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Hoosier Care Connect Capitation Rate Presentation Family and Social Services Administration. Presented by Robert M. Damler, FSA, MAAA Principal and Consulting Actuary Christine Mytelka, FSA, MAAA Consulting Actuary. August 5, 2014. Overview. - PowerPoint PPT Presentation
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Hoosier Care ConnectCapitation Rate PresentationFamily and Social Services Administration
Presented by
Robert M. Damler, FSA, MAAAPrincipal and Consulting Actuary
Christine Mytelka, FSA, MAAAConsulting Actuary
August 5, 2014
2 August 5, 2014
Overview July 24, 2014 Hoosier Care Connect Capitation Rate
Development and Certification
Aged, Blind, and Disabled Non-Dual Population
Three year contract– April 1, 2015 – December 31, 2015
– Calendar Year 2016
– Calendar Year 2017
Actuarially Sound Rate Range
Population Low Rate High Rate
Adult $1,083.14 $1,141.81
Child 653.18 674.83
Dual 229.95 239.65
3 August 5, 2014
DataBase Data for Rate Development
Primarily SFY 2012 and SFY 2013 claims and enrollment data– Fee for service claims
– Encounter data for MA-U
– Pharmacy and dental: fee for service
Hospital data: At Medicaid reimbursement (without HAF, without GME)
Pharmacy data: Before rebates
4 August 5, 2014
Covered PopulationsPopulations to be Covered by MCOs
Aged, Blind, and Disabled– Includes prior spend-down individuals that are now fully eligible
Child and Adult Rate Cells
Retroactive Medicare Eligible Rate
Population exclusions– Medicare enrolled
– Long term care (institutional and waiver)
– Foster care and adoption assistance
– Limited benefit
5 August 5, 2014
Covered ServicesServices to be Provided by MCOs
Indiana Health Coverage Program covered services excluding:– Medicaid Rehabilitation Option Services
– Nursing home services indicated for more than 30 days
– Institutional hospice services
– ICF/ID and PRTF services
– HCBS waiver services
– First Steps and school corporation services
Newly covered services under managed care:– Dental
– Pharmacy
6 August 5, 2014
Adjustments – Base DataAdjustments Made to Base Data for Historical Actuarial Models
Encounter data repriced at Medicaid reimbursement
Spend-down liability repricing
Removal of GME, HAF
May and June 2013 Pharmacy Completion
7 August 5, 2014
Adjustments – FFS ProjectionAdjusting Base Data to Rate Period Midpoint
Utilization Trend
Claims Completion
Reimbursement Changes– Emergency Reimbursement Reduction Expirations
– Physician Fee Schedule Increase
– Pharmacy Dispensing Fee Rate Change
Third Party Liability (Pay and Chase)
8 August 5, 2014
Adjustments – Managed CareAdjusting Data to a Risk-Based Managed Care Environment
Pharmacy Copayment
Managed Care Utilization
Managed Care Contracting– Pharmacy Dispensing Fee Only
9 August 5, 2014
Non-Medical Adjustments
Administration Load– Variable load of 9.0% for adult and child rate cells
– Retroactive Medicare eligible administrative load set equal to adult rate
– Includes allowance for administration, profit, and risk/contingency
Withhold of 1.5% in the first contract year
Health Insurer Assessment Fee– No adjustment in the first contract period
10 August 5, 2014
Risk Mitigation
Risk adjustment will be performed initially using fee-for-service data
Cost neutral to state
Will use an actuarially sound risk adjustment methodology
11 August 5, 2014
Limitations
This presentation has been prepared for the State of Indiana, Family and Social Services Administration and their consultants and advisors. Any user of the material presented should possess a certain level of expertise in actuarial science and healthcare modeling and have access to the full report issued by Milliman. The material may not be provided to third parties without the prior written consent of Milliman. Even if distribution is allowed, this material is not meant to benefit or be relied upon by any third parties.
Milliman does not intend to benefit and assumes no duty or liability to third parties who receive this presentation, even if we consent to its release. Milliman recommends that any recipient be aided by its own actuary or other qualified professional when reviewing this presentation.
In developing this presentation, we relied on data and other information obtained from FSSA and its vendors. We have not audited or verified this data and other information. We performed a limited review of the data used directly in our analysis for reasonableness and consistency. If the underlying data or information is inaccurate or incomplete, the results of our analysis may likewise be inaccurate or incomplete.
The presenters of this material are members of the American Academy of Actuaries and meet the Qualification Standards of the Academy for performing the analyses contained herein. To the best of our knowledge and belief, this information is complete and accurate and has been prepared in accordance with generally recognized and accepted actuarial principles and practices.
The services provided for this project were performed under the contract between Milliman and FSSA approved May 14, 2010, as amended December 30, 2013.
