• Resources
• LDH Resources

LDH Resources

• Risk-bearing MCO Rate Certification Letter and Appendices

  Details:

  December 06, 2023

  • Medicaid
  • Managed Care

  Original Period Certified: July 2023 - June 2024 Actual Period Covered: July 2023 - December 2023 The Louisiana Department of Health (LDH) has contracted with Milliman, Inc. to develop actuarially sound capitation rate ranges for the Healthy Louisiana program (formerly Bayou Health). Rate certification letters certify universal rates for a given time period, e.g., a state fiscal year. Rates shown in these letters are not the rates actually paid to participating Managed Care Organizations (MCO), as the actual rates paid to each MCO are risk-adjusted. That is, the rates paid to each MCO are the universal rates in the rate letter as adjusted for the expected costs of that MCO’s enrolled members, based on the members’ health conditions and health status. Original rate letters are often replaced with revised rate letters for the same time period. Revisions are necessary whenever there are programmatic changes (e.g., changes in services or populations covered) that impact rates effective within the original rate letter time period. Revisions may cover the entire period or only part of the period (going forward from the effective date of a program change prior to the end the period). Sometimes a rate letter is supplemented with an issue-specific companion certification. For example, the Affordable Care Act (ACA) Primary Care Physician (PCP) enhanced payment, which was an add-on to PMPMs paid in 2013 and 2014 as required by Section 1202 of the Affordable Care Act, had its own certification letter. Keywords: Managed Care 3.0, Capitation Rate, Certification-12-6-2023

  Downloadable Assets:

  Risk-bearing MCO Rate Certification Letters Appendix 2 Appendix 3 Appendix 4 Appendix 5