Projected Benefit Costs Clause Samples

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. B. Description of Key Assumption C. Changes to Benefit Plan No benefit changes have been made to the Extension benefit plan, other than items discussed in Section I, 2. D. Other Material Changes or Adjustments to Benefit Costs We did not make any other adjustments in the Extension rate development process other than those previously outlined in the report.

Projected Benefit Costs. ‌ III.2.A. Description of Projected Benefit Costs‌ III.2.A.i. Documentation if State Previously Covered the New Adult Group‌

Projected Benefit Costs i. 2015 Experience Used in Rate Development 2015 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 CY 2017 capitation rates. ii. Changes in Data Sources, Assumptions, or Methodologies Since Last Certification The data sources, assumptions, and methodologies are consistent with the CY 2016 certification and the July amendment to the CY 2016 certification. Discussion of other assumption changes is provided in the next section. iii. Assumption Changes Since Last Certification

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. ii. Changes in Data Sources, Assumptions, or Methodologies Since Last Certification As mentioned previously, the 2015 Extension rate certification developed by ODM’s previous actuarial vendor was based on a blend of CFC and ABD experience due to the lack of credible data for the Extension population, while the 2016 rate development process uses actual 2014 Extension experience. Discussion of other assumption changes is provided in the next section. iii. Assumption Changes Since 2014 and 2015 Certification Pent-up demand was observed for Extension enrollees entering the MMC delivery system from January 2014 through May 2014, with pent-up demand being the highest amongst enrollees in the January through March time frame. A calendar year 2014 pent-up demand factor for each Extension rate cell was developed based on calculating an estimated calendar year 2014 PMPM expense with and without pent-up demand for the January through May time frame. After rounding, we estimated the pent-up demand included in each Extension rate cell during calendar year 2014 was 1.5%. While total Extension enrollment was approximately 210,000 member months during the January through May 2014 time period, enrollment during the June through December 2014 time period was 2.2 million member months. To the extent enrollment had not increased significantly during the last seven months of the year, the pent-up demand adjustment may have been greater. We summarized calendar year 2014 Extension enrollee experience by month of entry into the population, and calculated a 2014 PMPM by month of entry into the population. We assumed enrollees entering the Extension population after December 31, 2014 would have a acuity profile similar to the population that enrolled in the program during the June 2014 through December 2014 time frame. We estimated the relative acuity mix of 2016 enrollees by using the December 2014 enrollment mix (by month of entry) and estimated growth in enrollment through Calendar Year 2016. This acuity mix was compa...