Final Trend Estimates and CY05 Rates - Maryland Medical Care 最终趋势估计和cy05率-马里兰医疗.pptVIP

2 Final Trend Estimates and CY07 Rates Outline of Presentation A. Rate Impact B. Rate-Setting Methodology A. Rate Impact Recall from the June 22, 2006 presentation that Trend = Rate Increase Aggregate rate increase/decrease is due to Medical inflation (trend) Benefit program changes Demographic mix changes (enrollment distribution across rate cells) Other (e.g., rebasing) Overall revenue increase/decrease is additionally due to Total enrollment changes A. Rate Impact (continued) Program-wide CY07 PMPM increase of 5.2 percent over mid-year CY06 rates based on March member months simulations MCO-specific PMPM increases to be distributed after the presentation today B: Rate-Setting Methodology 1. CY04 adjusted HFMR base as starting point 2. Program changes 3. Medical trends 4. Administrative and profit load 5. Relational modeling 6. Regional factors 7. Low birth weight babies B.1: CY04 Adjusted HFMR Base as Starting Point MCOs submitted CY04 HFMRs adjusted for CG and LE reviews Non-State Plan services Removal of adult dental FQHC pricing B.2: Program Changes Physician fee schedule Increase to specified codes effective July 1, 2005 and July 1, 2006 Impacts physician PMPM by 16 percent Pharmacy copay $3 copay for all brand drugs not on the preferred drug list, $1 copay for all generic drugs for adults. Pregnant women, children, and family planning drugs are excluded from copays Increase in dental fees for restorative services $0.52 million increase B.2: Program Changes  (continued) TPL $1.5 million removed from total expenses B.3: Medical Trends Preliminary trend ranges presented on June 22, 2006 Final trend estimates presented in this section Trend Methodology Data analysis Analyze MCO-reported financial and encounter data Analyze HSCRC hospital data Trend estimation Past trends: Assessed based on the historical data Future trends: Assessed with past trends as baseline compared to other benchmarks Inpatient Hospital Unit Cost Tr