Types of Data. The SFY 2022 encounter data for the Opt-In program served as the primary data source for the CY 2024 capitation rate development for the MyCare Opt-In program. The following data sources were utilized to inform adjustments to the plan-submitted encounter data: ▪ Historical MyCare eligibility files provided by ODM; ▪ Annual and quarterly MyCare cost report data submitted by the MCOPs; ▪ Re-priced inpatient and outpatient hospital claims experience provided by ODM; ▪ Fee-for-service (FFS) data for dual eligibles; ▪ 2024 MCOP Survey submissions completed by each MCOP, which includes SFY 2022 claims and eligibility data (SFY 2022 cost report data); ▪ ODM fee schedules applicable to services affected by reimbursement changes due to legislative budget appropriations; and, ▪ Member-level enrollment data related to the PHE unwinding.
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Sources: Provider Agreement, Provider Agreement