Risk Adjustment Calculation Timeline. For Contract Year 2022, the MCO’s aggregate risk scores will be calculated two times. 4.5.5.1 For Capitation Payments for January through June 2022, the MCO will receive aggregate risk scores calculated by the STATE, using: • Encounter claims and FFS claims for dates of service of January 2020 through June 2021 (the assessment period) that include a warrant date no later than October 12, 2021, and • The MCO’s enrollment as of October 2021 (the exposure month), for each population subject to risk adjustment. 4.5.5.2 Exception process for Contract Year 2022 for the Hennepin, ▇▇▇▇▇▇ and Metro rate setting regions. The STATE will apply an aggregate risk score of 1.0 to January 2022 through June 2022 Capitation Payments, until such time as the aggregate risk score is calculated as below to be applied to forthcoming capitation payments. The STATE will then process retrospective adjustments for January 2022 through June 2022 Capitation Payments as necessary using the risk scores calculated in section 4.5.5.3 below. 4.5.5.3 For Capitation Payments for July through December 2022, the MCO will receive aggregate risk scores calculated by the STATE, using: • Encounter claims and FFS claims for dates of service of July 2021 through December 2021 (the assessment period) that include a warrant date no later than April 12, 2022 and • The MCO’s enrollment as of April 2022 (the exposure month), for each population subject to risk adjustment.
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Risk Adjustment Calculation Timeline. For Contract Year 2022, the MCO’s aggregate risk scores will be calculated two times.
4.5.5.1 For Capitation Payments for January through June 2022, the MCO will receive aggregate risk scores calculated by the STATE, using: using: • Encounter claims and FFS claims for dates of service of January 2020 through June 2021 (the assessment period) that include a warrant date no later than October 12, 2021, and • The MCO’s enrollment as of October 2021 (the exposure month), for each population subject to risk adjustment.
4.5.5.2 Exception process for Contract Year 2022 for the Hennepin, ▇▇▇▇▇▇ and Metro rate setting regions. The STATE will apply an aggregate risk score of 1.0 to January 2022 through June 2022 Capitation Payments, until such time as the aggregate risk score is calculated as below to be applied to forthcoming capitation payments. The STATE will then process retrospective adjustments for January 2022 through June 2022 Capitation Payments as necessary using the risk scores calculated in section 4.5.5.3 below.
4.5.5.3 For Capitation Payments for July through December 2022, the MCO will receive aggregate risk scores calculated by the STATE, using: using: • Encounter claims and FFS claims for dates of service of July 2021 through December 2021 (the assessment period) that include a warrant date no later than April 12, 2022 and • The MCO’s enrollment as of April 2022 (the exposure month), for each population subject to risk adjustment.
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