F 75,729 781.14 798.61 2.2% 3,998 555.29 549.56 (1.03%) EXT 45-54 M 77,168 947.09 967.23 2.1% 4,226 669.44 647.29 (3.31%) EXT 45-54 F 80,589 972.03 995.00 2.4% 4,913 693.71 679.99 (1.98%) EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% 3,354 843.76 810.76 (3.91%) EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% 4,068 795.06 759.76 (4.44%) ABD <21 52,254 2,213 $ 1,132.61 829.32 $ 1,156.23 2.1832.16 0.34% ABD 21+ 150,389 1,677.90 1,721.10 2.67,083 1,360.87 1,291.39 (5.11%) HF/HST <1 M+F 70,925 $ 933.41 $ 960.51 2.90% HF/HST 1 M+F 69,206 186.86 206.09 10.29% HF/HST 2-13 M+F 718,010 138.10 158.83 15.01% HF/HST 14-18 M 117,504 187.60 201.94 7.64% HF/HST 14-18 F 119,660 222.79 233.18 4.66% HF 19-44 M 105,740 246.22 256.32 4.10% HF 19-44 F 307,700 359.03 363.17 1.15% HF 45+ M+F 54,076 564.64 549.63 (2.66%) HST 19-64 F 34,019 391.40 404.23 3.28% EXT 19-34 M 132,541 $ 302.31 $ 309.29 2.31% EXT 19-34 F 118,316 356.57 360.95 1.23% EXT 35-44 M 65,992 504.94 497.13 (1.55%) EXT 35-44 F 55,396 598.39 585.16 (2.21%) EXT 45-54 M 66,475 749.19 718.73 (4.07%) EXT 45-54 F 70,182 774.96 750.09 (3.21%) EXT 55-64 M 50,509 874.10 843.79 (3.47%) EXT 55-64 F 58,714 833.51 804.58 (3.47%) ABD <21 35,579 $ 963.46 $ 927.45 (3.74%) ABD 21+ 120,358 1,490.96 1,401.88 (5.97%) The following are the MCP Managed Care Plan’s (MCP’s) responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall will provide both members and eligible individuals with a copy of their practice guidelines.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2018 amendment to the certified calendar year (CY) 2021 2018 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this reportletter, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report letter will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report letter to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report letter prepared for ODM 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 report letter must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2018 amendment to the certified CY 2018 capitation rates capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 4,094 $ 999.86 4,189.42 $ 1,004.70 4,198.15 0.2% Community Well 18-44 1,702 534.74 537.70 0.6% Community Well 45-64 2,651 586.70 590.31 0.6% Community Well 65+ 2,379 728.75 735.03 0.9% NFLOC 4,686 $ 3,123.62 $ 3,129.10 0.2% Community Well 18-44 1,536 320.60 324.58 1.2% Community Well 45-64 2,464 379.58 383.83 1.1% Community Well 65+ 1,812 577.23 582.58 0.9% NFLOC 6,942 $ 3,856.23 $ 3,864.08 0.2% Community Well 18-44 3,462 329.83 333.84 1.2% Community Well 45-64 5,688 393.69 397.99 1.1% Community Well 65+ 5,433 606.69 612.16 0.9% NFLOC 2,178 $ 3,538.70 $ 3,556.45 0.5% HF/HST 1 M+F 4,570 206.06 201.25 Community Well 18-44 1,150 295.77 299.43 1.2% Community Well 45-64 1,848 362.27 366.13 1.1% Community Well 65+ 1,333 602.29 606.96 0.8% NFLOC 2,400 $ 3,566.16 $ 3,572.25 0.2% Community Well 18-44 1,291 396.72 394.61 (2.30.5%) HF/HST 2Community Well 45-13 M+F 49,838 194.74 192.69 64 1,970 459.28 458.03 (1.10.3%) HF/HST 14Community Well 65+ 1,301 673.35 676.13 0.4% NFLOC 4,218 $ 3,817.55 $ 3,811.92 (0.1%) Community Well 18-18 M 8,846 230.65 230.14 44 2,023 319.56 321.90 0.7% Community Well 45-64 3,214 403.71 405.73 0.5% Community Well 65+ 2,145 716.81 720.00 0.4% NFLOC 3,248 $ 3,333.99 $ 3,328.25 (0.2%) HF/HST 14Community Well 18-18 F 8,683 289.81 290.04 44 1,152 323.11 328.92 1.8% Community Well 45-64 1,696 375.23 380.54 1.4% Community Well 65+ 1,015 536.32 539.64 0.6% NFLOC 27,766 $ 3,664.77 $ 3,669.34 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.112,316 358.51 361.59 0.9% HF 19-44 F 24,684 527.73 537.14 1.8% HF Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.819,531 421.80 425.11 0.8% EXT 19Community Well 65+ 15,418 637.99 642.82 0.8% Prepared for: Deputy Director Rate Setting Ohio Department of Medicaid Prepared by: FSA, MAAA Principal and Consulting Actuary FSA, MAAA Principal and Consulting Actuary ASA, MAAA Associate Actuary Market Tower 00 Xxxx Xxxxxx Xxxxxx Xxxxx 0000 Xxxxxxxxxxxx, XX 00000-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 0000 XXX Tel +0 000 000 0000 Fax +0 000 000 0000 xxxxxxxx.xxx Summary of Methodology 3 Inpatient Hospital Facility Reimbursement Changes 4 Nursing Facility Reimbursement Changes 4 Serious Mental Illness (0.7%SMI) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollmentHealth Home 4 Immaterial Program Adjustments. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.4
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2019 amendment to the certified calendar year (CY) 2021 2019 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2019 amendment to the certified CY 2019 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 27,389 $ 999.86 3,710.02 $ 1,004.70 0.53,780.22 1.9% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 13,371 339.73 $ 344.61 1.4% Community Well 45-64 22,867 388.79 $ 395.03 1.6% Community Well 65+ 18,166 436.57 $ 446.84 2.4% NFLOC 4,069 $ 4,267.31 $ 4,332.13 1.5% Community Well 18-44 1,829 428.84 433.71 1.1% HF 19Community Well 45-64 3,191 542.68 548.79 1.1% Community Well 65+ 2,909 581.25 591.49 1.8% NFLOC 4,634 $ 3,267.58 $ 3,339.81 2.2% Community Well 18-44 F 24,684 527.73 537.14 1.81,703 281.92 287.27 1.9% HF Community Well 45-64 2,773 343.40 351.73 2.4% Community Well 65+ M+F 3,791 764.60 777.49 2,099 409.60 423.18 3.3% NFLOC 6,515 $ 3,873.91 $ 3,936.98 1.6% Community Well 18-44 3,632 359.56 364.14 1.3% Community Well 45-64 6,325 369.92 375.55 1.5% Community Well 65+ 6,019 394.57 402.72 2.1% NFLOC 2,341 $ 3,707.25 $ 3,794.17 2.3% Community Well 18-44 1,167 318.26 322.53 1.3% Community Well 45-64 2,062 360.29 366.55 1.7% HST 19Community Well 65+ 1,543 402.40 413.65 2.8% NFLOC 2,532 $ 3,609.06 $ 3,649.39 1.1% Community Well 18-44 1,473 281.75 285.95 1.5% Community Well 45-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 2,530 338.74 343.05 1.3% EXT 35Community Well 65+ 1,567 355.03 360.80 1.6% NFLOC 4,275 $ 3,725.03 $ 3,807.04 2.2% Community Well 18-44 M 5,909 865.18 878.33 2,316 324.12 328.93 1.5% EXT 35Community Well 45-64 3,875 374.16 380.52 1.7% Community Well 65+ 2,666 432.93 443.05 2.3% NFLOC 3,023 $ 3,350.40 $ 3,435.48 2.5% Community Well 18-44 F 4,531 912.74 928.83 1.81,251 347.74 354.37 1.9% EXT Community Well 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2,111 387.04 394.65 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45Community Well 65+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 1,363 494.29 513.28 3.8% EXT 19Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. xxxxxxxx.xxx MILLIMAN CLIENT REPORT July 2019 MyCare Ohio Provider Agreement Rate Amendment Summary Opt-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19Out Capitation Rates June 18, 2019 Xxxxxx X. Xxxxxx, FSA, MAAA Xxxxx X. Xxxxx, FSA, MAAA Principal and Consulting Actuary Consulting Actuary Xxxxxxx X. Xxxxxx, FSA, MAAA Principal and Consulting Actuary MILLIMAN CLIENT REPORT Table of Contents I. INTRODUCTION & EXECUTIVE SUMMARY 3 BACKGROUND 3 SUMMARY OF METHODOLOGY 4 II. PROSPECTIVE DATA ADJUSTMENTS 5 PROGRAM ADJUSTMENTS: JULY THROUGH DECEMBER 2019 5 NURSING FACILITY REIMBURSEMENT CHANGES 5 VENTILATOR-34 F 29,214 603.11 616.40 2.2% EXT 35DEPENDENT NURSING FACILITY RATE CHANGE 5 IMMATERIAL PROGRAM ADJUSTMENTS 5
III. NON-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 BENEFIT EXPENSES 6 CARE MANAGEMENT COSTS 6 ADMINISTRATIVE EXPENSE COST ALLOWANCE 6 STATE TAXES AND FEES 6 IV. OTHER ITEMS 7 INCENTIVES AND WITHHOLDS 7 V. MEMBER ENROLLMENT MIX ADJUSTMENT (0.3%MEMA) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment8 VI. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.LIMITATIONS AND DATA RELIANCE 9
I. Introduction & Executive Summary
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2020 amendment to the certified calendar year (CY) 2021 2020 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2020 amendment to the certified CY 2020 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 22,557 $ 999.86 4,099.22 $ 1,004.70 4,127.24 0.7% Community Well 18-44 4,878 303.11 308.14 1.7% Community Well 45-64 10,554 365.42 371.05 1.5% Community Well 65+ 9,917 435.98 442.91 1.6% NFLOC 2,462 $ 4,744.90 $ 4,763.98 0.4% Community Well 18-44 643 336.86 342.46 1.7% Community Well 45-64 1,250 455.96 461.72 1.3% Community Well 65+ 1,261 582.25 588.14 1.0% NFLOC 3,898 $ 3,623.66 $ 3,641.62 0.5% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.1656 277.18 281.75 1.6% HF 19Community Well 45-64 1,497 345.67 351.24 1.6% Community Well 65+ 1,384 452.22 460.01 1.7% NFLOC 5,946 $ 4,266.90 $ 4,296.53 0.7% Community Well 18-44 F 24,684 527.73 537.14 1.81,179 308.90 313.11 1.4% HF Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.82,634 371.28 376.18 1.3% EXT 19Community Well 65+ 3,268 434.30 440.84 1.5% NFLOC 1,340 $ 3,772.36 $ 3,795.52 0.6% Community Well 18-34 M 11,813 $ 582.92 $ 591.19 44 434 265.47 269.55 1.5% Community Well 45-64 925 321.03 325.22 1.3% Community Well 65+ 813 378.38 383.54 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 NFLOC 1,367 $ 943.34 4,123.12 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 4,102.09 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19Community Well 18-44 M 23,665 349.19 356.00 446 328.42 333.55 1.6% Community Well 45-64 950 373.29 378.30 1.3% Community Well 65+ 665 345.83 350.35 1.3% NFLOC 4,104 $ 4,518.99 $ 4,583.16 1.4% Community Well 18-44 913 302.42 308.41 2.0% HF 19Community Well 45-64 1,881 356.57 363.73 2.0% Community Well 65+ 1,534 422.74 432.11 2.2% NFLOC 3,440 $ 3,503.17 $ 3,524.44 0.6% Community Well 18-44 F 71,281 563.74 580.36 2.9607 293.46 299.17 1.9% HF Community Well 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1,417 330.94 337.22 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45Community Well 65+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 992 361.08 368.70 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP MCOP’s responsibilities related to communicating with eligible individuals pre-enrollment and MCP MCOP members post-enrollment. Upon request, the MCP shall MCOP will provide both members and eligible individuals with a copy of their practice guidelines.
1. The MyCare Ohio logo shall be on all member communications and marketing materials, excluding nominal gifts.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2017 amendment to the certified calendar year (CY) 2021 2017 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Opt-Out Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs MCOPs in the development of the July 1, 2017 amendment to the certified CY 2017 capitation rates. Milliman has relied upon ODM and the MCOPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 Region: Central / Southeast Projected AverageRate Cell Monthly Members January - December 2017 Capitation Rate July - December 2017 Capitation Rate Total Change NFLOC Total 2,173 304 621 861 3,959 Projected Average Monthly Members $ 999.86 4,777.16 542.66 746.75 994.94 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 2,997.25 January - December 2017 Capitation Rate $ 4,506.12 (2.35.67%) HF/HST 2-13 M+F 49,838 194.74 192.69 Community Well 65+ 973.56 (1.12.15%) HF/HST 14-18 M 8,846 230.65 230.14 NFLOC Total 2,601 328 702 662 4,293 Projected Average Monthly Members $ 3,892.59 345.05 408.82 827.21 $ 2,579.18 January - December 2017 Capitation Rate $ 3,674.13 (0.25.61%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 65+ 808.95 (2.21%) NFLOC Total 4,634 Community Well 18-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 450 Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 1,120 Community Well 65+ 1,529 All Populations 7,733 Region: Northeast Central Projected AverageRate Cell Monthly Members $ 582.92 4,319.74 436.40 509.30 713.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 2,828.92 January - December 2017 Capitation Rate $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 4,040.43 (0.76.47%) HF/HST 1 M+F 3,252 216.22 213.31 694.39 (1.32.74%) HF/HST 2-13 M+F 33,863 160.73 157.34 NFLOC Total 1,051 195 403 362 2,011 Projected Average Monthly Members $ 4,456.99 304.05 356.92 789.60 $ 2,572.48 January - December 2017 Capitation Rate $ 4,193.99 (2.15.90%) HF/HST 14-18 M 6,148 240.46 240.31 Community Well 65+ 773.03 (0.12.10%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 NFLOC Total 1,141 212 385 350 2,088 Projected Average Monthly Members $ 548.84 4,472.59 472.90 522.64 640.52 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 2,695.82 January - December 2017 Capitation Rate $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 4,221.09 (0.15.62%) HF/HST 1 M+F 15,372 288.51 287.04 Community Well 65+ 642.93 0.38% NFLOC Total 3,373 462 953 886 5,674 Projected Average Monthly Members $ 4,712.23 382.73 471.20 949.75 $ 3,059.87 January - December 2017 Capitation Rate $ 4,482.57 (0.54.87%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1Community Well 65+ 950.12 0.04% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 NFLOC Total 3,058 345 755 447 4,605 Projected Average Monthly Members $ 601.51 3,687.58 444.42 516.58 874.02 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 2,651.61 January - December 2017 Capitation Rate $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 3,448.26 (0.36.49%) HF/HST 1 M+F 4,784 233.22 229.74 Community Well 65+ 853.93 (1.52.30%) HF/HST 2-13 M+F 53,831 194.79 194.39 NFLOC Total 18,031 $ 4,297.13 $ 4,046.38 (0.25.84%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45Community Well 65+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 5,097 831.47 816.92 (1.01.75%) HF/HST Appendix 01 - Rate Change Xxxxxxxx, Inc. Page 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <of 1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP MyCare Ohio Plan’s (MCOP’s) responsibilities related to communicating with eligible individuals pre-enrollment pre‐enrollment and MCP MCOP members post-enrollmentpost‐enrollment. Upon request, the MCP shall MCOP will provide both members and eligible individuals with a copy of their practice guidelines.
1. The MyCare Ohio logo must be on all member communications and marketing materials, excluding nominal gifts.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2018 amendment to the certified calendar year (CY) 2021 2018 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the July 1, 2018 amendment to the certified CY 2018 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,831 $ 999.86 833.97 $ 1,004.70 0.5842.78 1.06% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.24,655 165.62 174.92 5.62% HF/HST 2-13 M+F 195,275 209.02 210.22 0.648,224 133.99 175.87 31.26% HF/HST 14-18 M 34,218 244.22 246.87 1.17,544 177.01 237.38 34.11% HF/HST 14-18 F 34,248 316.37 321.05 1.57,662 232.28 293.69 26.44% HF 19-44 M 25,453 345.00 351.93 2.06,515 275.14 323.02 17.40% HF 19-44 F 87,917 494.47 507.49 2.621,226 390.07 444.98 14.08% HF 45+ M+F 14,354 677.16 692.62 2.33,348 607.61 652.45 7.38% HST 19-64 F 7,148 551.47 569.97 3.41,808 435.80 562.72 29.12% EXT 19-34 M 42,323 9,890 $ 516.42 309.55 $ 528.92 2.4393.68 27.18% EXT 19-34 F 35,855 531.85 543.10 2.18,753 353.73 430.90 21.82% EXT 35-44 M 23,577 745.91 763.14 2.34,728 492.04 585.86 19.07% EXT 35-44 F 18,522 790.64 810.28 2.53,813 581.19 667.38 14.83% EXT 45-54 M 18,469 935.82 957.10 2.34,440 710.82 784.29 10.34% EXT 45-54 F 18,972 1,005.41 1,030.53 2.54,605 775.27 850.46 9.70% EXT 55-64 M 15,046 1,153.35 1,179.15 2.23,334 881.49 936.58 6.25% EXT 55-64 F 16,926 1,041.51 1,065.35 2.33,681 863.73 912.11 5.60% ABD <21 12,397 3,796 $ 1,162.87 716.26 $ 1,186.20 2.0905.62 26.44% ABD 21+ 33,463 1,648.92 1,692.23 2.610,301 1,614.35 1,759.32 8.98% HF/HST <1 M+F 14,934 3,451 $ 1,631.73 821.10 $ 1,629.98 (0.1%) 821.86 0.09% HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) 2,972 153.33 159.79 4.21% HF/HST 2-13 M+F 169,110 208.57 208.76 0.132,032 133.28 152.15 14.16% HF/HST 14-18 M 28,913 254.04 256.54 1.05,112 190.99 224.40 17.49% HF/HST 14-18 F 29,231 318.77 322.18 1.15,328 210.95 242.34 14.88% HF 19-44 M 23,665 349.19 356.00 2.03,800 277.11 312.62 12.81% HF 19-44 F 71,281 563.74 580.36 2.911,636 385.41 426.30 10.61% HF 45+ M+F 14,148 708.47 725.94 2.51,719 618.02 645.81 4.50% HST 19-64 F 5,883 586.12 608.58 3.81,449 416.14 520.50 25.08% EXT 19-34 M 33,504 4,499 $ 601.51 318.00 $ 615.92 2.4394.67 24.11% EXT 19-34 F 29,214 603.11 616.40 2.24,633 351.63 415.85 18.26% EXT 35-44 M 18,111 880.49 903.51 2.62,305 524.38 590.74 12.65% EXT 35-44 F 14,846 877.94 899.88 2.52,338 612.74 675.44 10.23% EXT 45-54 M 14,468 1,104.90 1,132.14 2.52,192 813.11 863.90 6.25% EXT 45-54 F 14,970 1,041.40 1,068.72 2.62,608 856.00 904.78 5.70% EXT 55-64 M 10,764 1,286.32 1,322.63 2.81,757 891.03 922.09 3.49% EXT 55-64 F 12,385 1,158.77 1,190.11 2.72,182 852.34 878.11 3.02% ABD <21 9,842 1,586 $ 1,232.54 752.20 $ 1,259.01 2.1840.72 11.77% ABD 21+ 29,961 1,752.05 1,804.35 3.04,382 1,429.60 1,527.93 6.88% HF/HST <1 M+F 4,722 18,179 $ 1,225.57 926.97 $ 1,221.70 921.57 (0.30.58%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) 17,110 196.31 199.90 1.83% HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) 183,342 151.84 178.39 17.49% HF/HST 14-18 M 9,872 264.29 265.91 0.628,685 207.03 245.92 18.78% HF/HST 14-18 F 9,973 315.68 318.51 0.929,620 249.20 288.01 15.57% HF 19-44 M 9,424 361.81 368.52 1.922,437 262.89 296.59 12.82% HF 19-44 F 25,116 514.02 527.35 2.672,266 370.26 416.77 12.56% HF 45+ M+F 4,614 799.91 820.48 2.612,372 605.75 641.04 5.83% HST 19-64 F 1,786 561.24 583.02 3.96,632 385.45 498.31 29.28% EXT 19-34 M 12,036 34,216 $ 500.88 305.51 $ 511.86 2.2372.02 21.77% EXT 19-34 F 10,527 567.53 580.47 2.329,944 358.32 419.41 17.05% EXT 35-44 M 6,721 683.18 705.15 3.217,659 483.15 559.90 15.89% EXT 35-44 F 5,793 810.55 830.53 2.514,271 581.46 661.46 13.76% EXT 45-54 M 5,528 880.19 898.79 2.116,722 712.31 773.38 8.57% EXT 45-54 F 6,208 971.78 996.97 2.616,897 784.85 846.05 7.80% EXT 55-64 M 4,889 1,100.09 1,132.22 2.912,278 850.15 888.76 4.54% EXT 55-64 F 5,633 1,076.35 1,102.72 2.414,236 819.99 854.31 4.19% ABD <21 3,162 11,527 $ 1,223.04 1,100.74 $ 1,246.28 1.91,269.49 15.33% ABD 21+ 11,894 1,549.61 1,593.82 2.930,997 1,498.08 1,633.32 9.03% HF/HST <1 M+F 18,881 15,879 $ 1,375.64 1,128.61 $ 1,362.27 1,126.97 (1.00.15%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) 15,272 241.68 245.60 1.62% HF/HST 2-13 M+F 224,655 212.38 213.43 0.5155,158 154.91 179.34 15.77% HF/HST 14-18 M 40,560 248.78 251.88 1.224,176 180.97 226.12 24.95% HF/HST 14-18 F 40,839 304.53 309.14 1.524,468 228.70 273.57 19.62% HF 19-44 M 32,969 322.73 327.89 1.621,582 271.47 308.16 13.52% HF 19-44 F 112,237 490.07 501.31 2.358,143 408.98 468.91 14.65% HF 45+ M+F 20,522 675.31 691.25 2.411,639 586.28 629.79 7.42% HST 19-64 F 7,105 638.81 659.09 3.25,846 422.20 549.88 30.24% EXT 19-34 M 62,187 25,808 $ 474.15 366.77 $ 482.33 1.7438.07 19.44% EXT 19-34 F 50,610 473.53 481.26 1.623,664 384.74 468.20 21.69% EXT 35-44 M 31,273 671.62 684.60 1.912,736 549.88 626.87 14.00% EXT 35-44 F 23,623 695.39 708.63 1.911,208 610.05 699.71 14.70% EXT 45-54 M 26,371 869.64 885.73 1.911,906 815.88 883.14 8.24% EXT 45-54 F 26,643 904.61 924.19 2.212,860 802.66 878.39 9.43% EXT 55-64 M 22,966 1,070.04 1,087.93 1.78,599 952.45 1,008.75 5.91% EXT 55-64 F 25,852 970.77 989.78 2.010,246 874.76 929.07 6.21% ABD <21 17,875 8,927 $ 1,102.71 1,198.36 $ 1,127.93 2.31,343.92 12.15% ABD 21+ 50,902 1,677.75 1,716.97 2.329,729 1,485.12 1,620.33 9.10% HF/HST <1 M+F 4,852 5,083 $ 943.93 1,041.31 $ 930.70 1,038.80 (1.40.24%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) 4,827 177.86 181.82 2.23% HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) 52,749 145.24 168.88 16.28% HF/HST 14-18 M 9,435 232.90 234.29 0.69,270 189.94 228.81 20.46% HF/HST 14-18 F 9,558 286.31 289.76 1.29,193 233.94 276.61 18.24% HF 19-44 M 7,730 320.29 325.64 1.79,001 283.12 315.56 11.46% HF 19-44 F 24,818 459.17 470.62 2.522,016 376.88 426.92 13.28% HF 45+ M+F 3,897 666.61 681.52 2.23,956 569.57 603.59 5.97% HST 19-64 F 1,881 509.02 531.96 4.52,240 462.88 597.65 29.12% EXT 19-34 M 11,012 10,378 $ 477.49 312.17 $ 486.84 2.0376.24 20.52% EXT 19-34 F 9,978 489.01 497.61 1.89,161 360.17 433.45 20.35% EXT 35-44 M 6,119 674.86 688.08 2.05,039 501.37 562.83 12.26% EXT 35-44 F 5,416 753.87 770.48 2.24,345 553.85 621.11 12.14% EXT 45-54 M 5,062 909.71 927.27 1.94,939 718.55 763.67 6.28% EXT 45-54 F 5,664 935.40 955.98 2.25,694 761.01 816.93 7.35% EXT 55-64 M 4,312 1,064.55 1,085.81 2.03,970 817.41 847.56 3.69% EXT 55-64 F 5,244 1,023.93 1,044.55 2.04,583 844.49 874.61 3.57% ABD <21 3,413 2,995 $ 1,161.76 966.15 $ 1,180.81 1.61,114.99 15.41% ABD 21+ 9,197 1,581.29 1,624.62 2.711,426 1,313.06 1,428.96 8.83% HF/HST <1 M+F 68,698 20,873 $ 1,315.48 1,127.97 $ 1,311.11 (0.3%) 1,132.79 0.43% HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) 19,639 219.14 226.16 3.20% HF/HST 2-13 M+F 780,446 204.79 205.11 0.2209,194 154.64 187.90 21.51% HF/HST 14-18 M 137,992 247.24 249.51 0.935,614 191.41 238.53 24.62% HF/HST 14-18 F 138,541 306.84 310.53 1.236,605 225.38 276.11 22.51% HF 19-44 M 110,930 342.11 348.14 1.828,245 252.81 283.28 12.05% HF 19-44 F 360,856 507.19 519.91 2.592,405 366.95 416.57 13.52% HF 45+ M+F 63,557 696.97 713.12 2.317,129 571.87 606.31 6.02% HST 19-64 F 26,968 576.45 596.43 3.56,946 482.21 628.87 30.41% EXT 19-34 M 178,709 46,641 $ 519.67 301.37 $ 530.45 2.1364.38 20.91% EXT 19-34 F 151,571 524.77 534.79 1.940,539 345.06 398.79 15.57% EXT 35-44 M 94,931 744.24 760.84 2.222,631 454.16 521.15 14.75% EXT 35-44 F 75,729 781.14 798.61 2.217,928 538.61 604.04 12.15% EXT 45-54 M 77,168 947.09 967.23 2.122,747 688.14 744.23 8.15% EXT 45-54 F 80,589 972.03 995.00 2.423,307 725.52 779.97 7.50% EXT 55-64 M 63,984 1,142.70 1,167.37 2.218,900 818.55 853.93 4.32% EXT 55-64 F 73,014 1,040.15 1,063.13 2.221,324 782.47 819.71 4.76% ABD <21 52,254 17,030 $ 1,132.61 856.47 $ 1,156.23 2.11,036.09 20.97% ABD 21+ 150,389 1,677.90 1,721.10 2.648,187 1,487.60 1,617.89 8.76% HF/HST <1 M+F 5,193 $ 878.07 $ 873.44 (0.53%) HF/HST 1 M+F 4,813 159.45 163.07 2.27% HF/HST 2-13 M+F 51,224 142.76 165.69 16.06% HF/HST 14-18 M 8,318 185.43 226.39 22.09% HF/HST 14-18 F 8,622 229.10 269.55 17.66% HF 19-44 M 6,746 257.86 285.84 10.85% HF 19-44 F 20,718 361.60 401.01 10.90% HF 45+ M+F 3,390 507.88 535.38 5.41% HST 19-64 F 2,069 425.58 528.97 24.29% EXT 19-34 M 8,835 $ 271.99 $ 341.09 25.41% EXT 19-34 F 8,170 346.41 404.05 16.64% EXT 35-44 M 4,388 440.45 508.73 15.50% EXT 35-44 F 4,099 541.67 611.63 12.92% EXT 45-54 M 4,339 639.14 689.45 7.87% EXT 45-54 F 4,955 721.43 762.86 5.74% EXT 55-64 M 3,613 798.19 823.15 3.13% EXT 55-64 F 4,208 762.72 784.31 2.83% ABD <21 3,137 $ 925.64 $ 1,091.77 17.95% ABD 21+ 8,470 1,357.31 1,458.00 7.42% HF/HST <1 M+F 73,489 $ 1,021.00 $ 1,020.79 (0.02%) HF/HST 1 M+F 69,287 205.03 210.20 2.52% HF/HST 2-13 M+F 731,923 150.19 178.42 18.80% HF/HST 14-18 M 118,718 191.59 235.50 22.92% HF/HST 14-18 F 121,497 232.57 277.70 19.40% HF 19-44 M 98,324 264.75 298.67 12.81% HF 19-44 F 298,410 378.67 428.90 13.26% HF 45+ M+F 53,552 582.32 618.90 6.28% HST 19-64 F 26,990 432.83 559.18 29.19% EXT 19-34 M 140,266 $ 314.47 $ 382.25 21.55% EXT 19-34 F 124,864 357.81 422.66 18.12% EXT 35-44 M 69,486 486.54 559.33 14.96% EXT 35-44 F 58,002 570.10 645.51 13.23% EXT 45-54 M 67,285 721.39 780.49 8.19% EXT 45-54 F 70,926 764.23 824.49 7.89% EXT 55-64 M 52,451 852.84 892.40 4.64% EXT 55-64 F 60,460 817.74 855.82 4.66% ABD <21 48,998 $ 973.12 $ 1,139.04 17.05% ABD 21+ 143,491 1,475.09 1,604.65 8.78% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the November 1, 2021 amendment to the certified calendar year (CY) 2021 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the existing participating Medicaid MCPs MyCare Ohio Plans (MCOPs) for this purpose and accepted it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purpose. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 $ 999.86 $ 1,004.70 0.5% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2022 amendment to the certified calendar year (CY) 2021 2022 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care MyCare Ohio Program (MMCMyCare). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the existing participating Medicaid MCPs MyCare Ohio Plans (MCOPs) for this purpose and accepted it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purpose. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 NFLOC 24,085 $ 999.86 3,961.94 $ 1,004.70 0.54,095.17 3.4% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19Community Well 18-44 M 6,999 383.79 388.01 1.15,549 305.99 311.69 1.9% HF 19Community Well 45-64 14,161 346.79 355.53 2.5% Community Well 65+ 14,806 409.16 425.07 3.9% NFLOC 2,616 $ 4,618.73 $ 4,749.93 2.8% Community Well 18-44 F 24,684 527.73 537.14 686 363.04 370.19 2.0% Community Well 45-64 1,757 450.01 460.48 2.3% Community Well 65+ 2,087 542.43 560.81 3.4% NFLOC 4,512 $ 3,580.05 $ 3,683.91 2.9% Community Well 18-44 834 266.45 271.95 2.1% Community Well 45-64 2,049 310.18 318.61 2.7% Community Well 65+ 1,927 404.64 420.72 4.0% NFLOC 6,501 $ 4,099.93 $ 4,217.98 2.9% Community Well 18-44 1,378 296.85 301.46 1.6% Community Well 45-64 3,590 338.60 346.44 2.3% Community Well 65+ 4,756 403.21 417.37 3.5% NFLOC 1,542 $ 3,475.98 $ 3,625.31 4.3% Community Well 18-44 535 253.66 258.60 1.9% Community Well 45-64 1,292 280.93 288.78 2.8% Community Well 65+ 1,212 333.51 347.80 4.3% NFLOC 1,286 $ 3,863.03 $ 4,055.17 5.0% Community Well 18-44 481 336.62 342.59 1.8% HF Community Well 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.81,271 338.32 345.89 2.2% EXT 19-34 M 11,813 Community Well 65+ 1,016 294.44 306.78 4.2% NFLOC 4,032 $ 582.92 4,391.40 $ 591.19 1.44,586.17 4.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35Community Well 18-44 M 5,909 865.18 878.33 1.5962 322.52 329.33 2.1% EXT 35Community Well 45-64 2,441 365.59 376.78 3.1% Community Well 65+ 2,336 438.68 460.42 5.0% NFLOC 3,596 $ 3,476.04 $ 3,578.08 2.9% Community Well 18-44 F 4,531 912.74 928.83 673 311.64 317.16 1.8% EXT Community Well 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 1,761 331.49 338.82 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3Community Well 65+ 1,472 339.95 352.38 3.7% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% HF/HST 14-18 F 9,973 315.68 318.51 0.9% HF 19-44 M 9,424 361.81 368.52 1.9% HF 19-44 F 25,116 514.02 527.35 2.6% HF 45+ M+F 4,614 799.91 820.48 2.6% HST 19-64 F 1,786 561.24 583.02 3.9% EXT 19-34 M 12,036 $ 500.88 $ 511.86 2.2% EXT 19-34 F 10,527 567.53 580.47 2.3% EXT 35-44 M 6,721 683.18 705.15 3.2% EXT 35-44 F 5,793 810.55 830.53 2.5% EXT 45-54 M 5,528 880.19 898.79 2.1% EXT 45-54 F 6,208 971.78 996.97 2.6% EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% ABD <21 3,162 $ 1,223.04 $ 1,246.28 1.9% ABD 21+ 11,894 1,549.61 1,593.82 2.9% HF/HST <1 M+F 18,881 $ 1,375.64 $ 1,362.27 (1.0%) HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% HF/HST 14-18 F 9,558 286.31 289.76 1.2% HF 19-44 M 7,730 320.29 325.64 1.7% HF 19-44 F 24,818 459.17 470.62 2.5% HF 45+ M+F 3,897 666.61 681.52 2.2% HST 19-64 F 1,881 509.02 531.96 4.5% EXT 19-34 M 11,012 $ 477.49 $ 486.84 2.0% EXT 19-34 F 9,978 489.01 497.61 1.8% EXT 35-44 M 6,119 674.86 688.08 2.0% EXT 35-44 F 5,416 753.87 770.48 2.2% EXT 45-54 M 5,062 909.71 927.27 1.9% EXT 45-54 F 5,664 935.40 955.98 2.2% EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% ABD <21 3,413 $ 1,161.76 $ 1,180.81 1.6% ABD 21+ 9,197 1,581.29 1,624.62 2.7% HF/HST <1 M+F 68,698 $ 1,315.48 $ 1,311.11 (0.3%) HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% HF 19-44 M 110,930 342.11 348.14 1.8% HF 19-44 F 360,856 507.19 519.91 2.5% HF 45+ M+F 63,557 696.97 713.12 2.3% HST 19-64 F 26,968 576.45 596.43 3.5% EXT 19-34 M 178,709 $ 519.67 $ 530.45 2.1% EXT 19-34 F 151,571 524.77 534.79 1.9% EXT 35-44 M 94,931 744.24 760.84 2.2% EXT 35-44 F 75,729 781.14 798.61 2.2% EXT 45-54 M 77,168 947.09 967.23 2.1% EXT 45-54 F 80,589 972.03 995.00 2.4% EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% ABD <21 52,254 $ 1,132.61 $ 1,156.23 2.1% ABD 21+ 150,389 1,677.90 1,721.10 2.6% Milliman is among the world’s largest providers of actuarial and related products and services. The firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the globe. xxxxxxxx.xxx The following are the MCP MCOP’s responsibilities related to communicating with eligible individuals individuals’ pre-enrollment and MCP MCOP members post-enrollment. Upon request, the MCP shall MCOP will provide both members and eligible individuals with a copy of their practice guidelines.
1. The MyCare Ohio logo shall be on all member communications and marketing materials, excluding nominal gifts.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2020 amendment to the certified calendar year (CY) 2021 2020 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the July 1, 2020 amendment to the certified CY 2020 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12, 2019. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,779 $ 999.86 1,023.28 $ 1,004.70 0.51,031.60 0.8% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) 4,200 192.11 199.21 3.7% HF/HST 2-13 M+F 49,838 194.74 192.69 49,823 178.83 181.45 1.5% HF/HST 14-18 M 7,870 235.22 238.09 1.2% HF/HST 14-18 F 7,969 304.85 306.11 0.4% HF 19-44 M 6,189 427.78 409.99 (1.14.2%) HF 19-44 F 21,343 577.38 565.45 (2.1%) HF 45+ M+F 3,356 897.67 872.26 (2.8%) HST 19-64 F 1,285 826.07 740.91 (10.3%) EXT 19-34 M 8,560 $ 624.90 $ 593.85 (5.0%) EXT 19-34 F 8,358 591.81 566.81 (4.2%) EXT 35-44 M 4,161 907.14 865.11 (4.6%) EXT 35-44 F 3,922 993.14 951.14 (4.2%) EXT 45-54 M 4,107 1,057.64 1,009.02 (4.6%) EXT 45-54 F 4,493 1,043.51 999.85 (4.2%) EXT 55-64 M 3,826 1,178.91 1,134.78 (3.7%) EXT 55-64 F 4,277 1,145.34 1,105.30 (3.5%) ABD <21 3,897 $ 851.86 $ 859.57 0.9% ABD 21+ 10,631 1,821.16 1,822.30 0.1% HF/HST <1 M+F 3,342 $ 871.70 $ 880.76 1.0% HF/HST 1 M+F 2,901 180.98 186.81 3.2% HF/HST 2-13 M+F 33,461 153.00 155.20 1.4% HF/HST 14-18 M 5,403 263.16 264.11 0.4% HF/HST 14-18 F 5,544 256.55 257.95 0.5% HF 19-44 M 4,098 403.01 385.55 (4.3%) HF 19-44 F 12,497 514.15 503.57 (2.1%) HF 45+ M+F 1,992 862.44 837.72 (2.9%) HST 19-64 F 1,014 586.33 529.42 (9.7%) EXT 19-34 M 4,325 $ 638.82 $ 606.56 (5.0%) EXT 19-34 F 5,074 552.52 528.33 (4.4%) EXT 35-44 M 2,354 794.95 758.47 (4.6%) EXT 35-44 F 2,551 814.66 780.80 (4.2%) EXT 45-54 M 2,274 1,071.22 1,018.46 (4.9%) EXT 45-54 F 2,844 1,130.75 1,081.99 (4.3%) EXT 55-64 M 2,266 1,284.29 1,233.93 (3.9%) EXT 55-64 F 2,752 1,082.93 1,045.28 (3.5%) ABD <21 1,668 $ 814.06 $ 819.88 0.7% ABD 21+ 4,580 1,632.09 1,633.30 0.1% HF/HST <1 M+F 18,540 $ 1,202.89 $ 1,207.81 0.4% HF/HST 1 M+F 16,608 240.65 243.66 1.3% HF/HST 2-13 M+F 193,305 192.88 190.89 (1.0%) HF/HST 14-18 M 8,846 230.65 230.14 29,917 257.45 255.31 (0.20.8%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% 31,001 311.00 307.83 (1.0%) HF 19-44 M 6,999 383.79 388.01 1.1% 22,152 400.38 379.44 (5.2%) HF 19-44 F 24,684 527.73 537.14 1.8% 76,386 529.76 515.57 (2.7%) HF 45+ M+F 3,791 764.60 777.49 1.7% 12,545 780.18 755.00 (3.2%) HST 19-64 F 1,784 597.62 614.09 2.8% 4,958 743.93 669.93 (9.9%) EXT 19-34 M 11,813 31,931 $ 582.92 578.67 $ 591.19 1.4% 546.29 (5.6%) EXT 19-34 F 9,772 535.82 542.74 1.3% 30,900 583.14 554.61 (4.9%) EXT 35-44 M 5,909 865.18 878.33 1.5% 17,533 796.19 756.22 (5.0%) EXT 35-44 F 4,531 912.74 928.83 1.8% 15,565 864.65 825.15 (4.6%) EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% 16,114 1,012.54 960.10 (5.2%) EXT 45-54 F 5,059 991.99 1,010.62 1.9% 17,024 1,066.21 1,017.32 (4.6%) EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% 14,711 1,187.94 1,139.20 (4.1%) EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% 16,269 1,108.08 1,067.28 (3.7%) ABD <21 3,848 12,450 $ 943.34 1,125.95 $ 960.93 1.91,129.43 0.3% ABD 21+ 10,355 1,829.06 1,865.11 2.0% 33,847 1,725.47 1,723.18 (0.1%) HF/HST <1 M+F 3,160 15,710 $ 917.12 1,475.83 $ 910.53 (0.7%) 1,482.60 0.5% HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) 14,208 262.42 264.82 0.9% HF/HST 2-13 M+F 33,863 160.73 157.34 166,896 197.56 195.74 (2.10.9%) HF/HST 14-18 M 6,148 240.46 240.31 25,723 269.80 267.74 (0.10.8%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% 26,119 335.97 332.70 (1.0%) HF 19-44 M 4,690 361.17 366.83 1.6% 21,432 405.72 385.44 (5.0%) HF 19-44 F 14,803 474.99 484.86 2.1% 61,624 600.34 584.40 (2.7%) HF 45+ M+F 2,231 676.02 688.62 1.9% 12,378 795.65 771.01 (3.1%) HST 19-64 F 1,381 427.98 441.58 3.2% 4,044 751.06 677.40 (9.8%) EXT 19-34 M 5,834 25,789 $ 548.84 670.37 $ 561.41 2.3% 632.64 (5.6%) EXT 19-34 F 5,615 497.91 506.20 1.7% 25,111 659.17 626.69 (4.9%) EXT 35-44 M 3,221 708.29 720.92 1.8% 13,599 980.70 931.04 (5.1%) EXT 35-44 F 2,998 712.36 726.39 2.0% 12,554 966.49 922.92 (4.5%) EXT 45-54 M 2,600 989.46 1,014.67 2.5% 12,821 1,201.03 1,138.65 (5.2%) EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% 13,713 1,111.36 1,061.06 (4.5%) EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% 10,752 1,351.68 1,296.19 (4.1%) EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% 12,264 1,208.12 1,161.72 (3.8%) ABD <21 1,717 9,712 $ 852.44 1,203.28 $ 868.45 1.91,207.20 0.3% ABD 21+ 4,617 1,592.24 1,632.60 2.5% 30,651 1,814.90 1,813.17 (0.1%) HF/HST <1 M+F 17,597 5,014 $ 1,262.30 1,190.27 $ 1,265.69 0.31,194.97 0.4% HF/HST 1 M+F 18,049 281.37 281.84 0.24,473 261.24 264.74 1.3% HF/HST 2-13 M+F 195,275 209.02 210.22 54,654 190.72 189.56 (0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 (0.1%) HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% HF/HST 14-18 M 28,913 254.04 256.54 1.0% HF/HST 14-18 F 29,231 318.77 322.18 1.1% HF 19-44 M 23,665 349.19 356.00 2.0% HF 19-44 F 71,281 563.74 580.36 2.9% HF 45+ M+F 14,148 708.47 725.94 2.5% HST 19-64 F 5,883 586.12 608.58 3.8% EXT 19-34 M 33,504 $ 601.51 $ 615.92 2.4% EXT 19-34 F 29,214 603.11 616.40 2.2% EXT 35-44 M 18,111 880.49 903.51 2.6% EXT 35-44 F 14,846 877.94 899.88 2.5% EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% ABD <21 9,842 $ 1,232.54 $ 1,259.01 2.1% ABD 21+ 29,961 1,752.05 1,804.35 3.0% HF/HST <1 M+F 4,722 $ 1,225.57 $ 1,221.70 (0.3%) HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% 9,176 275.22 273.38 (0.7%) HF/HST 14-18 F 9,973 315.68 318.51 0.9% 9,302 317.92 315.78 (0.7%) HF 19-44 M 9,424 361.81 368.52 1.9% 8,950 442.05 419.18 (5.2%) HF 19-44 F 25,116 514.02 527.35 22,848 562.21 547.87 (2.6% %) HF 45+ M+F 4,614 799.91 820.48 2.6% 4,142 844.10 817.04 (3.2%) HST 19-64 F 1,786 561.24 583.02 3.9% 1,494 693.20 621.57 (10.3%) EXT 19-34 M 12,036 9,955 $ 500.88 587.28 $ 511.86 2.2% 554.77 (5.5%) EXT 19-34 F 10,527 567.53 580.47 2.3% 9,543 593.60 565.16 (4.8%) EXT 35-44 M 6,721 683.18 705.15 3.2% 5,316 772.44 735.83 (4.7%) EXT 35-44 F 5,793 810.55 830.53 2.5% 5,045 871.15 832.72 (4.4%) EXT 45-54 M 5,528 880.19 898.79 2.1% 5,151 1,012.96 961.77 (5.1%) EXT 45-54 F 6,208 971.78 996.97 2.6% 5,941 1,000.44 956.17 (4.4%) EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% 4,891 1,196.43 1,148.53 (4.0%) EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% 5,695 1,128.96 1,086.82 (3.7%) ABD <21 3,162 3,116 $ 1,223.04 1,136.21 $ 1,246.28 1.91,141.11 0.4% ABD 21+ 11,894 1,549.61 1,593.82 2.9% 12,168 1,603.59 1,602.22 (0.1%) HF/HST <1 M+F 18,881 20,391 $ 1,375.64 1,308.30 $ 1,362.27 (1.0%) 1,309.35 0.1% HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) 18,714 245.23 248.29 1.2% HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% HF/HST 14-18 M 40,560 248.78 251.88 1.2% HF/HST 14-18 F 40,839 304.53 309.14 1.5% HF 19-44 M 32,969 322.73 327.89 1.6% HF 19-44 F 112,237 490.07 501.31 2.3% HF 45+ M+F 20,522 675.31 691.25 2.4% HST 19-64 F 7,105 638.81 659.09 3.2% EXT 19-34 M 62,187 $ 474.15 $ 482.33 1.7% EXT 19-34 F 50,610 473.53 481.26 1.6% EXT 35-44 M 31,273 671.62 684.60 1.9% EXT 35-44 F 23,623 695.39 708.63 1.9% EXT 45-54 M 26,371 869.64 885.73 1.9% EXT 45-54 F 26,643 904.61 924.19 2.2% EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% EXT 55-64 F 25,852 970.77 989.78 2.0% ABD <21 17,875 $ 1,102.71 $ 1,127.93 2.3% ABD 21+ 50,902 1,677.75 1,716.97 2.3% HF/HST <1 M+F 4,852 $ 943.93 $ 930.70 229,076 199.81 198.15 (1.4%) HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) HF/HST 2-13 M+F 53,874 192.98 192.70 (0.10.8%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% 37,192 253.24 251.86 (0.5%) HF/HST 14-18 F 9,558 286.31 289.76 1.2% 38,584 302.54 300.33 (0.7%) HF 19-44 M 7,730 320.29 325.64 1.7% 30,284 363.38 345.89 (4.8%) HF 19-44 F 24,818 459.17 470.62 100,984 519.68 506.81 (2.5% %) HF 45+ M+F 3,897 666.61 681.52 2.2% 18,885 738.70 716.49 (3.0%) HST 19-64 F 1,881 509.02 531.96 4.5% 5,149 823.87 740.51 (10.1%) EXT 19-34 M 11,012 49,370 $ 477.49 538.47 $ 486.84 2.0% 509.69 (5.3%) EXT 19-34 F 9,978 489.01 497.61 1.8% 45,315 531.19 506.54 (4.6%) EXT 35-44 M 6,119 674.86 688.08 2.0% 24,482 725.21 690.08 (4.8%) EXT 35-44 F 5,416 753.87 770.48 2.2% 21,055 752.76 719.99 (4.4%) EXT 45-54 M 5,062 909.71 927.27 1.9% 24,253 954.82 907.20 (5.0%) EXT 45-54 F 5,664 935.40 955.98 2.2% 25,228 962.73 920.25 (4.4%) EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% 23,518 1,120.57 1,076.68 (3.9%) EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% 26,356 987.06 950.91 (3.7%) ABD <21 3,413 17,881 $ 1,161.76 1,069.38 $ 1,180.81 1.61,073.55 0.4% ABD 21+ 9,197 1,581.29 1,624.62 2.751,605 1,712.51 1,713.42 0.1% HF/HST <1 M+F 68,698 5,264 $ 1,315.48 978.15 $ 1,311.11 982.35 0.4% HF/HST 1 M+F 4,589 216.86 220.51 1.7% HF/HST 2-13 M+F 54,515 181.13 180.39 (0.4%) HF/HST 14-18 M 8,562 242.26 241.45 (0.3%) HF/HST 14-18 F 8,878 291.79 289.86 (0.7%) HF 19-44 M 6,892 392.86 373.57 (4.9%) HF 19-44 F 22,074 490.54 478.32 (2.5%) HF 45+ M+F 3,521 720.43 698.14 (3.1%) HST 19-64 F 1,498 632.94 566.47 (10.5%) EXT 19-34 M 8,517 $ 554.21 $ 524.13 (5.4%) EXT 19-34 F 9,179 530.38 505.43 (4.7%) EXT 35-44 M 4,520 740.77 704.66 (4.9%) EXT 35-44 F 4,703 805.78 769.75 (4.5%) EXT 45-54 M 4,496 930.40 883.60 (5.0%) EXT 45-54 F 5,235 943.49 901.98 (4.4%) EXT 55-64 M 4,337 1,154.40 1,107.24 (4.1%) EXT 55-64 F 5,270 998.07 960.08 (3.8%) ABD <21 3,374 $ 1,145.96 $ 1,150.70 0.4% ABD 21+ 9,138 1,539.66 1,538.52 (0.1%) HF/HST <1 M+F 70,522 261.59 260.32 73,040 $ 1,247.06 $ 1,251.64 0.4% HF/HST 1 M+F 65,692 240.66 244.02 1.4% HF/HST 2-13 M+F 781,730 192.34 191.10 (0.6%) HF/HST 14-18 M 123,842 257.85 256.53 (0.5%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% HF/HST 14-18 M 137,992 247.24 249.51 0.9% HF/HST 14-18 F 138,541 306.84 310.53 1.2% 127,397 309.97 307.71 (0.7%) HF 19-44 M 110,930 342.11 348.14 1.8% 99,996 395.33 375.86 (4.9%) HF 19-44 F 360,856 507.19 519.91 317,756 542.44 528.75 (2.5% %) HF 45+ M+F 63,557 696.97 713.12 2.3% 56,818 780.54 756.51 (3.1%) HST 19-64 F 26,968 576.45 596.43 3.5% 19,442 751.34 675.85 (10.0%) EXT 19-34 M 178,709 138,447 $ 519.67 585.27 $ 530.45 2.1% 553.39 (5.4%) EXT 19-34 F 151,571 524.77 534.79 1.9% 133,480 576.31 548.99 (4.7%) EXT 35-44 M 94,931 744.24 760.84 2.2% 71,964 808.05 768.38 (4.9%) EXT 35-44 F 75,729 781.14 798.61 2.2% 65,394 850.20 812.49 (4.4%) EXT 45-54 M 77,168 947.09 967.23 2.1% 69,215 1,026.53 974.61 (5.1%) EXT 45-54 F 80,589 972.03 995.00 2.4% 74,477 1,026.69 980.92 (4.5%) EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% 64,302 1,191.92 1,144.21 (4.0%) EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% 72,884 1,076.06 1,036.27 (3.7%) ABD <21 52,254 52,097 $ 1,132.61 1,092.37 $ 1,156.23 2.11,096.73 0.4% ABD 21+ 150,389 1,677.90 1,721.10 2.6% 152,619 1,722.07 1,721.46 (0.0%) The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2016 amendment to the certified calendar year (CY) 2021 2016 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the July 1, 2016 amendment to the certified CY 2016 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,706 4,706 $ 999.86 585.91 $ 1,004.70 0.5% 584.57 (0.23%) HF/HST 1 M+F 4,570 206.06 201.25 4,852 4,845 147.00 138.61 (2.35.71%) HF/HST 2-13 M+F 49,838 194.74 192.69 47,789 47,600 116.15 113.81 (1.12.02%) HF/HST 14-18 M 8,846 230.65 230.14 7,419 7,382 166.95 163.98 (0.21.78%) HF/HST 14-18 F 8,683 289.81 290.04 0.17,558 7,533 217.95 219.79 0.84% HF 19-44 M 6,999 383.79 388.01 1.1% 7,434 7,415 292.22 290.65 (0.54%) HF 19-44 F 24,684 527.73 537.14 1.822,300 22,245 382.96 384.17 0.32% HF 45+ M+F 3,791 764.60 777.49 1.7% 3,519 3,488 721.29 716.19 (0.71%) HST 19-64 F 1,784 597.62 614.09 2.82,127 2,125 398.99 401.30 0.58% EXT 19-34 M 11,813 9,411 9,353 $ 582.92 317.04 $ 591.19 1.4% 312.46 (1.45%) EXT 19-34 F 9,772 535.82 542.74 1.3% 8,476 8,438 363.59 356.64 (1.91%) EXT 35-44 M 5,909 865.18 878.33 1.5% 4,382 4,343 526.07 521.69 (0.83%) EXT 35-44 F 4,531 912.74 928.83 1.8% 3,539 3,510 613.99 605.74 (1.34%) EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% 4,472 4,390 740.07 722.84 (2.33%) EXT 45-54 F 5,059 991.99 1,010.62 1.9% 4,752 4,684 825.04 812.64 (1.50%) EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% 3,317 3,247 921.54 912.70 (0.96%) EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% 3,802 3,735 813.90 800.65 (1.63%) ABD <21 3,848 2,511 2,784 $ 943.34 519.12 $ 960.93 1.9556.86 7.27% ABD 2121 + 10,355 1,829.06 1,865.11 2.0% 7,591 8,132 1,587.89 1,582.67 (0.33%) HF/HST <1 M+F 3,160 3,350 3,350 $ 917.12 582.28 $ 910.53 580.94 (0.70.23%) HF/HST 1 M+F 3,252 216.22 213.31 3,282 3,280 148.11 139.94 (1.35.51%) HF/HST 2-13 M+F 33,863 160.73 157.34 33,281 33,186 117.78 115.35 (2.12.07%) HF/HST 14-18 M 6,148 240.46 240.31 5,383 5,350 161.31 158.53 (0.11.73%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% 5,362 5,345 188.65 186.73 (1.02%) HF 19-44 M 4,690 361.17 366.83 1.6% 4,750 4,738 256.99 256.25 (0.29%) HF 19-44 F 14,803 474.99 484.86 2.1% 13,470 13,434 365.37 362.27 (0.85%) HF 45+ M+F 2,231 676.02 688.62 1.9% 1,995 1,981 684.10 675.24 (1.29%) HST 19-64 F 1,381 427.98 441.58 3.2% 1,713 1,711 334.73 333.30 (0.43%) EXT 19-34 M 5,834 4,529 4,510 $ 548.84 290.01 $ 561.41 2.3% 287.05 (1.02%) EXT 19-34 F 5,615 497.91 506.20 1.7% 4,756 4,739 347.79 346.14 (0.47%) EXT 35-44 M 3,221 708.29 720.92 1.8% 2,208 2,200 543.91 533.59 (1.90%) EXT 35-44 F 2,998 712.36 726.39 2.0% 2,227 2,212 676.49 671.65 (0.72%) EXT 45-54 M 2,600 989.46 1,014.67 2.5% 2,302 2,285 837.91 834.52 (0.40%) EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% 2,801 2,782 799.12 786.77 (1.55%) EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% 1,895 1,880 862.61 861.73 (0.10%) EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% 2,188 2,170 878.24 843.66 (3.94%) ABD <21 1,717 526 685 $ 852.44 518.96 $ 868.45 1.9555.37 7.02% ABD 2121 + 4,617 1,592.24 1,632.60 2.52,927 3,107 1,411.81 1,430.40 1.32% HF/HST <1 M+F 17,597 17,085 17,085 $ 1,262.30 851.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 850.66 (0.10.08%) HF/HST 1 M+F 15,372 288.51 287.04 17,283 17,262 184.05 173.43 (0.55.77%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% 182,585 181,991 142.04 138.86 (2.24%) HF/HST 14-18 M 28,913 254.04 256.54 1.0% 28,339 28,192 210.22 206.37 (1.83%) HF/HST 14-18 F 29,231 318.77 322.18 1.1% 29,181 29,088 235.85 234.67 (0.50%) HF 19-44 M 23,665 349.19 356.00 2.0% 25,968 25,900 267.83 265.20 (0.98%) HF 19-44 F 71,281 563.74 580.36 2.9% 80,251 80,071 363.93 362.90 (0.28%) HF 45+ M+F 14,148 708.47 725.94 2.5% 13,279 13,197 653.26 646.41 (1.05%) HST 19-64 F 5,883 586.12 608.58 3.88,341 8,332 358.09 358.41 0.09% EXT 19-34 M 33,504 33,129 32,993 $ 601.51 313.38 $ 615.92 2.4% 308.95 (1.41%) EXT 19-34 F 29,214 603.11 616.40 2.2% 28,527 28,429 367.33 362.40 (1.34%) EXT 35-44 M 18,111 880.49 903.51 2.6% 16,512 16,428 505.59 500.26 (1.05%) EXT 35-44 F 14,846 877.94 899.88 2.5% 13,087 13,001 573.36 565.23 (1.42%) EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% 17,023 16,862 746.30 738.25 (1.08%) EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% 17,687 17,515 761.36 753.47 (1.04%) EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% 12,213 12,008 831.05 819.30 (1.41%) EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% 14,338 14,154 777.16 769.32 (1.01%) ABD <21 9,842 6,453 7,377 $ 1,232.54 892.80 $ 1,259.01 2.1960.76 7.61% ABD 2121 + 29,961 1,752.05 1,804.35 3.0% 22,721 24,119 1,455.42 1,453.10 (0.16%) HF/HST <1 M+F 4,722 15,277 15,277 $ 1,225.57 904.99 $ 1,221.70 904.97 (0.30.00%) HF/HST 1 M+F 4,784 233.22 229.74 15,582 15,567 181.44 170.55 (1.56.00%) HF/HST 2-13 M+F 53,831 194.79 194.39 155,070 154,565 129.57 127.01 (0.21.98%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% 24,158 24,038 159.89 157.15 (1.72%) HF/HST 14-18 F 9,973 315.68 318.51 0.924,411 24,332 211.02 212.82 0.85% HF 19-44 M 9,424 361.81 368.52 1.9% 25,329 25,237 292.13 289.17 (1.01%) HF 19-44 F 25,116 514.02 527.35 2.667,032 66,822 394.54 395.02 0.12% HF 45+ M+F 4,614 799.91 820.48 2.6% 12,199 12,064 667.64 658.67 (1.34%) HST 19-64 F 1,786 561.24 583.02 3.97,101 7,088 399.97 402.86 0.72% EXT 19-34 M 12,036 26,592 26,458 $ 500.88 334.60 $ 511.86 2.2% 329.20 (1.61%) EXT 19-34 F 10,527 567.53 580.47 2.3% 23,655 23,562 361.33 354.28 (1.95%) EXT 35-44 M 6,721 683.18 705.15 3.2% 12,793 12,678 546.03 538.07 (1.46%) EXT 35-44 F 5,793 810.55 830.53 2.5% 10,669 10,579 616.05 605.54 (1.71%) EXT 45-54 M 5,528 880.19 898.79 2.1% 12,506 12,328 794.03 775.04 (2.39%) EXT 45-54 F 6,208 971.78 996.97 2.6% 13,314 13,110 726.03 712.35 (1.88%) EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% 8,719 8,528 768.78 757.36 (1.48%) EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% 10,633 10,434 791.46 776.91 (1.84%) ABD <21 3,162 5,164 5,948 $ 1,223.04 836.02 $ 1,246.28 1.9890.52 6.52% ABD 2121 + 11,894 1,549.61 1,593.82 2.923,148 24,739 1,432.56 1,442.24 0.68% HF/HST <1 M+F 18,881 5,154 5,154 $ 1,375.64 868.00 $ 1,362.27 (1.0%) 868.04 0.00% HF/HST 1 M+F 19,478 256.11 255.01 4,886 4,881 167.27 157.35 (0.45.93%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% 52,997 52,850 141.70 138.83 (2.02%) HF/HST 14-18 M 40,560 248.78 251.88 1.2% 9,413 9,371 185.69 182.35 (1.80%) HF/HST 14-18 F 40,839 304.53 309.14 1.5% 9,336 9,312 215.88 213.66 (1.03%) HF 19-44 M 32,969 322.73 327.89 1.6% 10,495 10,469 253.45 251.62 (0.72%) HF 19-44 F 112,237 490.07 501.31 2.3% 24,143 24,078 372.72 369.63 (0.83%) HF 45+ M+F 20,522 675.31 691.25 2.4% 4,234 4,205 610.19 606.80 (0.56%) HST 19-64 F 7,105 638.81 659.09 3.2% 2,607 2,605 368.91 368.23 (0.18%) EXT 19-34 M 62,187 10,825 10,788 $ 474.15 233.97 $ 482.33 1.7% 232.27 (0.73%) EXT 19-34 F 50,610 473.53 481.26 1.6% 9,391 9,369 347.84 346.71 (0.33%) EXT 35-44 M 31,273 671.62 684.60 1.9% 4,890 4,869 466.32 462.13 (0.90%) EXT 35-44 F 23,623 695.39 708.63 1.9% 4,654 4,621 582.39 576.43 (1.02%) EXT 45-54 M 26,371 869.64 885.73 1.9% 5,204 5,149 654.70 648.19 (0.99%) EXT 45-54 F 26,643 904.61 924.19 2.2% 6,017 5,960 669.49 662.54 (1.04%) EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% 3,815 3,771 797.37 788.16 (1.16%) EXT 55-64 F 25,852 970.77 989.78 2.0% 4,791 4,745 752.04 748.86 (0.42%) ABD <21 17,875 1,390 1,623 $ 1,102.71 708.15 $ 1,127.93 2.3759.97 7.32% ABD 2121 + 50,902 1,677.75 1,716.97 2.3% 8,632 9,055 1,306.30 1,302.64 (0.28%) HF/HST <1 M+F 4,852 18,046 18,046 $ 943.93 946.10 $ 930.70 (1.4%) 946.28 0.02% HF/HST 1 M+F 5,017 236.24 235.11 19,496 19,463 192.72 181.39 (0.55.88%) HF/HST 2-13 M+F 53,874 192.98 192.70 205,245 204,331 130.69 127.91 (0.12.12%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% 35,916 35,661 171.62 168.73 (1.69%) HF/HST 14-18 F 9,558 286.31 289.76 1.2% 36,369 36,222 204.81 204.56 (0.13%) HF 19-44 M 7,730 320.29 325.64 1.7% 31,710 31,607 261.77 257.44 (1.65%) HF 19-44 F 24,818 459.17 470.62 2.5% 99,378 99,043 357.47 355.80 (0.47%) HF 45+ M+F 3,897 666.61 681.52 2.2% 18,593 18,439 619.51 608.57 (1.77%) HST 19-64 F 1,881 509.02 531.96 4.57,767 7,751 395.36 395.94 0.15% EXT 19-34 M 11,012 45,330 45,120 $ 477.49 287.12 $ 486.84 2.0% 282.23 (1.70%) EXT 19-34 F 9,978 489.01 497.61 1.8% 40,117 39,990 320.18 317.88 (0.72%) EXT 35-44 M 6,119 674.86 688.08 2.0% 21,546 21,401 435.73 429.72 (1.38%) EXT 35-44 F 5,416 753.87 770.48 2.2% 17,327 17,233 518.25 513.01 (1.01%) EXT 45-54 M 5,062 909.71 927.27 1.9% 23,563 23,312 644.99 633.01 (1.86%) EXT 45-54 F 5,664 935.40 955.98 2.2% 24,511 24,225 683.85 673.53 (1.51%) EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% 18,876 18,552 784.41 774.72 (1.24%) EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% 22,266 21,926 668.90 660.44 (1.26%) ABD <21 3,413 10,698 12,142 $ 1,161.76 675.51 $ 1,180.81 1.6726.01 7.48% ABD 2121 + 9,197 1,581.29 1,624.62 2.7% 35,887 38,176 1,489.12 1,488.95 (0.01%) HF/HST <1 M+F 68,698 5,081 5,081 $ 1,315.48 654.66 $ 1,311.11 654.51 (0.30.02%) HF/HST 1 M+F 70,522 261.59 260.32 5,061 5,058 177.88 168.51 (0.55.27%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% 51,192 51,052 125.13 122.77 (1.88%) HF/HST 14-18 M 137,992 247.24 249.51 0.9% 8,625 8,586 165.40 162.60 (1.69%) HF/HST 14-18 F 138,541 306.84 310.53 1.28,624 8,601 202.22 203.83 0.79% HF 19-44 M 110,930 342.11 348.14 1.8% 8,311 8,295 226.77 225.56 (0.53%) HF 19-44 F 360,856 507.19 519.91 2.522,669 22,627 344.04 344.34 0.09% HF 45+ M+F 63,557 696.97 713.12 2.3% 3,892 3,874 546.04 542.75 (0.60%) HST 19-64 F 26,968 576.45 596.43 3.52,549 2,547 362.29 363.78 0.41% EXT 19-34 M 178,709 8,355 8,325 $ 519.67 249.59 $ 530.45 2.1247.29 (0.92%) EXT 19-34 F 8,107 8,088 371.60 368.30 (0.89%) EXT 35-44 M 4,152 4,133 420.87 418.07 (0.67%) EXT 35-44 F 3,934 3,917 580.23 576.54 (0.64%) EXT 45-54 M 4,333 4,315 709.46 703.88 (0.79%) EXT 45-54 F 5,069 5,035 625.36 620.16 (0.83%) EXT 55-64 M 3,373 3,344 757.92 748.47 (1.25%) EXT 55-64 F 4,383 4,348 723.43 715.12 (1.15%) ABD <21 1,602 1,819 $ 666.17 $ 713.44 7.10% ABD 21 + 6,219 6,484 1,288.62 1,294.02 0.42% HF/HST <1 M+F 68,700 68,700 $ 843.55 $ 843.27 (0.03%) HF/HST 1 M+F 70,443 70,357 180.04 169.57 (5.82%) HF/HST 2-13 M+F 728,159 725,576 132.16 129.40 (2.09%) HF/HST 14-18 M 119,253 118,579 178.32 175.21 (1.75%) HF/HST 14-18 F 120,841 120,433 214.34 214.31 (0.01%) HF 19-44 M 113,997 113,662 268.37 265.51 (1.06%) HF 19-44 F 329,244 328,320 368.84 367.93 (0.25%) HF 45+ M+F 57,712 57,247 640.25 632.13 (1.27%) HST 19-64 F 32,206 32,157 378.98 379.97 0.26% EXT 19-34 M 138,170 137,547 $ 298.25 $ 293.86 (1.47%) EXT 19-34 F 151,571 524.77 534.79 1.9% 123,029 122,615 348.58 344.48 (1.18%) EXT 35-44 M 94,931 744.24 760.84 2.2% 66,483 66,052 485.18 479.23 (1.23%) EXT 35-44 F 75,729 781.14 798.61 2.2% 55,436 55,073 572.33 565.23 (1.24%) EXT 45-54 M 77,168 947.09 967.23 2.1% 69,402 68,642 713.97 702.42 (1.62%) EXT 45-54 F 80,589 972.03 995.00 2.4% 74,151 73,310 718.15 708.20 (1.39%) EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% 52,208 51,330 803.50 793.46 (1.25%) EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% 62,401 61,513 741.05 730.91 (1.37%) ABD <21 52,254 28,344 32,380 $ 1,132.61 738.55 $ 1,156.23 2.1792.56 7.31% ABD 2121 + 150,389 1,677.90 1,721.10 2.6107,126 113,812 1,448.26 1,450.37 0.15% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.Background 1
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2016 amendment to the certified calendar year (CY) 2021 2016 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the July 1, 2016 amendment to the certified CY 2016 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report may likewise capitation rate development would need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,706 4,706 $ 999.86 585.91 $ 1,004.70 0.5% 584.57 (0.23%) HF/HST 1 M+F 4,570 206.06 201.25 4,852 4,845 147.00 138.61 (2.35.71%) HF/HST 2-13 M+F 49,838 194.74 192.69 47,789 47,600 116.15 113.81 (1.12.02%) HF/HST 14-18 M 8,846 230.65 230.14 7,419 7,382 166.95 163.98 (0.21.78%) HF/HST 14-18 F 8,683 289.81 290.04 0.17,558 7,533 217.95 219.79 0.84% HF 19-44 M 6,999 383.79 388.01 1.1% 7,434 7,415 292.22 290.65 (0.54%) HF 19-44 F 24,684 527.73 537.14 1.822,300 22,245 382.96 384.17 0.32% HF 45+ M+F 3,791 764.60 777.49 1.7% 3,519 3,488 721.29 716.19 (0.71%) HST 19-64 F 1,784 597.62 614.09 2.82,127 2,125 398.99 401.30 0.58% EXT 19-34 M 11,813 9,411 9,353 $ 582.92 317.04 $ 591.19 1.4% 312.46 (1.45%) EXT 19-34 F 9,772 535.82 542.74 1.3% 8,476 8,438 363.59 356.64 (1.91%) EXT 35-44 M 5,909 865.18 878.33 1.5% 4,382 4,343 526.07 521.69 (0.83%) EXT 35-44 F 4,531 912.74 928.83 1.8% 3,539 3,510 613.99 605.74 (1.34%) EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% 4,472 4,390 740.07 722.84 (2.33%) EXT 45-54 F 5,059 991.99 1,010.62 1.9% 4,752 4,684 825.04 812.64 (1.50%) EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% 3,317 3,247 921.54 912.70 (0.96%) EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% 3,802 3,735 813.90 800.65 (1.63%) ABD <21 3,848 2,511 2,784 $ 943.34 519.12 $ 960.93 1.9556.86 7.27% ABD 2121 + 10,355 1,829.06 1,865.11 2.0% 7,591 8,132 1,587.89 1,582.67 (0.33%) HF/HST <1 M+F 3,160 3,350 3,350 $ 917.12 582.28 $ 910.53 580.94 (0.70.23%) HF/HST 1 M+F 3,252 216.22 213.31 3,282 3,280 148.11 139.94 (1.35.51%) HF/HST 2-13 M+F 33,863 160.73 157.34 33,281 33,186 117.78 115.35 (2.12.07%) HF/HST 14-18 M 6,148 240.46 240.31 5,383 5,350 161.31 158.53 (0.11.73%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% 5,362 5,345 188.65 186.73 (1.02%) HF 19-44 M 4,690 361.17 366.83 1.6% 4,750 4,738 256.99 256.25 (0.29%) HF 19-44 F 14,803 474.99 484.86 2.1% 13,470 13,434 365.37 362.27 (0.85%) HF 45+ M+F 2,231 676.02 688.62 1.9% 1,995 1,981 684.10 675.24 (1.29%) HST 19-64 F 1,381 427.98 441.58 3.2% 1,713 1,711 334.73 333.30 (0.43%) EXT 19-34 M 5,834 4,529 4,510 $ 548.84 290.01 $ 561.41 2.3% 287.05 (1.02%) EXT 19-34 F 5,615 497.91 506.20 1.7% 4,756 4,739 347.79 346.14 (0.47%) EXT 35-44 M 3,221 708.29 720.92 1.8% 2,208 2,200 543.91 533.59 (1.90%) EXT 35-44 F 2,998 712.36 726.39 2.0% 2,227 2,212 676.49 671.65 (0.72%) EXT 45-54 M 2,600 989.46 1,014.67 2.5% 2,302 2,285 837.91 834.52 (0.40%) EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% 2,801 2,782 799.12 786.77 (1.55%) EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% 1,895 1,880 862.61 861.73 (0.10%) EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% 2,188 2,170 878.24 843.66 (3.94%) ABD <21 1,717 526 685 $ 852.44 518.96 $ 868.45 1.9555.37 7.02% ABD 2121 + 4,617 1,592.24 1,632.60 2.52,927 3,107 1,411.81 1,430.40 1.32% HF/HST <1 M+F 17,597 17,085 17,085 $ 1,262.30 851.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.2% HF/HST 2-13 M+F 195,275 209.02 210.22 0.6% HF/HST 14-18 M 34,218 244.22 246.87 1.1% HF/HST 14-18 F 34,248 316.37 321.05 1.5% HF 19-44 M 25,453 345.00 351.93 2.0% HF 19-44 F 87,917 494.47 507.49 2.6% HF 45+ M+F 14,354 677.16 692.62 2.3% HST 19-64 F 7,148 551.47 569.97 3.4% EXT 19-34 M 42,323 $ 516.42 $ 528.92 2.4% EXT 19-34 F 35,855 531.85 543.10 2.1% EXT 35-44 M 23,577 745.91 763.14 2.3% EXT 35-44 F 18,522 790.64 810.28 2.5% EXT 45-54 M 18,469 935.82 957.10 2.3% EXT 45-54 F 18,972 1,005.41 1,030.53 2.5% EXT 55-64 M 15,046 1,153.35 1,179.15 2.2% EXT 55-64 F 16,926 1,041.51 1,065.35 2.3% ABD <21 12,397 $ 1,162.87 $ 1,186.20 2.0% ABD 21+ 33,463 1,648.92 1,692.23 2.6% HF/HST <1 M+F 14,934 $ 1,631.73 $ 1,629.98 850.66 (0.10.08%) HF/HST 1 M+F 15,372 288.51 287.04 17,283 17,262 184.05 173.43 (0.55.77%) HF/HST 2-13 M+F 169,110 208.57 208.76 0.1% 182,585 181,991 142.04 138.86 (2.24%) HF/HST 14-18 M 28,913 254.04 256.54 1.0% 28,339 28,192 210.22 206.37 (1.83%) HF/HST 14-18 F 29,231 318.77 322.18 1.1% 29,181 29,088 235.85 234.67 (0.50%) HF 19-44 M 23,665 349.19 356.00 2.0% 25,968 25,900 267.83 265.20 (0.98%) HF 19-44 F 71,281 563.74 580.36 2.9% 80,251 80,071 363.93 362.90 (0.28%) HF 45+ M+F 14,148 708.47 725.94 2.5% 13,279 13,197 653.26 646.41 (1.05%) HST 19-64 F 5,883 586.12 608.58 3.88,341 8,332 358.09 358.41 0.09% EXT 19-34 M 33,504 33,129 32,993 $ 601.51 313.38 $ 615.92 2.4% 308.95 (1.41%) EXT 19-34 F 29,214 603.11 616.40 2.2% 28,527 28,429 367.33 362.40 (1.34%) EXT 35-44 M 18,111 880.49 903.51 2.6% 16,512 16,428 505.59 500.26 (1.05%) EXT 35-44 F 14,846 877.94 899.88 2.5% 13,087 13,001 573.36 565.23 (1.42%) EXT 45-54 M 14,468 1,104.90 1,132.14 2.5% 17,023 16,862 746.30 738.25 (1.08%) EXT 45-54 F 14,970 1,041.40 1,068.72 2.6% 17,687 17,515 761.36 753.47 (1.04%) EXT 55-64 M 10,764 1,286.32 1,322.63 2.8% 12,213 12,008 831.05 819.30 (1.41%) EXT 55-64 F 12,385 1,158.77 1,190.11 2.7% 14,338 14,154 777.16 769.32 (1.01%) ABD <21 9,842 6,453 7,377 $ 1,232.54 892.80 $ 1,259.01 2.1960.76 7.61% ABD 2121 + 29,961 1,752.05 1,804.35 3.0% 22,721 24,119 1,455.42 1,453.10 (0.16%) HF/HST <1 M+F 4,722 15,277 15,277 $ 1,225.57 904.99 $ 1,221.70 904.97 (0.30.00%) HF/HST 1 M+F 4,784 233.22 229.74 15,582 15,567 181.44 170.55 (1.56.00%) HF/HST 2-13 M+F 53,831 194.79 194.39 155,070 154,565 129.57 127.01 (0.21.98%) HF/HST 14-18 M 9,872 264.29 265.91 0.6% 24,158 24,038 159.89 157.15 (1.72%) HF/HST 14-18 F 9,973 315.68 318.51 0.924,411 24,332 211.02 212.82 0.85% HF 19-44 M 9,424 361.81 368.52 1.9% 25,329 25,237 292.13 289.17 (1.01%) HF 19-44 F 25,116 514.02 527.35 2.667,032 66,822 394.54 395.02 0.12% HF 45+ M+F 4,614 799.91 820.48 2.6% 12,199 12,064 667.64 658.67 (1.34%) HST 19-64 F 1,786 561.24 583.02 3.97,101 7,088 399.97 402.86 0.72% EXT 19-34 M 12,036 26,592 26,458 $ 500.88 334.60 $ 511.86 2.2% 329.20 (1.61%) EXT 19-34 F 10,527 567.53 580.47 2.3% 23,655 23,562 361.33 354.28 (1.95%) EXT 35-44 M 6,721 683.18 705.15 3.2% 12,793 12,678 546.03 538.07 (1.46%) EXT 35-44 F 5,793 810.55 830.53 2.5% 10,669 10,579 616.05 605.54 (1.71%) EXT 45-54 M 5,528 880.19 898.79 2.1% 12,506 12,328 794.03 775.04 (2.39%) EXT 45-54 F 6,208 971.78 996.97 2.6% 13,314 13,110 726.03 712.35 (1.88%) EXT 55-64 M 4,889 1,100.09 1,132.22 2.9% 8,719 8,528 768.78 757.36 (1.48%) EXT 55-64 F 5,633 1,076.35 1,102.72 2.4% 10,633 10,434 791.46 776.91 (1.84%) ABD <21 3,162 5,164 5,948 $ 1,223.04 836.02 $ 1,246.28 1.9890.52 6.52% ABD 2121 + 11,894 1,549.61 1,593.82 2.923,148 24,739 1,432.56 1,442.24 0.68% HF/HST <1 M+F 18,881 5,154 5,154 $ 1,375.64 868.00 $ 1,362.27 (1.0%) 868.04 0.00% HF/HST 1 M+F 19,478 256.11 255.01 4,886 4,881 167.27 157.35 (0.45.93%) HF/HST 2-13 M+F 224,655 212.38 213.43 0.5% 52,997 52,850 141.70 138.83 (2.02%) HF/HST 14-18 M 40,560 248.78 251.88 1.2% 9,413 9,371 185.69 182.35 (1.80%) HF/HST 14-18 F 40,839 304.53 309.14 1.5% 9,336 9,312 215.88 213.66 (1.03%) HF 19-44 M 32,969 322.73 327.89 1.6% 10,495 10,469 253.45 251.62 (0.72%) HF 19-44 F 112,237 490.07 501.31 2.3% 24,143 24,078 372.72 369.63 (0.83%) HF 45+ M+F 20,522 675.31 691.25 2.4% 4,234 4,205 610.19 606.80 (0.56%) HST 19-64 F 7,105 638.81 659.09 3.2% 2,607 2,605 368.91 368.23 (0.18%) EXT 19-34 M 62,187 10,825 10,788 $ 474.15 233.97 $ 482.33 1.7% 232.27 (0.73%) EXT 19-34 F 50,610 473.53 481.26 1.6% 9,391 9,369 347.84 346.71 (0.33%) EXT 35-44 M 31,273 671.62 684.60 1.9% 4,890 4,869 466.32 462.13 (0.90%) EXT 35-44 F 23,623 695.39 708.63 1.9% 4,654 4,621 582.39 576.43 (1.02%) EXT 45-54 M 26,371 869.64 885.73 1.9% 5,204 5,149 654.70 648.19 (0.99%) EXT 45-54 F 26,643 904.61 924.19 2.2% 6,017 5,960 669.49 662.54 (1.04%) EXT 55-64 M 22,966 1,070.04 1,087.93 1.7% 3,815 3,771 797.37 788.16 (1.16%) EXT 55-64 F 25,852 970.77 989.78 2.0% 4,791 4,745 752.04 748.86 (0.42%) ABD <21 17,875 1,390 1,623 $ 1,102.71 708.15 $ 1,127.93 2.3759.97 7.32% ABD 2121 + 50,902 1,677.75 1,716.97 2.3% 8,632 9,055 1,306.30 1,302.64 (0.28%) HF/HST <1 M+F 4,852 18,046 18,046 $ 943.93 946.10 $ 930.70 (1.4%) 946.28 0.02% HF/HST 1 M+F 5,017 236.24 235.11 19,496 19,463 192.72 181.39 (0.55.88%) HF/HST 2-13 M+F 53,874 192.98 192.70 205,245 204,331 130.69 127.91 (0.12.12%) HF/HST 14-18 M 9,435 232.90 234.29 0.6% 35,916 35,661 171.62 168.73 (1.69%) HF/HST 14-18 F 9,558 286.31 289.76 1.2% 36,369 36,222 204.81 204.56 (0.13%) HF 19-44 M 7,730 320.29 325.64 1.7% 31,710 31,607 261.77 257.44 (1.65%) HF 19-44 F 24,818 459.17 470.62 2.5% 99,378 99,043 357.47 355.80 (0.47%) HF 45+ M+F 3,897 666.61 681.52 2.2% 18,593 18,439 619.51 608.57 (1.77%) HST 19-64 F 1,881 509.02 531.96 4.57,767 7,751 395.36 395.94 0.15% EXT 19-34 M 11,012 45,330 45,120 $ 477.49 287.12 $ 486.84 2.0% 282.23 (1.70%) EXT 19-34 F 9,978 489.01 497.61 1.8% 40,117 39,990 320.18 317.88 (0.72%) EXT 35-44 M 6,119 674.86 688.08 2.0% 21,546 21,401 435.73 429.72 (1.38%) EXT 35-44 F 5,416 753.87 770.48 2.2% 17,327 17,233 518.25 513.01 (1.01%) EXT 45-54 M 5,062 909.71 927.27 1.9% 23,563 23,312 644.99 633.01 (1.86%) EXT 45-54 F 5,664 935.40 955.98 2.2% 24,511 24,225 683.85 673.53 (1.51%) EXT 55-64 M 4,312 1,064.55 1,085.81 2.0% 18,876 18,552 784.41 774.72 (1.24%) EXT 55-64 F 5,244 1,023.93 1,044.55 2.0% 22,266 21,926 668.90 660.44 (1.26%) ABD <21 3,413 10,698 12,142 $ 1,161.76 675.51 $ 1,180.81 1.6726.01 7.48% ABD 2121 + 9,197 1,581.29 1,624.62 2.7% 35,887 38,176 1,489.12 1,488.95 (0.01%) HF/HST <1 M+F 68,698 5,081 5,081 $ 1,315.48 654.66 $ 1,311.11 654.51 (0.30.02%) HF/HST 1 M+F 70,522 261.59 260.32 5,061 5,058 177.88 168.51 (0.55.27%) HF/HST 2-13 M+F 780,446 204.79 205.11 0.2% 51,192 51,052 125.13 122.77 (1.88%) HF/HST 14-18 M 137,992 247.24 249.51 0.9% 8,625 8,586 165.40 162.60 (1.69%) HF/HST 14-18 F 138,541 306.84 310.53 1.28,624 8,601 202.22 203.83 0.79% HF 19-44 M 110,930 342.11 348.14 1.8% 8,311 8,295 226.77 225.56 (0.53%) HF 19-44 F 360,856 507.19 519.91 2.522,669 22,627 344.04 344.34 0.09% HF 45+ M+F 63,557 696.97 713.12 2.3% 3,892 3,874 546.04 542.75 (0.60%) HST 19-64 F 26,968 576.45 596.43 3.52,549 2,547 362.29 363.78 0.41% EXT 19-34 M 178,709 8,355 8,325 $ 519.67 249.59 $ 530.45 2.1247.29 (0.92%) EXT 19-34 F 8,107 8,088 371.60 368.30 (0.89%) EXT 35-44 M 4,152 4,133 420.87 418.07 (0.67%) EXT 35-44 F 3,934 3,917 580.23 576.54 (0.64%) EXT 45-54 M 4,333 4,315 709.46 703.88 (0.79%) EXT 45-54 F 5,069 5,035 625.36 620.16 (0.83%) EXT 55-64 M 3,373 3,344 757.92 748.47 (1.25%) EXT 55-64 F 4,383 4,348 723.43 715.12 (1.15%) ABD <21 1,602 1,819 $ 666.17 $ 713.44 7.10% ABD 21 + 6,219 6,484 1,288.62 1,294.02 0.42% HF/HST <1 M+F 68,700 68,700 $ 843.55 $ 843.27 (0.03%) HF/HST 1 M+F 70,443 70,357 180.04 169.57 (5.82%) HF/HST 2-13 M+F 728,159 725,576 132.16 129.40 (2.09%) HF/HST 14-18 M 119,253 118,579 178.32 175.21 (1.75%) HF/HST 14-18 F 120,841 120,433 214.34 214.31 (0.01%) HF 19-44 M 113,997 113,662 268.37 265.51 (1.06%) HF 19-44 F 329,244 328,320 368.84 367.93 (0.25%) HF 45+ M+F 57,712 57,247 640.25 632.13 (1.27%) HST 19-64 F 32,206 32,157 378.98 379.97 0.26% EXT 19-34 M 138,170 137,547 $ 298.25 $ 293.86 (1.47%) EXT 19-34 F 151,571 524.77 534.79 1.9% 123,029 122,615 348.58 344.48 (1.18%) EXT 35-44 M 94,931 744.24 760.84 2.2% 66,483 66,052 485.18 479.23 (1.23%) EXT 35-44 F 75,729 781.14 798.61 2.2% 55,436 55,073 572.33 565.23 (1.24%) EXT 45-54 M 77,168 947.09 967.23 2.1% 69,402 68,642 713.97 702.42 (1.62%) EXT 45-54 F 80,589 972.03 995.00 2.4% 74,151 73,310 718.15 708.20 (1.39%) EXT 55-64 M 63,984 1,142.70 1,167.37 2.2% 52,208 51,330 803.50 793.46 (1.25%) EXT 55-64 F 73,014 1,040.15 1,063.13 2.2% 62,401 61,513 741.05 730.91 (1.37%) ABD <21 52,254 28,344 32,380 $ 1,132.61 738.55 $ 1,156.23 2.1792.56 7.31% ABD 2121 + 150,389 1,677.90 1,721.10 2.6107,126 113,812 1,448.26 1,450.37 0.15% The following are the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollment. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.Background 1
Appears in 1 contract
Samples: Provider Agreement
Limitations and Data Reliance. The information contained in this report has been prepared for the Ohio Department of Medicaid (ODM) to provide documentation of the development of an the July 1, 2019 amendment to the certified calendar year (CY) 2021 2019 capitation rates, to extend the rating period to the 18 months spanning January 1, 2021 to June 30, 2022 rates for the Medicaid Managed Care Program (MMC). The amended capitation rates in this report are effective for the January 1, 2022 through June 30, 2022 time period. The data and information presented may not be appropriate for any other purpose. The information contained in this report, including the appendicesenclosures, has been prepared for ODM and their consultants and advisors. It is our understanding that the information contained in this report will be shared with CMS and may be utilized in a public document. Any distribution of the information should be in its entirety. Any user of the data must possess a certain level of expertise in actuarial science and healthcare modeling so as not to misinterpret the information presented. Milliman makes no representations or warranties regarding the contents of this report to third parties. Likewise, third parties are instructed that they are to place no reliance upon this report prepared for ODM 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 report must rely upon their own experts in drawing conclusions about the capitation rates, assumptions, and trends. Milliman has developed certain models to estimate the values included in this report. We have reviewed the models, including their inputs, calculations, and outputs for consistency, reasonableness, and appropriateness to the intended purpose and in compliance with generally accepted actuarial practice and relevant actuarial standards of practice (ASOP). The models rely on data and information as input to the models. We have relied upon certain data and information provided by ODM and the participating Medicaid MCPs in the development of the July 1, 2019 amendment to the certified CY 2019 capitation rates. Milliman has relied upon ODM and the MCPs for this purpose the accuracy of the data and accepted accept it without audit. To the extent that the data and information provided is not accurate, or is not complete, the values provided in this report capitation rate development may likewise need to be inaccurate or incomplete. The models, including all input, calculations, and output may not be appropriate for any other purposemodified to reflect revised information. It should be emphasized that capitation rates are a projection of future costs based on a set of assumptions. Results will differ if actual experience is different from the assumptions contained in this report. The services provided by Milliman to ODM were performed under the signed contract agreement between Milliman and XXX ODM dated July 12June 11, 20192015. Guidelines issued by the American Academy of Actuaries require actuaries to include their professional qualifications in all actuarial communications. The authors of this report are members of the American Academy of Actuaries and meet the qualification standards for performing the analyses contained herein. HF/HST <1 M+F 4,552 4,841 $ 999.86 918.53 $ 1,004.70 0.5925.85 0.8% HF/HST 1 M+F 4,570 206.06 201.25 (2.3%) HF/HST 2-13 M+F 49,838 194.74 192.69 (1.1%) HF/HST 14-18 M 8,846 230.65 230.14 (0.2%) HF/HST 14-18 F 8,683 289.81 290.04 0.1% HF 19-44 M 6,999 383.79 388.01 1.1% HF 19-44 F 24,684 527.73 537.14 1.8% HF 45+ M+F 3,791 764.60 777.49 1.7% HST 19-64 F 1,784 597.62 614.09 2.8% EXT 19-34 M 11,813 $ 582.92 $ 591.19 1.4% EXT 19-34 F 9,772 535.82 542.74 1.3% EXT 35-44 M 5,909 865.18 878.33 1.5% EXT 35-44 F 4,531 912.74 928.83 1.8% EXT 45-54 M 4,670 1,036.30 1,054.49 1.8% EXT 45-54 F 5,059 991.99 1,010.62 1.9% EXT 55-64 M 3,741 1,209.84 1,229.68 1.6% EXT 55-64 F 4,226 1,067.44 1,087.00 1.8% ABD <21 3,848 $ 943.34 $ 960.93 1.9% ABD 21+ 10,355 1,829.06 1,865.11 2.0% HF/HST <1 M+F 3,160 $ 917.12 $ 910.53 (0.7%) HF/HST 1 M+F 3,252 216.22 213.31 (1.3%) HF/HST 2-13 M+F 33,863 160.73 157.34 (2.1%) HF/HST 14-18 M 6,148 240.46 240.31 (0.1%) HF/HST 14-18 F 6,009 252.71 252.85 0.1% HF 19-44 M 4,690 361.17 366.83 1.6% HF 19-44 F 14,803 474.99 484.86 2.1% HF 45+ M+F 2,231 676.02 688.62 1.9% HST 19-64 F 1,381 427.98 441.58 3.2% EXT 19-34 M 5,834 $ 548.84 $ 561.41 2.3% EXT 19-34 F 5,615 497.91 506.20 1.7% EXT 35-44 M 3,221 708.29 720.92 1.8% EXT 35-44 F 2,998 712.36 726.39 2.0% EXT 45-54 M 2,600 989.46 1,014.67 2.5% EXT 45-54 F 3,073 1,047.63 1,072.64 2.4% EXT 55-64 M 2,266 1,255.99 1,285.03 2.3% EXT 55-64 F 2,748 1,064.59 1,084.91 1.9% ABD <21 1,717 $ 852.44 $ 868.45 1.9% ABD 21+ 4,617 1,592.24 1,632.60 2.5% HF/HST <1 M+F 17,597 $ 1,262.30 $ 1,265.69 0.3% HF/HST 1 M+F 18,049 281.37 281.84 0.24,167 153.78 161.10 4.8% HF/HST 2-13 M+F 195,275 209.02 210.22 0.644,702 164.01 171.33 4.5% HF/HST 14-18 M 34,218 244.22 246.87 1.17,107 217.67 224.99 3.4% HF/HST 14-18 F 34,248 316.37 321.05 1.57,326 273.57 280.89 2.7% HF 19-44 M 25,453 345.00 351.93 2.04,531 341.78 349.10 2.1% HF 19-44 F 87,917 494.47 507.49 2.619,304 444.31 451.64 1.6% HF 45+ M+F 14,354 677.16 692.62 2.32,891 615.97 623.31 1.2% HST 19-64 F 7,148 551.47 569.97 3.4834 605.75 613.07 1.2% EXT 19-34 M 42,323 6,398 $ 516.42 454.09 $ 528.92 2.4461.42 1.6% EXT 19-34 F 35,855 531.85 543.10 2.16,837 482.09 489.41 1.5% EXT 35-44 M 23,577 745.91 763.14 2.33,336 641.91 649.27 1.1% EXT 35-44 F 18,522 790.64 810.28 2.53,335 760.33 767.69 1.0% EXT 45-54 M 18,469 935.82 957.10 2.33,369 809.97 817.42 0.9% EXT 45-54 F 18,972 1,005.41 1,030.53 2.53,774 864.68 872.08 0.9% EXT 55-64 M 15,046 1,153.35 1,179.15 2.23,057 927.51 935.14 0.8% EXT 55-64 F 16,926 1,041.51 1,065.35 2.33,563 893.48 900.98 0.8% ABD <21 12,397 4,081 $ 1,162.87 823.93 $ 1,186.20 2.0831.25 0.9% ABD 21+ 33,463 1,648.92 1,692.23 2.610,874 1,657.57 1,665.17 0.5% HF/HST <1 M+F 14,934 3,346 $ 1,631.73 915.82 $ 1,629.98 (0.1%) 922.28 0.7% HF/HST 1 M+F 15,372 288.51 287.04 (0.5%) 2,830 167.45 173.92 3.9% HF/HST 2-13 M+F 169,110 208.57 208.76 0.129,872 141.86 148.32 4.6% HF/HST 14-18 M 28,913 254.04 256.54 1.04,879 221.52 227.98 2.9% HF/HST 14-18 F 29,231 318.77 322.18 1.15,073 237.34 243.81 2.7% HF 19-44 M 23,665 349.19 356.00 2,944 325.84 332.30 2.0% HF 19-44 F 71,281 563.74 580.36 2.911,081 431.74 438.22 1.5% HF 45+ M+F 14,148 708.47 725.94 2.51,647 589.49 596.00 1.1% HST 19-64 F 5,883 586.12 608.58 3.8825 520.42 526.89 1.2% EXT 19-34 M 33,504 3,357 $ 601.51 453.18 $ 615.92 2.4459.69 1.4% EXT 19-34 F 29,214 603.11 616.40 2.23,974 471.03 477.52 1.4% EXT 35-44 M 18,111 880.49 903.51 2.61,823 617.35 623.93 1.1% EXT 35-44 F 14,846 877.94 899.88 2.52,093 708.79 715.28 0.9% EXT 45-54 M 14,468 1,104.90 1,132.14 2.51,763 883.71 890.45 0.8% EXT 45-54 F 14,970 1,041.40 1,068.72 2.62,303 957.30 964.00 0.7% EXT 55-64 M 10,764 1,286.32 1,322.63 2.81,692 1,045.09 1,052.39 0.7% EXT 55-64 F 12,385 1,158.77 1,190.11 2.72,218 931.91 938.91 0.8% ABD <21 9,842 1,682 $ 1,232.54 846.94 $ 1,259.01 2.1853.40 0.8% ABD 21+ 29,961 1,752.05 1,804.35 3.04,634 1,467.63 1,474.84 0.5% HF/HST <1 M+F 4,722 18,856 $ 1,225.57 1,019.64 $ 1,221.70 (1,022.97 0.3%) % HF/HST 1 M+F 4,784 233.22 229.74 (1.5%) 15,925 195.33 198.67 1.7% HF/HST 2-13 M+F 53,831 194.79 194.39 (0.2%) 173,198 175.94 179.27 1.9% HF/HST 14-18 M 9,872 264.29 265.91 0.627,330 240.74 244.07 1.4% HF/HST 14-18 F 9,973 315.68 318.51 0.928,224 281.42 284.76 1.2% HF 19-44 M 9,424 361.81 368.52 1.916,537 318.03 321.39 1.1% HF 19-44 F 25,116 514.02 527.35 2.668,747 420.80 424.14 0.8% HF 45+ M+F 4,614 799.91 820.48 2.610,836 610.30 613.70 0.6% HST 19-64 F 1,786 561.24 583.02 3.93,823 523.30 526.64 0.6% EXT 19-34 M 12,036 24,464 $ 500.88 447.74 $ 511.86 2.2451.16 0.8% EXT 19-34 F 10,527 567.53 580.47 2.324,831 467.25 470.64 0.7% EXT 35-44 M 6,721 683.18 705.15 3.213,885 664.53 668.06 0.5% EXT 35-44 F 5,793 810.55 830.53 2.512,771 718.58 722.06 0.5% EXT 45-54 M 5,528 880.19 898.79 2.113,048 829.40 833.26 0.5% EXT 45-54 F 6,208 971.78 996.97 2.614,307 889.03 892.75 0.4% EXT 55-64 M 4,889 1,100.09 1,132.22 2.911,829 921.08 925.51 0.5% EXT 55-64 F 5,633 1,076.35 1,102.72 2.413,308 930.11 934.18 0.4% ABD <21 3,162 12,600 $ 1,223.04 1,149.65 $ 1,246.28 1.91,152.98 0.3% ABD 21+ 11,894 1,549.61 1,593.82 2.933,759 1,618.71 1,623.21 0.3% HF/HST <1 M+F 18,881 16,055 $ 1,375.64 1,246.14 $ 1,362.27 (1.0%) 1,250.23 0.3% HF/HST 1 M+F 19,478 256.11 255.01 (0.4%) 14,160 215.76 219.85 1.9% HF/HST 2-13 M+F 224,655 212.38 213.43 0.5150,870 184.01 188.10 2.2% HF/HST 14-18 M 40,560 248.78 251.88 1.223,762 269.46 273.56 1.5% HF/HST 14-18 F 40,839 304.53 309.14 1.524,146 307.29 311.38 1.3% HF 19-44 M 32,969 322.73 327.89 1.616,795 327.98 332.08 1.3% HF 19-44 F 112,237 490.07 501.31 2.356,757 483.09 487.19 0.8% HF 45+ M+F 20,522 675.31 691.25 2.410,844 611.03 615.20 0.7% HST 19-64 F 7,105 638.81 659.09 3.23,540 532.79 536.88 0.8% EXT 19-34 M 62,187 20,673 $ 474.15 497.68 $ 482.33 1.7501.82 0.8% EXT 19-34 F 50,610 473.53 481.26 1.620,967 535.32 539.47 0.8% EXT 35-44 M 31,273 671.62 684.60 1.911,241 726.74 731.05 0.6% EXT 35-44 F 23,623 695.39 708.63 1.910,842 761.65 765.92 0.6% EXT 45-54 M 26,371 869.64 885.73 1.910,468 910.51 915.19 0.5% EXT 45-54 F 26,643 904.61 924.19 2.211,843 949.18 953.71 0.5% EXT 55-64 M 22,966 1,070.04 1,087.93 1.78,755 1,008.55 1,014.05 0.5% EXT 55-64 F 25,852 970.77 989.78 2.010,151 987.37 992.31 0.5% ABD <21 17,875 9,870 $ 1,102.71 1,250.41 $ 1,127.93 2.31,254.51 0.3% ABD 21+ 50,902 1,677.75 1,716.97 2.331,481 1,645.89 1,651.13 0.3% HF/HST <1 M+F 4,852 5,108 $ 943.93 927.00 $ 930.70 (1.4%) 931.91 0.5% HF/HST 1 M+F 5,017 236.24 235.11 (0.5%) 4,370 166.81 171.66 2.9% HF/HST 2-13 M+F 53,874 192.98 192.70 (0.1%) 49,651 166.61 171.45 2.9% HF/HST 14-18 M 9,435 232.90 234.29 0.68,581 236.69 241.54 2.0% HF/HST 14-18 F 9,558 286.31 289.76 1.28,703 271.64 276.52 1.8% HF 19-44 M 7,730 320.29 325.64 1.76,841 329.43 334.27 1.5% HF 19-44 F 24,818 459.17 470.62 2.520,978 445.99 450.84 1.1% HF 45+ M+F 3,897 666.61 681.52 2.23,582 581.20 586.12 0.8% HST 19-64 F 1,881 509.02 531.96 4.51,276 546.19 551.03 0.9% EXT 19-34 M 11,012 7,970 $ 477.49 409.17 $ 486.84 2.0414.05 1.2% EXT 19-34 F 9,978 489.01 497.61 1.87,893 483.24 488.15 1.0% EXT 35-44 M 6,119 674.86 688.08 2.04,456 653.89 658.82 0.8% EXT 35-44 F 5,416 753.87 770.48 2.24,232 715.12 720.04 0.7% EXT 45-54 M 5,062 909.71 927.27 1.94,304 824.84 829.99 0.6% EXT 45-54 F 5,664 935.40 955.98 2.25,057 827.32 832.42 0.6% EXT 55-64 M 4,312 1,064.55 1,085.81 2.03,987 913.03 918.59 0.6% EXT 55-64 F 5,244 1,023.93 1,044.55 2.04,590 919.10 924.56 0.6% ABD <21 3,413 3,210 $ 1,161.76 987.56 $ 1,180.81 1.6992.40 0.5% ABD 21+ 9,197 1,581.29 1,624.62 2.712,335 1,396.19 1,401.86 0.4% HF/HST <1 M+F 68,698 20,755 $ 1,315.48 1,161.90 $ 1,311.11 (1,165.92 0.3%) % HF/HST 1 M+F 70,522 261.59 260.32 (0.5%) 18,331 195.56 199.58 2.1% HF/HST 2-13 M+F 780,446 204.79 205.11 0.2204,365 176.41 180.43 2.3% HF/HST 14-18 M 137,992 247.24 249.51 0.934,132 232.95 236.97 1.7% HF/HST 14-18 F 138,541 306.84 310.53 1.235,392 268.30 272.32 1.5% HF 19-44 M 110,930 342.11 348.14 22,496 280.87 284.91 1.4% HF 19-44 F 91,458 409.89 413.93 1.0% HF 45+ M+F 15,983 573.84 577.95 0.7% HST 19-64 F 3,796 601.72 605.74 0.7% EXT 19-34 M 36,771 $ 423.56 $ 427.63 1.0% EXT 19-34 F 35,623 427.74 431.79 0.9% EXT 35-44 M 19,298 571.00 575.17 0.7% EXT 35-44 F 16,997 621.88 626.02 0.7% EXT 45-54 M 18,947 780.26 784.69 0.6% EXT 45-54 F 20,907 801.31 805.63 0.5% EXT 55-64 M 18,705 851.00 856.03 0.6% EXT 55-64 F 21,031 829.05 833.61 0.6% ABD <21 18,292 $ 982.66 $ 986.69 0.4% ABD 21+ 51,383 1,537.61 1,542.78 0.3% HF/HST <1 M+F 5,213 $ 828.55 $ 833.07 0.5% HF/HST 1 M+F 4,465 164.74 169.26 2.7% HF/HST 2-13 M+F 49,204 164.27 168.80 2.8% HF/HST 14-18 M 7,936 230.13 234.67 2.0% HF/HST 14-18 F 8,217 251.16 255.69 1.8% HF 19-44 M 5,161 287.51 292.05 1.6% HF 19-44 F 360,856 507.19 519.91 2.520,312 392.83 397.37 1.2% HF 45+ M+F 63,557 696.97 713.12 2.33,076 584.84 589.44 0.8% HST 19-64 F 26,968 576.45 596.43 3.51,169 502.98 507.51 0.9% EXT 19-34 M 178,709 6,860 $ 519.67 410.84 $ 530.45 2.1415.40 1.1% EXT 19-34 F 151,571 524.77 534.79 1.97,533 417.44 421.99 1.1% EXT 35-44 M 94,931 744.24 760.84 2.23,814 582.46 587.18 0.8% EXT 35-44 F 75,729 781.14 798.61 2.24,018 618.68 623.32 0.7% EXT 45-54 M 77,168 947.09 967.23 2.13,720 709.96 714.84 0.7% EXT 45-54 F 80,589 972.03 995.00 2.44,434 795.49 800.26 0.6% EXT 55-64 M 63,984 1,142.70 1,167.37 2.23,585 914.69 920.58 0.6% EXT 55-64 F 73,014 1,040.15 1,063.13 2.24,253 828.04 833.12 0.6% ABD <21 52,254 3,293 $ 1,132.61 1,057.92 $ 1,156.23 2.11,062.45 0.4% ABD 21+ 150,389 1,677.90 1,721.10 2.68,992 1,403.14 1,408.67 0.4% HF/HST <1 M+F 74,174 $ 1,077.38 $ 1,081.66 0.4% HF/HST 1 M+F 64,248 191.91 196.19 2.2% HF/HST 2-13 M+F 701,862 174.12 178.40 2.5% HF/HST 14-18 M 113,727 241.09 245.37 1.8% HF/HST 14-18 F 117,081 277.54 281.82 1.5% HF 19-44 M 75,305 309.83 314.13 1.4% HF 19-44 F 288,637 431.45 435.74 1.0% HF 45+ M+F 48,859 594.43 598.76 0.7% HST 19-64 F 15,263 549.71 554.00 0.8% EXT 19-34 M 106,493 $ 444.37 $ 448.67 1.0% EXT 19-34 F 107,658 466.20 470.52 0.9% EXT 35-44 M 57,853 636.40 640.80 0.7% EXT 35-44 F 54,288 691.43 695.83 0.6% EXT 45-54 M 55,619 820.13 824.81 0.6% EXT 45-54 F 62,625 860.56 865.15 0.5% EXT 55-64 M 51,610 913.90 919.20 0.6% EXT 55-64 F 59,114 893.65 898.54 0.5% ABD <21 53,028 $ 1,060.62 $ 1,064.91 0.4% ABD 21+ 153,458 1,564.80 1,570.14 0.3% Milliman is among the world’s largest providers of actuarial and related products and services. The following are firm has consulting practices in life insurance and financial services, property & casualty insurance, healthcare, and employee benefits. Founded in 1947, Milliman is an independent firm with offices in major cities around the MCP responsibilities related to communicating with eligible individuals pre-enrollment and MCP members post-enrollmentglobe. Upon request, the MCP shall provide both members and eligible individuals with a copy of their practice guidelines.xxxxxxxx.xxx
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Samples: Provider Agreement
