PROJECTED NON-BENEFIT COSTS Sample Clauses
The PROJECTED NON-BENEFIT COSTS clause defines and governs the estimation and allocation of costs that are not directly related to benefits provided under an agreement, such as administrative expenses, overhead, or other operational costs. In practice, this clause outlines which specific non-benefit costs are anticipated, how they are calculated, and the method for their inclusion in budgeting or reimbursement processes. Its core function is to ensure transparency and predictability in financial planning by clearly identifying and managing expenses that fall outside of direct benefit payments, thereby preventing disputes over unexpected or ambiguous costs.
PROJECTED NON-BENEFIT COSTS. This section provides information on the development of projected non-benefit costs.
PROJECTED NON-BENEFIT COSTS. 16
A. Data, assumptions and methodologies 16
i. Description of the data, assumptions, and methodologies 16
(a) Data 16
(b) Assumptions and methodology 16
ii. Material changes 16
B. Non-benefit costs, by cost category 17 C. PMPM versus percentage 17
PROJECTED NON-BENEFIT COSTS. A. Changes in Data Sources, Assumptions, or Methodologies Since Last Certification Cost report data, including non-benefit costs, was available for CY 2016. We used this information to evaluate the reasonableness of our non-benefit expense assumptions for the Extension population. As reported non-benefit expenses in the CY 2016 cost reports did not differ significantly between the CFC Adult and Extension populations, the non-benefit expense percentage loads have been set equal for the two populations in the development of the CY 2018 rates. This assumption is consistent with the prior certification.
B. Assumption Differences Relative to Other Medicaid Populations As stated previously, non-benefit expense assumptions for the Extension population were set equal to the CFC Adult population.
PROJECTED NON-BENEFIT COSTS. A. RATE DEVELOPMENT STANDARDS
ii. PMPM Versus Percentage The non-benefit cost was developed as a percentage of the capitation rate.
iii. Basis for Variation in Assumptions Any assumption variation between covered populations is the result of program differences and is in no way based on the rate of federal financial participation associated with the population.
iv. Health Insurance Providers Fee Detail regarding the health insurance providers fee is provided in a later section of this letter.
PROJECTED NON-BENEFIT COSTS. I.5.A. Rate Development Standards This section of the 2023 Guide provides information on the non-benefit component of the capitation rates. I.5.B. Appropriate Documentation I.5.B.i. Description of the Development of Projected Non-Benefit Costs I.5.B.i.(a) Data, Assumptions, and Methodology The primary data source used to develop the administrative component of the CYE 23 capitation rates for the ACC populations was the historical and projected administrative expense data submitted by the Contractors per a supplemental data request, as noted in Section I.2.B.ii.(b)(ii). The primary data source used to develop the administrative component of the CYE 23 capitation rates for the RBHA populations was the administrative expense PMPM submitted by the Offerors during the CYE 23 CCE, as noted in Section I.2.B.ii.(b)(ii). As part of the CCE, the Offerors were required to bid actuarially sound administrative costs by GSA and risk group with detailed administrative category of service information for five years (CYE 23 through CYE 27) as well as provide the projected member months assumed for each of the years by GSA and risk group. The ACC, ACC-RBHA, and prior RBHA Contractors’ supplemental administrative data request included amounts for administrative expenses for CYE 21 actuals, CYE 22 year-to-date (through 12/31/21) actuals, actual/projected amounts for CYE 22, and projected amounts for CYE 23. This data request included administrative breakouts into different categories, breakdowns of fixed and variable administrative costs for the ACC populations, and the ACC, ACC-RBHA, and prior RBHA Contractors’ member months for each of the time frames. The CYE 21 financial statements and CYE 22 Q1 financial statements were also reviewed. Other sources of data reviewed and utilized in the development of the non-benefit cost projections were trends and forecasts for various Consumer Price Indices (CPI) and Employment Cost Indices (ECI) data from IHS Markit. For the ACC population, the actuaries developed and reviewed several methodologies for projecting administrative expenses, comparing the results across the methodologies, reviewing the results as a percentage of capitation rates, and comparing the results to national information1 on Medicaid administrative costs. The ACC population administrative PMPMs included in the capitation rates were developed primarily using the Contractors’ supplemental administrative data and CYE 23 projected member months from both the Contract...
PROJECTED NON-BENEFIT COSTS. III.3.A. Description of Issues III.3.A.i. Changes in Data Sources, Assumptions, Methodologies The development of the projected non-benefit costs, including any changes in data, assumptions, or methodologies since the last rate certification, for the CYE 23 capitation rates for the ACC and ACC-RBHA Program, including the new adult group, are described in Section I.5.
PROJECTED NON-BENEFIT COSTS. A. RATE DEVELOPMENT STANDARDS
i. Overview In accordance with 42 CFR §438.5(e), the non-benefit component of the capitation rate includes reasonable, appropriate and attainable expenses related to MCOP operation of the MyCare program. The remainder of this section provides documentation of the data, assumptions and methodology that we utilized to develop the non-benefit cost component of the capitation rate.
ii. PMPM Versus Percentage The non-benefit cost was developed as a percentage of the capitation rate.
iii. Basis for Variation in Assumptions Any assumption variation between covered populations is the result of program differences and is in no way based on the rate of federal financial participation associated with the population.
iv. Health Insurance Providers Fee Detail regarding the health insurance providers fee is provided in a later section of this report.
PROJECTED NON-BENEFIT COSTS. Not applicable to the APSI for the CYE 23 ACC and ACC-RBHA Program rate update.
PROJECTED NON-BENEFIT COSTS. Not applicable to the HEALTHII for the CYE 23 ACC and ACC-RBHA Program rate update.
PROJECTED NON-BENEFIT COSTS. There have been no changes to administrative costs or the percentages for premium tax and underwriting gain from the original capitation rate certification. Please see the original capitation rate certification for all projected non-benefit costs used in the development of the CYE 24 capitation rates for the ACC and ACC-RBHA Program.