Dhcs capitated rates development division pegrjmo

Dhcs capitated rates development division

22.01.2021

Muntz22343

Medi-Cal must pay capitated rates to health plans participating in managed care. Capitated rates must be developed using actuarial methods. Medi-Cal must utilize a county and model specific rate methodology to develop the rates. The rate development process uses plan specific data that is submitted by the health plans to Medi-Cal. effect before the next rate development process, in which case the monthly capitation adjustment would operate retroactively. Supplemental Rates In addition to the base monthly capitation pay-ments MMCPs receive, DHCS also makes supple-mental payments for other covered benefits. As with risk adjustment, this applies only in counties This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans for BHT services by county and State Fiscal Year. Medi-Cal beneficiaries under 21 years of age, are eligible for BHT services when determined medically necessary and based upon a recommendation from a physician or a psychologist. Capitated Rate Development Division Presenters: Stuart N. Busby, CPA, DABFA – Chief of the Capitated Rates Development Division . deemed necessary by DHCS to establish rates. • Rates are to be distributed typically by the first week of the Budget Year. This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in the COHS model, by State Fiscal Year. The COHS serve beneficiaries in 22 counties. In the COHS model counties, the Department of Health Care Services (DHCS) contracts with a health plan created by the county Board of Supervisors. DHCS’ Capitated Rate Development Division develops capitation rates in consultation with its contracted actuary, Mercer. Once rates have been developed, Mercer provides the actuarial soundness certification required by federal regulations. Historically, the rate development process resulted in a rate range, which represented the minimum and Within the DHCS Health Care Financing program, the Capitated Rates Development Division develops and coordinates capitation rates and monitors health plan expenditures. For behavioral health, the DHCS Mental Health and Substance Use Disorder program provides statewide oversight and administration of county-administered mental health and

DHCS Executive Staff Telephone List. Updated: 5/1/2018 Chief, Fee-for- Service Rates Development Division. Carol Gallegos Deputy Director, Director, Audits & Investigations Division. Jennifer Lopez Chief, Capitated Rates Development.

This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans for BHT services by county and State Fiscal Year. Medi-Cal beneficiaries under 21 years of age, are eligible for BHT services when determined medically necessary and based upon a recommendation from a physician or a psychologist. Medi-Cal must pay capitated rates to health plans participating in managed care. Capitated rates must be developed using actuarial methods. Medi-Cal must utilize a county and model specific rate methodology to develop the rates. The rate development process uses plan specific data that is submitted by the health plans to Medi-Cal. effect before the next rate development process, in which case the monthly capitation adjustment would operate retroactively. Supplemental Rates In addition to the base monthly capitation pay-ments MMCPs receive, DHCS also makes supple-mental payments for other covered benefits. As with risk adjustment, this applies only in counties This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans for BHT services by county and State Fiscal Year. Medi-Cal beneficiaries under 21 years of age, are eligible for BHT services when determined medically necessary and based upon a recommendation from a physician or a psychologist.

Beginning with the rate year 2009/10 rate range development, DHCS took two additional steps in the measured matching of payment to risk for the Two Plan and GMC models: 1. Introduction of a maternity supplemental (kick) payment and . 2. Introduction of risk-adjusted county average rates. Timeline

Within the DHCS Health Care Financing program, the Capitated Rates Development Division develops and coordinates capitation rates and monitors health plan expenditures. For behavioral health, the DHCS Mental Health and Substance Use Disorder program provides statewide oversight and administration of county-administered mental health and

DHCS Division Descriptions February 2020 Page 1 Administration Division Capitated Rates Development Division (CRDD) CRDD is responsible for developing and implementing managed care organization (MCO) capitation rates in compliance with contractual, state, and federal regulatory

Capitated Rate Development Division Presenters: Stuart N. Busby, CPA, DABFA – Chief of the Capitated Rates Development Division . deemed necessary by DHCS to establish rates. • Rates are to be distributed typically by the first week of the Budget Year. This dataset displays reimbursement rates paid to Medi-Cal Managed Care health plans in the COHS model, by State Fiscal Year. The COHS serve beneficiaries in 22 counties. In the COHS model counties, the Department of Health Care Services (DHCS) contracts with a health plan created by the county Board of Supervisors. DHCS’ Capitated Rate Development Division develops capitation rates in consultation with its contracted actuary, Mercer. Once rates have been developed, Mercer provides the actuarial soundness certification required by federal regulations. Historically, the rate development process resulted in a rate range, which represented the minimum and Within the DHCS Health Care Financing program, the Capitated Rates Development Division develops and coordinates capitation rates and monitors health plan expenditures. For behavioral health, the DHCS Mental Health and Substance Use Disorder program provides statewide oversight and administration of county-administered mental health and the DHCS lacks controls to ensure that the increased capitation payments to Medi-Cal MCPs are paid to hospitals and expended on hospital services to Medi-Cal enrollees. The DHCS is responsible for disbursing these payments through capitation rates. However, the DHCS has no processes ∗Medi-Cal must pay capitated rates to health plans participating in managed care. ∗Capitated rates must be developed using actuarial methods. Medi-Cal must utilize a county and model specific rate methodology to develop the rates. ∗The rate development process uses plan specific data that is submitted by the health plans to Medi-Cal. This rates information is an extract of pricing data from the automated Medi-Cal pricing system as of the specific date shown. It lists the maximum reimbursement rates payable by the Medi-Cal program for covered procedures described in the HCPCS and CPT ® coding system. Although every attempt will be made to keep this information up-to-date, it does not reflect changes made subsequent to the

DHCS Division Descriptions February 2020 Page 1 Administration Division Capitated Rates Development Division (CRDD) CRDD is responsible for developing and implementing managed care organization (MCO) capitation rates in compliance with contractual, state, and federal regulatory

Capitated Rates Development Division Chief, Capitated Rates Development Division The Department of Health Care Services (DHCS/Department) proposes to allocate the position above to the Career Executive Assignment (CEA) category. The proposed CEA Level B, Chief, Capitated Rates Development Division (CRDD), will serve as the principle policy maker for all health plan rate setting and DHCS Division Descriptions February 2020 Page 1 Administration Division Capitated Rates Development Division (CRDD) CRDD is responsible for developing and implementing managed care organization (MCO) capitation rates in compliance with contractual, state, and federal regulatory