Medicaid Rate Calculation. The Medicaid financing strategy used by the MDHHS, as stated in the 1115 Waiver, is to contain the growth of Medicaid expenditures, not to create savings. The Medicaid Rate Calculation is based on the actuarial documentation letter from Milliman USA. Five sets of rate calculations are required: 1) one set of factors for the 1115 state plan and 1915(i) [formerly (b)(3)] services; 2) one set of factors for 1915 (c) Habilitation Supports Waiver services; 3) one set of factors for 1915 (c) Children’s Waiver Program services; 4) one set of factors for 1915 (c) Waiver for Children with Serious Emotional Disturbances; 5) one set of factors for the 1115 Healthy Michigan Plan. The Milliman USA letter documents the calculation rate methodology and provides the required certification regarding actuarial soundness as required by the Balanced Budget Act Rules effective 1. The MDHHS shall not reduce the 1115, 1915(i) PEPM, 1115 Health Michigan Plan PEPM or the C- waiver rates to the PIHP to offset a statewide increase in the number of Medicaid eligibles. All PEPM rates must be certified as falling within the actuarially sound rate range.
Appears in 5 contracts
Samples: Amendment to the Agreement Between Michigan Department of Health and Human Services and Pihp, Agreement Between Michigan Department of Health and Human Services and Pihp, Agreement Between Michigan Department of Health and Human Services and Pihp
