Question 37 History of Rate re-casts.docx

Nevada Medicaid Managed Care Capitation Rate Setting Mid-Term Rate Adjustment Five-Year History

Re-certification 12/24/2014 10 months

1 year 09/26/2014

12/22/2014

· PCP Enhancement removal

· Legislative changes effective July 1, 2015

· Inpatient Mental Health Fee increase

· Vaccines for Children

· Circumcision Original with concurrent re-certification 12/30/2014

· In late 2017, CMS required DHCFP to re-cast 2016 rates due to an overestimation of children’s behavioral health/applied behavioral analysis utilization as well as volatile increases in cost and utilization of expensive drugs (e.g. Hep C treatments).

Original with concurrent re-certification 12/29/2015

2017 H1 (Jan–Jun) Rates re-cast due to:

· Removal of long stays at institutions for mental disease (IMDs) from the rates submitted to CMS for federal financial participation. This was done after further guidance from CMS.

· Applying the fee schedule adjustment for NICU InterQual Level II claims after application of the credibility adjustment. This was done to be consistent with CMS’s conclusions from the review of the 2016 rates.

· Inclusion of rates effective July 1, 2017 for the new managed care organizations MCOs SilverSummit Health Plan and Aetna Better Health.

CY 2017

09/30/2016

8 months

05/28/2017

2017 H2 (Jul-Dec)

Rates re-cast due to:

· Adjustment for emerging experience. The experience period used in the original rates was April 1, 2014 through March 31, 2016 for all populations. To develop an experience adjustment, we prepared an analysis utilizing emerging experience during the periods CY 2015 and CY 2016 for TANF and Check-up, CY 2016 only for Expansion. As part of the experience comparison analysis, we updated underlying assumptions necessary for projection of medical costs to the contract period (e.g. completion factors, and Hepatitis C adjustments).

· IMD Exclusion enrollment month pro-ration. We updated the treatment of claims incurred during months with stays greater than 15 days in institutions for mental disease (IMDs) changed. In the original July 2017 rates, all claims incurred during a “long stay” month were excluded from the rates. In a subsequent CMS FAQ document released in August 2017, it was clarified that only claims incurred during the long stay itself should be excluded. We have updated our methodology to reflect this change.

· Adjustment for managed care enrollment policy change. Effective in October 2016, DHCFP began enrolling members directly to managed care upon becoming eligible for Medicaid. This includes pro-rated capitation payments for members with partial month MCO enrollment, as DHCFP has implemented pro-rated payments to reflect partial month experience for the MCOs.

· Legislative policy change updates. Several fee schedule changes became effective July 1, 2017, but the nature and magnitude of these changes was not known until the legislative session ended in June 2017.

· Risk adjustment factor update. Risk adjustment will be retrospective rather than prospective for this rating period, as the entry of a new MCO to the market introduces uncertainty and potentially lacking experience for the development of prospective risk scores.

· HPN premium tax update. The premium tax for Health Plan of Nevada is changed to 3.33% rather than 3.27% to be more consistent with HPN’s projections. This amount will be reconciled to actuals at the end of the rating period.

July update 06/01/2017

· CMS required rates to be revised due to a material change to the safety net enhancement payment. The original rate certification submitted in September 2017 used the UPL (upper payment limit) as the base amount rather than the 2016 actual amount, which was the lesser of the two. An amendment was submitted to CMS in March 2018.

Dental - N/A Original 09/29/2017

Amendment 03/18/18

Original 09/29/2017 18 months

17 months 03/21/2019

02/07/2019

· An adjustment to the reinsurance methodology to account for members who switch rate cells.

· Revised description in Section I.5.B.iii to address the Health Insurance Providers Fee payable in CY 2020 and based on the CY 2019 rates.

Dental – N/A

Medical 10/12/2018

Dental 10/10/2018 In progress

In progress Pending approval

Pending approval

Note: Rationales listed above are paraphrased and/or quoted from rate certifications and amendments produced by the State’s existing actuary.