Agency: Florida Agency for Health Care Administration

Market: Florida

Line of Business: Medicaid

Market: Florida

Line of Business: Medicaid

Agency: Florida Agency for Health Care Administration

Source: Medicaid Actuarial Services

Advanced financial and statistical support relating to Capitation Rates, Risk Adjustment Models, and Payment Methodologies.

Medicaid Actuarial Services

This post is useful for those seeking information on Medicaid actuarial services and related rates in Florida.

  • Outlines Medicaid actuarial services provided by the Bureau, including advanced financial and statistical support for Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
  • Provides information on Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental Capitation Rates for various years.
  • Includes a link to a Special Needs Plan Revenue and Expense Schedule Statement Template Tool.

Unit Responsibilities include:

  • Support of Capitation Rate Development and Adjustment
  • Management of External Actuarial Service Contracts
  • Monitoring Medicaid Program Changes
  • Trend Analysis
  • Rate Impact Analysis

Medicaid Actuarial Services

This post is useful for those seeking information on Medicaid actuarial services and related rates in Florida.

  • Outlines Medicaid actuarial services provided by the Bureau, including advanced financial and statistical support for Capitation Rates, Risk Adjustment Models, and Payment Methodologies.
  • Provides information on Managed Medical Assistance (MMA), Long-Term Care (LTC), and Dental Capitation Rates for various years.
  • Includes a link to a Special Needs Plan Revenue and Expense Schedule Statement Template Tool.

For Institutional Reimbursement rates, please click here.

SMMC Capitation Information

Managed Medical Assistance (MMA)

Long-Term Care (LTC)

Dental

Medicare Dual Eligible Special Needs Plans (D-SNPs) and Fully Liable Medicare Advantage Plans

Special Needs Plan Revenue and Expense Schedule Statement Template Tool [ excel 160.5 kB ] Effective July 1

As Medicare Advantage continues to grow, a gradual but significant reshaping of the Medicare program is taking place.

A new KFF analysis finds that nearly half of eligible Medicare beneficiaries – 28.4 million out of 58.6 million Medicare beneficiaries overall – are now enrolled in Medicare Advantage plans. That represents a more than doubling of the share of the eligible Medicare population enrolled in such plans from 2007 to 2022 (19% to 48%). Enrollment is projected to cross the 50 percent threshold as soon as next year, making Medicare Advantage the predominant way that Medicare beneficiaries with Parts A and B get their coverage and care.

Statutory and Plan-Bid Components of the Regional MA Benchmarks

The annual election period for 2020 coverage is set to start Oct. 15 and run until Dec. 7. The capitation payment spreadsheet below shows about how much Medicare Advantage program managers think they should be paying each month for each Medicare Advantage plan enrollee’s care.

Carriers set their actual prices by bidding against the capitation payment amounts. Carriers with plans that do well on Medicare Advantage program quality measures get a higher monthly capitation payment.

  • The 2020 county-level averages range from $755 per month, in Presidio, Texas, up to $1,609, in Nome, Alaska.
  • To simplify things, we calculated state-level averages. The 2020 state-level averages ranged from $883 per month, in Hawaii, up to $1,168, in Alaska.
  • We also calculated how fast each state’s average capitation level changed between 2019 and 2020. The year-over-year change ranged from 4%, in Delaware, up to 8.2%, in one state.

ACCESS THE 2021 MEDICARE RATEBOOK: 2021 Medicare Ratebook (National, County Level Capitation Rates)

Determining Medicare payment for regional MA plans

Aside from a few special payment incentives, payment for regional MA plans is determined like payment for local plans, except that the benchmarks are calculated differently. CMS determines the benchmarks for the MA regional plans by using a more complicated formula that incorporates the plan bids. A region’s benchmark is a weighted average of the average county rate and the average plan bid.

As directed by law, CMS computes the average county rate as the individual county rates weighted by the number of Medicare beneficiaries who live in each county. The average plan bid is each plan’s bid weighted by each plan’s projected number of enrollees. CMS then combines the average county rate and the average bid into an overall average. In calculating the overall average, the average bid is weighted by the number of enrollees in all private plans across the country, and the average county rate is weighted by the number of all Medicare beneficiaries who remain in FFS Medicare.

#CMS #FFS Medicare #Medicare #2021RateBook

Title 42. Public HealthChapter IV. CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES Subchapter B. MEDICARE PROGRAM Part 422. MEDICARE ADVANTAGE PROGRAM Subpart F. Submission of Bids, Premiums, and Related Information and Plan Approval Section 422.258. Calculation of benchmarks.