Projected Benefit Costs. This section provides the documentation of the methodology utilized to develop the benefit cost component of the capitation rates at the rate cell level.
Projected Benefit Costs. A. Description of Projected Benefit Cost Issues CY 2016 Extension population experience, in the form of adjusted encounter data, is used as the underlying data source for the development of the CY 2018 capitation rates. The 2017 rate setting process placed 75% credibility on cost report data expenditures, with 25% credibility on encounter data expenditures. The CY 2018 rate development process assumes full credibility of MCP encounter data, after applying data quality adjustments. In developing the adjusted base data for the CY 2018 capitation rates, rate cells were reassigned based on each member’s rate cell as of July 1, 2017. For members included in the CY 2016 encounter data but not enrolled as of July 1, 2017, we reassigned member rate cells based on state data exchange (SDX) files for the state of Ohio. The SDX files contain information related to which MMC enrollees receive SSI. This process produced total benefit expense equal to the CY 2016 incurred encounter data, while reflecting post-1634 member rate cell assignment. Other data sources, assumptions, and methodologies are generally consistent with the CY 2017 certification and the July amendment to the CY 2017 certification. Discussion of other assumption changes is provided in the next section.
Projected Benefit Costs i. 2014 and 2015 Experience Used in Rate Development 2014 Extension population experience, in the form of both encounter data and cost report data, is used as the underlying data source for the development of the calendar year 2016 capitation rates. Emerging data from these two data sources in the first half of calendar year 2015 was used to assess emerging enrollment and cost patterns, particularly from beneficiaries entering the program in the first half of 2015.
