Other Populations. Neither waiver coordination services nor non-waiver care management services are required to be contracted with the AAAs for the other MyCare populations. Thus, the total care management costs are additionally referenced as plan management costs. Upon review of the total care management costs from the CY 2017 through first half 2021 cost reports, we determined that the care management costs represent approximately half of total administrative expenses for all MCOPs in composite. The care management costs for the Community Waiver 45-64 population were developed as a member weighted average of the Community Waiver 45-64 plan management PMPM and the AAA Plus Plan Management PMPM Costs.
Other Populations. Neither waiver coordination services nor non-waiver care management services are required to be contracted with the AAAs for the other MyCare populations. Thus, the total care management costs are additionally referenced as plan management costs. Upon review of the total care management costs from the CY 2021 through first half 2023 cost reports, we determined that the care management costs represent approximately half of total administrative expenses for all MCOPs in composite. Using a consistent approach with the administrative cost development, we increased care management costs for the Institutional, Community Waiver 18-44 and all Community Well populations for CY 2024. The care management costs for the Community Waiver 45-64 population were developed as a member weighted average of the Community Waiver 45-64 plan management PMPM and the AAA Plus Plan Management PMPM Costs. Taxes, licensing and regulatory fees, and other assessments and fees Fees and Taxes are loaded to the capitation rates after the application of non-benefit expenses. This includes the Health Insuring Corporation (HIC) Franchise Fee along with the HIC tax. The HIC Franchise Fee consists of a PMPM amount that varies based on an entity’s Medicaid member months. The development of the actuarially sound capitation rates includes HIC Franchise Fee (collected by ODM) and HIC tax (collected by the Ohio Department of Insurance) components. HIC Franchise Fee amounts were developed by MCOP based on projected Medicaid member months for January through June 2024, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, we anticipate amending the CY 2024 capitation rates to reflect HIC Franchise Fee amounts applicable to July through December 2024. The HIC tax will remain at 1% of total capitation.
Other Populations. Neither waiver coordination services nor non-waiver care management services are required to be contracted with the AAAs for the other MyCare populations. Thus, the total care management costs are additionally referenced as plan management costs. We determined that the 4.0% trend increase over the current PMPM care management values, after rebasing of the Community Waiver 60+ costs, would result in a reasonable composite normalized PMPM in comparison to the YTD June 2017 cost report data. As a result, care management costs for the Institutional, Community Waiver 18 – 44 and all Community Well populations were increased by 4.0% over current levels. The resulting PMPMs were then averaged based upon July 2017 MyCare enrollment to develop plan management rates that are uniform across regions. The care management costs for the Community Waiver 45-64 population were developed as a member weighted average of the Community Waiver 18-44 and 65+ amounts.
Other Populations. Neither waiver coordination services nor non-waiver care management services are required to be contracted with the AAAs for the other MyCare populations. Thus, the total care management costs are additionally referenced as plan management costs. Care management costs from the YTD June 2016 cost reports were used to develop expenditure estimates for these populations. Because large variances exist among MCOP care management costs on a population by population basis, the cost report care management data was composited and normalized for comparison to composite care management costs included in the current capitation rates. We determined that the 2.0% trend increase over the current PMPM care management values, after rebasing of the Community Waiver 60+ costs, would result in a reasonable composite normalized PMPM in comparison to the YTD June 2016 cost report data. As a result, care management costs for the Institutional, Community Waiver 18 – 44 and all Community Well populations were increased by 2.0% over current levels. The resulting PMPMs were then averaged based upon August 2016 MyCare enrollment to develop plan management rates that are uniform across. The care management costs for the Community Waiver 45-64 population were developed as a member weighted average of the Community Waiver 18-44 and 65+ amounts.
Other Populations. Neither waiver coordination services nor non-waiver care management services are required to be contracted with the AAAs for the other MyCare populations. Thus, the total care management costs are additionally referenced as plan management costs. Upon review of the total care management costs from the CY 2017 through first half 2020 cost reports, we determined that the care management costs represent approximately half of total administrative expenses for all MCOPs in composite. We determined that a 50% distribution between care management expenses and other administrative expenses, after rebasing of the Community Waiver 60+ costs, would result in a reasonable composite normalized PMPM in comparison to the CY 2019 cost report data. The care management costs for the Community Waiver 45-64 population were developed as a member weighted average of the Community Waiver 45-64 plan management PMPM and the AAA Plus Plan Management PMPM Costs.
