Common use of Other Populations Clause in Contracts

Other Populations. Neither waiver coordination services nor non-waiver care management services are required to be contracted with the AAAs for the other MyCare populations. Thus, the total care management costs are additionally referenced as plan management costs. Upon review of the total care management costs from the CY 2021 through first half 2023 cost reports, we determined that the care management costs represent approximately half of total administrative expenses for all MCOPs in composite. Using a consistent approach with the administrative cost development, we increased care management costs for the Institutional, Community Waiver 18-44 and all Community Well populations for CY 2024. The care management costs for the Community Waiver 45-64 population were developed as a member weighted average of the Community Waiver 45-64 plan management PMPM and the AAA Plus Plan Management PMPM Costs. Fees and Taxes are loaded to the capitation rates after the application of non-benefit expenses. This includes the Health Insuring Corporation (HIC) Franchise Fee along with the HIC tax. The HIC Franchise Fee consists of a PMPM amount that varies based on an entity’s Medicaid member months. The development of the actuarially sound capitation rates includes HIC Franchise Fee (collected by ODM) and HIC tax (collected by the Ohio Department of Insurance) components. HIC Franchise Fee amounts were developed by MCOP based on projected Medicaid member months for January through June 2024, and then weighted based on regional enrollment by MCOP. As the HIC Franchise Fee is assessed on a state fiscal year basis, we anticipate amending the CY 2024 capitation rates to reflect HIC Franchise Fee amounts applicable to July through December 2024. The HIC tax will remain at 1% of total capitation.