Projected costs for the C2 and C3 rating categories were developed by region following the same process as was used for CY 2013 rates. The C2A/C2B and the C3A/C3B relativity factors were applied to the projected medical PMPM for the C2 and C3 rating categories, respectively, to develop projected costs for the C2A/C2B and C3A/C3B rating categories. Adjustments for administration, seasonality, savings and enrollee contribution to care were applied to produce the final capitation rates. The C2A and C2B rate relativity factors applied to the C2 projected expenditures are: Eastern Western The Cape -9.4% -8.5% -8.9% C2A 37.4% 38.8% 38.3% C2B The C3A and C3B rate relativity factors applied to the C3 projected expenditures are: Eastern Western The Cape -6.7% -6.8% -9.4% C3A 78.0% 77.8% 72.8% C3B Category of Service Mapping: The following is a category of service mapping between the services reflected in the MassHealth base data and the service categories used in the rate development process. Descriptions of the MassHealth detailed categories of service can be found in Section 3 of the MassHealth Information Sharing Package, Data Detail.” “Base Medicaid Claims: Rate Development MassHealth Base Data Category of Service Detailed Category of Service Inpatient Non-MH/SA IP Non-Behavioral Health – – Inpatient MH/SA IP Behavioral Health – Hospital Outpatient Hospital Outpatient Outpatient MH/SA Outpatient BH Professional Professional HCBS/Home Health Community LTSS LTC Facility LTC Pharmacy (Non-Part D) Non-Part D Pharmacy DME and Supplies DME and Supplies Transportation Transportation All Other Other Services
Projected costs for the C2 and C3 rating categories were developed by region following the same process as was used for CY 2013 rates. The C2A/C2B and the C3A/C3B relativity factors were applied to the projected medical PMPM for the C2 and C3 rating categories, respectively, to develop projected costs for the C2A/C2B and C3A/C3B rating categories. Adjustments for administration, seasonality, savings and enrollee contribution to care were applied to produce the final capitation rates. The C2A and C2B rate relativity factors applied to the C2 projected expenditures are: Eastern Western The Cape C2A -9.4% -8.5% -8.9% C2B 37.4% 38.8% 38.3% The C3A and C3B rate relativity factors applied to the C3 projected expenditures are: Eastern Western The Cape C3A -6.7% -6.8% -9.4% C3B 78.0% 77.8% 72.8% Category of Service Mapping: The following is a category of service mapping between the services reflected in the MassHealth base data and the service categories used in the rate development process. Descriptions of the MassHealth detailed categories of service can be found in Section 3 of the MassHealth Information Sharing Package, “Base Data Detail.” Medicaid Claims: Rate Development Category of Service MassHealth Base Data Detailed Category of Service Inpatient – Non-MH/SA IP – Non-Behavioral Health Inpatient MH/SA IP – Behavioral Health Hospital Outpatient Hospital Outpatient Outpatient MH/SA Outpatient BH Professional Professional HCBS/Home Health Community LTSS LTC Facility LTC Pharmacy (Non-Part D) Non-Part D Pharmacy DME and Supplies DME and Supplies Transportation Transportation All Other Other Services
duals-demo-cy-2015-payment-rates.docx