Crossover Claims Completion Factors SFY SFY Category of Service 2012 2013 Inpatient Non-MH/SA 1.001 1.035 – Inpatient MH/SA 1.001 1.035 Hospital Outpatient 1.005 1.027 Outpatient MH/SA 1.005 1.027 Professional 1.005 1.027 HCBS/Home Health 1.000 1.000 LTC Facility 1.001 1.010 Pharmacy (Non-Part D) 1.006 1.056 DME & Supplies 1.006 1.056 Transportation 1.006 1.056 All Other 1.006 1.056 All Services 1.003 1.028 Counties and Regions: Rates will be paid on a Massachusetts county and MassHealth rating category basis. Rates, however, have been developed regionally. Five counties are not included in any of the One Care plan service areas: Barnstable. Bristol. Berkshire. Dukes. Nantucket. Since the Demonstration does not currently operate in these counties, any applicable claims and eligibility data for these counties has been removed from the base data. The resulting geographic classifications are as follows: Eastern: Essex, Middlesex, Norfolk and Suffolk counties Western: Franklin, Hampden, Hampshire and Worcester counties The Cape: Plymouth county Adjustment information below is provided by geographic region. Adjustments to Historical Base Data: As outlined in Appendix 6 of the MOU for this Demonstration and further detailed in Section 4 of the contract, rates have been developed based on expected costs for this population had the
Crossover Claims Completion Factors Category of Service SFY 2012 SFY 2013 Inpatient – Non-MH/SA 1.001 1.035 Inpatient MH/SA 1.001 1.035 Hospital Outpatient 1.005 1.027 Outpatient MH/SA 1.005 1.027 Professional 1.005 1.027 HCBS/Home Health 1.000 1.000 LTC Facility 1.001 1.010 Pharmacy (Non-Part D) 1.006 1.056 DME & Supplies 1.006 1.056 Transportation 1.006 1.056 All Other 1.006 1.056 All Services 1.003 1.028 Counties and Regions: Rates will be paid on a Massachusetts county and MassHealth rating category basis. Rates, however, have been developed regionally. Five counties are not included in any of the One Care plan service areas: Barnstable. Bristol. Berkshire. Dukes. Nantucket. Since the Demonstration does not currently operate in these counties, any applicable claims and eligibility data for these counties has been removed from the base data. The resulting geographic classifications are as follows: Eastern: Essex, Middlesex, Norfolk and Suffolk counties Western: Franklin, Hampden, Hampshire and Worcester counties The Cape: Plymouth county Adjustment information below is provided by geographic region. Adjustments to Historical Base Data: As outlined in Appendix 6 of the MOU for this Demonstration and further detailed in Section 4 of the contract, rates have been developed based on expected costs for this population had the