Risk Adjustment Method. The Department will analyze the risk profile of each MCO’s Enrollees using a risk adjustment model specified by the Department. A. Enrollees will be assigned risk scores based on attributes including, but not limited to, demographics, disease conditions, rate cell, and duration of enrollment in the study period. B. Not all Enrollees will be risk scored. Exclusions such as dual eligible Enrollees may exist. C. Each MCO’s proposed base Capitation rates will be risk adjusted based on its Enrollees’ risk scores relative to risk scores of other MCOs. D. The Department will update risk scores at least one (1) time per State Fiscal Year, either in the form of a full Enrollee re-score or an update for changes in Enrollee distributions, with all calculations including a budget neutrality adjustment. Supplemental Pass-Through Payments and Payments related to the HIF will not be risk-adjusted.
Appears in 6 contracts
Samples: Medicaid Managed Care Contract, Medicaid Managed Care Contract, Medicaid Managed Care Contract
Risk Adjustment Method. The Department will analyze the risk profile of each MCO’s Enrollees using a risk adjustment model specified by the Department.
A. Enrollees will be assigned risk scores based on attributes including, but not limited to, demographics, disease conditions, rate cell, and duration of enrollment in the study period.
B. Not all Enrollees will be risk scored. Exclusions such as dual eligible Enrollees may exist.
C. Each MCO’s proposed base Capitation rates will be risk adjusted based on its Enrollees’ risk scores relative to risk scores of other MCOs.
D. The Department will update risk scores at least one (1) time per State Fiscal Year, either in the form of a full Enrollee re-score or an update for changes in Enrollee distributions, with all calculations including a budget neutrality adjustment. Supplemental Pass-Through Payments and Payments related to the HIF will not be risk-adjustedrisk -adjusted.
Appears in 1 contract
Samples: Medicaid Managed Care Contract
