Acute Care Actuarial Memorandum
The purpose of this actuarial memorandum is to demonstrate that the Acute Care
capitation rates were developed in compliance with 42 CFR 438.6(c). It is not
intended for any other purpose.
11. Overview of Rate set tin^ Methodolow:
The contract year ending 201 0 (CYEI 0) rates were developed as a rate update from
the previously approved contract year ending 2009 (CYE09) capitation rates. The
CYElO rates cover the twelve month contract period of October 1, 2009 through
September 30,20 10.
The Acute Care rates were developed from historical Acute Care data including
Arizona Medicaid managed care encounter data (via an extract that provides
utilization and cost data, referred to as the "databook"), as well as health plan
financial statements. Other data sources include programmatic changes, anticipated
Arizona Health Care Cost Containment System (AHCCCS) Fee For Service rate
changes, Center for Medicare and Medicaid Services (CMS) National Health
Expenditure (NHE) Report estimates and Global Insight Prospective Hospital Market
Basket Inflation Index (GI) information.
The contract between the AHCCCS and the Health Plans (HPs) specifies that the HPs
may cover additional services. Non-covered services were removed from the
databook and not included in the rates.
Trend rates were calculated from the databook and other sources on a unit cost andlor
utilization basis by category of service (COS) and a cap was applied to limit the
negative and positive trends to a reasonable level. Unit cost trends were further
refined by anticipated changes in AHCCCS Fee For Service rates. These adjustments
also include state mandates, court ordered programs and other program changes, if
necessary. Additional analysis was performed on the AHCCCS Care (Non-MED)
population, due to shifts in the economy and policy impacts that have caused this
population to deviate from the historical encounter data. In order to capture these
changes AHCCCS used more recent encounter data as well as the most recent
financial data and applied an experience adjustment factor to this population. For
more information on trends and experience adjustments see Section III Projected
Trend Adjustments and Section IV Projected Experience Adjustments.
The Acute Care program has a large membership base, which allows for the
experience data to be analyzed by the different rate cells. These rate cells are
comprised of members with similar risk characteristics. The rate cells were analyzed
by major categories of aid (COA), i.e. risk groups, and COS. In addition, AHCCCS
develops rates by Geographic Service Area (GSA).
The experience data includes only Acute Care Medicaid eligible expenses for Acute
Care Medicaid eligible individuals, as well as reinsurance amounts. The Prior Period
Coverage (PPC) rates and the Non-MED rates are reconciled to a maximum 2%
Page 1 of 12
profit or loss. The Medical Expense Deduction (MED) rates are reconciled to a
maximum 3% profit or loss. Additional payments are made for members giving birth
via a Maternity Delivery Payment.
The general process in developing the prospective rates involves trending the CYE09
capitation rates to the midpoint of the effective period, which is April 1, 2010. The
next step involves the deduction of the reinsurance offsets. Following this
calculation, the projected administrative expenses, risklcontingency margin and
premium tax are added to the projected claim PMPMs to obtain the capitation rates.
In the final step, a risk adjustment factor is applied creating budget neutral results.
Each step is described in the sections below. In addition there are sections dedicated
to the development of other rates including, but not limited to, the Maternity Delivery
Payment and PPC rates.
1. Proiected Trend Adiustments
The trend analysis includes both the financial data experience and the encounter data
experience. Financial data experience is from the contract year ending September
2006 through March 2009. Encounter data experience is from the contract year
ending September 2006 through June 2008. Encounter data was used from those
plans that provided reasonably complete and accurate encounter submissions for the
trend analysis. The resulting data provides an actuarially sound data set for which to
trend the CYE09 rates forward. In addition to using encounter and financial data,
AHCCCS used information from CMS NHE Report estimates, GI information, and
changes in AHCCCS' Inpatient rates, Professional and Outpatient Fee Schedules,
Dental Fee Schedule, Transportation Schedule and other sources. AHCCCS
developed utilization and unit cost trend estimates using the encounter data. These
trends were developed by major COA and COS, with a cap on the percentage
increase and decrease to smooth out exceptional trends. In addition, unit cost trend
estimates were based on AHCCCS fee schedule changes for the majority of the COS
trends. Once these trends were developed they were analyzed by comparing the
results to reports and studies (for example the CMS NHE report). The utilization and
unit cost trend rates used in projecting the claim costs are summarized in Appendix I.
The prospective PMPM trends are shown below in Table I. These trends do not
reflect the impact of any program changes.
Table I: Prospective Average Annual PMPM Trends
Page 2 of 12
Hospital Inpatient TrendsL
Using the data sources mentioned in Section I1 and emphasizing the AHCCCS
encounter data, the inpatient utilization varied from -0.7 to 6.2 percent annually,
depending upon risk group. State legislation, signed into law in 2009, mandates that
"for rates effective October 1, 2009 through September 30, 2010, (AHCCCS) shall
not increase the inpatient hospital per diem rates...above the rates in effect on
September 30, 2009 ..." Based on this requirement, AHCCCS used this information
as well as encounter data to develop the hospital inpatient unit cost trends which
varied from 0.7 to 1.1 percent annually. On a combined basis, the per member per
month (PMPM) trends for inpatient hospital have been trended at 0.5 to 7.4 percent,
depending upon rating group. These ranges are summarized in Appendix I.
Hospital Outpatient and Emergency Room Trends
Per Arizona administrative Rule, on an annual basis the Outpatient Fee Schedule
(OPFS) rates are to be adjusted by multiplying the rates effective during the prior
year by the GI or by adjusting rates at varying levels with the total dollar impact
equal to that of the GI inflationary increase. However state legislation, signed into
law in 2009, mandates that for rates effective October 1, 2009 through September 30,
2010, (AHCCCS) shall not increase the aggregate outpatient hospital fee schedule
rates above the rates in effect on September 30, 2009. .." Based on this requirement,
PLHCCCS used this information as well as encounter data to develop the hospital
outpatient and emergency room unit cost trends. The utilization trends were
developed using the data sources mentioned in Section I with emphasis on the
AHCCCS encounter data. On a combined basis, the PMPM costs for hospital
outpatient and emergency room have been trended at 0.6 to 9.3 percent, depending
upon rating group. These ranges are summarized in Appendix I.
Physician and Related Service Trends
Using the data sources mentioned in Section I1 and emphasizing the AHCCCS
encounter data, the assumed utilization for physicians and other professionals ranged
from 3.4 to 7.4 percent annually, depending upon rating group and category of
service. Effective February 1, 2009, AHCCCS reduced the Physician Fee Schedule
(also including DME, radiology, and drugs administered in a physician's office) by
5% for all codes within this fee schedule. Many providers of these services are
contracted with the AHCCCS Health Plans based on these fees or a percentage of this
fee schedule. The individual impacts by Health Plan were taken as a reduction to
capitation rates as of May 1, 2009. Effective October 1, 2009, the full impact,
regardless of the percentage of each Health Plan's contracts tied to the AHCCCS
physician fee schedule, will now be applied for CYElO as an additional reduction to
the capitation rates. On a combined basis, the PMPM costs for physicians and other
professionals have been trended at 1.2 to 5.1 percent, depending upon rating group.
These ranges are summarized in Appendix I.
Using the data sources mentioned in Section I1 and emphasizing the AHCCCS
encounter data, the assumed pharmacy utilization increased by 0.7 to 10.5 percent,
depending upon rating group. Based on a review of the same sources, unit costs have
been trended at -8.9 to 6.3 percent. On a combined basis, the PMPM costs for
pharmacy have been trended at 0.7 to 11.4 percent, depending upon rating group.
These ranges are summarized in Appendix I.
Page 3 of 12
Other Services Trends
Effective October 1, 2009, AHCCCS is reducing by 5% the fee schedules for
Ambulatory Surgical Centers, Behavioral Health, Dental, Transportation (including
transportation regulated by the Arizona Department of Health Services) and Dialysis.
This information was used when setting the unit cost trends. The utilization trends
were set using data sources mentioned in Section I1 and emphasizing the AHCCCS
encounter data. The assumed PMPM costs for other services have been trended at 1.1
to 4.0 percent. These ranges are summarized in Appendix I.
IV. Proiected Experience Ad iustments
Based on the rapid growth in the prospective Non-MED population resulting from
previously unforeseen economic conditions and a federal mandate ultimately
requiring the elimination of redeterminations on this population for a period of six
months (thus adding to the overall member months), AHCCCS is applying an
experience adjustment for CYElO to these capitation rates. The projected experience
adjustments are calculated by GSA.
The projected experience adjustments are a hnction of three components: a financial
component, an encounter component and a medical capitation rate component. The
financial component is based on the health plans' reported profit/loss through March
3 1,2009. The encounter component is based on the encounter data from July 1, 2008
through December 3 1, 2008 with completion factors trended forward to the midpoint
of CYE09. The result is compared to the CYE09 medical component of the capitation
rate. These components and results were then analyzed and trended to arrive at a
necessary experience adjustment. This experience adjustment is applied to the final
medical rate, before reinsurance, admin, risk contingency and premium tax. The
statewide prospective Non-MED experience adjustment percentage is -3.83%.
V. State Mandates, Court Ordered Proprams, Propram Changes
and Other Chanpes
Outlier Hospital Reimbursement Rates
This amendment of State law, passed in the 2007 legislative session, changes the
methodology for the payment of inpatient hospital claims with extraordinary
operating costs per day. It stipulates that AHCCCS shall phase in the use of the most
recent statewide urban and rural average Medicare or Medicare approved cost-to-
charge ratios to qualify and pay extraordinary operating costs starting October 1,
2007. October 1, 2009, begins the third year of the three-year phase-in. Once fully-
phased in, these cost-to-charge ratios will be updated annually. The statewide impact,
net of reinsurance, is a 1.31% decrease. The third year impact is a decrease of
approximately $3 1 million.
Hospital Inpatient and Outpatient Rate Freeze
As noted previously, new legislation mandates that "For rates effective October 1,
2009, through September 30, 2010, the AHCCCS administration shall not increase
the inpatient hospital tier per diem rates, inpatient hospital outlier thresholds or
aggregate outpatient hospital fee schedule rates above the rates in effect on
September 30, 2009 ..." The statewide impact to the acute program is a decrease of
approximately $33.7 million.
Page 4 of 12
ADHS Regulated Transportation
This same state law removes for one year (fiscal year 2010) a mandate regarding
ADHS-regulated transportation rates that allows AHCCCS to reduce these rates by
5%. The statewide impact to the acute program is a decrease of approximately $1.8
Starting October 1, 2008, in accordance with Laws 2008, Chapter 131, AHCCCS
added coverage for eligible tobacco cessation products which include nicotine
replacement therapy (NRT) and tobacco use medications for eligible Title XIX
AHCCCS members who wish to stop tobacco use and who are enrolled in a tobacco
cessation program offered by the Arizona Department of Health Services. Based
upon review of CYE09 utilization, the statewide impact to the Acute program for
CYEI 0 is a decrease of approximately $1.4 million.
Dental Service Changes
AHCCCS is modifLing the following dental services effective October 1,2009:
o Elimination of behavior management as a reimbursable dental service
o Modification of some dental radiograph (xray) services, making them age
o Establishment of a maximum age limitation for dental sealants on permanent
The estimated savings for the Acute program is approximately $2.4 million.
Medical Management Changes
Effective October 1, 2009 AHCCCS will be implementing the following medical
o Establish medical necessity criteria for genetic testing.
o Eliminate coverage of allergic immunotherapy (testing, treatment, injections)
for adults except where therapy may be life saving.
o Adopt more restrictive medical necessity criteria for negative pressure wound
o Limit somnography to one study per contract year unless clinical
circumstances require additional studies.
The estimated savings for the Acute program is approximately $3.3 million.
Service Shifts from Children's Rehabilitative Services (CRS)
Costs for outpatient emergency services which do not result in a hospital admission
will be transferred from the CRS contractor to the AHCCCS Acute Care contractors
effective October 1, 2009. Also effective October 1, 2009, due to expansion of the
hospital network by the CRS contractor, the related emergency services (that result in
an inpatient admission) will now be covered by the CRS contractor. The total impact
of these changes is a savings of approximately $46,000.
Pharmacy costs account for an ever-increasing percentage of healthcare dollars and
will likely continue to rise significantly over the next several years. Over the past
several months, the AHCCCS Pharmacy Department has been looking at ways to
reduce AHCCCS pharmacy costs. One of the projects involved looking at what
AHCCCS Health Plan's spend on specific generic medications.
Page 5 of 12
An analysis of the Top 300 utilized generic medications was completed for the Acute
Care program. Encounter utilization data was used to calculate the average
ingredient price paid for each of these medications between 1/1/08 thm 12131/08.
These average prices were then compared to each health plan's ingredient costs on a
dmg-specific basis for each of those medications. If the health plan's ingredient cost
for a specific drug was greater than the average ingredient price for that drug, then
the potential savings was computed. If the health plan's pricing was equal to or less
than the average unit price of the drug, then the potential savings was notated as zero
and health plan's current ingredient costs are expected to remain the same.
Capitation rates effective October 1, 2009 include an adjustment to recognize savings
that can be generated by the Health Plans by reducing their ingredient costs.
AHCCCS recognized that achieving the full savings may be difficult and therefore
the capitation rate adjustment reflects 25% of the potential savings. The estimated
savings for the Acute program is approximately $4 million.
Hemophilia Factor Administration Costs
AHCCCS is in negotiations with the contractor that provides factor for the
hemophilia members in an effort to lower the administration costs on factor drugs.
The estimated capitation savings for the Acute program is approximately $2 15,000.
Elimination of HWA Parents
Effective October 1, 2009 H F A parents will no longer be covered by AHCCCS. An
analysis of this rate cohort shows that elimination of the HIFA population does not
impact the blended capitation base rates thus no adjustment is needed.
HlN 1 Influenza
A new influenza A, HlN1, was detected in the U.S. in April 2009. In June 2009, the
World Health Organization signaled that a pandemic of H l N l flu was underway.
AHCCCS contractors will be urging members to get immunized against HlNl once
the vaccine becomes available. The CDC's Advisory Committee on Immunization
Practices (ACIP) recommends that certain groups at highest risk for infection or
complications be the initial targets for vaccination. Pregnant women and children are
in the initial target group thus, because they make up a significant portion of the
AHCCCS membership, it is anticipated that vaccination-related costs will rise in
CYEI 0. AHCCCS also expects increased utilization for those members infected
with HlNl, and those who have flu-like symptoms. A review of encounter data
shows increased utilization during April and May 2009. The statewide impact of
H1N1-related activity in CYEIO is anticipated to be approximately $15 million.
VI. Prospective Proiected Net Claim PMPM
The CYE09 utilization, unit costs and net claims PMPMs are trended forward and
adjusted for experience trends, state mandates, court ordered programs and program
changes to arrive at the CYElO utilization, unit costs and net claims PMPMs for each
COS and COA.
Page 6 of 12
VII. Prospective Reinsurance Offsets
The CYE09 reinsurance offsets were reviewed by AHCCCS for appropriateness and
reasonableness using reinsurance encounter and payment information. As a result of
this review adjustments were made to the reinsurance offsets. The statewide impact is
0.1 1%. In addition, one contractor switched from the $35,000 deductible level to the
$20,000 deductible level, and two contractors switched from the $50,000 deductible
level to the $35,000 deductible level, which has a statewide impact of -0.95%.
VIII. Prospective Administrative Expenses and Risk Continpency
The administrative expense decreased from 8.5% to 8.0% for general administration,
which was determined to be appropriate to cover the contractors' average expenses.
The risk contingency load also decreased for all rate cohorts from 2% to 1%. The
estimated savings for these reductions is approximately $72 million.
IX. Prospective Proposed Capitation Rates and Their Impacts
The proposed capitation rates equal the sum of the projected net claim PMPM (in
Section VI) less the reinsurance offsets (in section VII) and the projected
administrative expenses and risk contingency PMPM (in section Vm), divided by
one minus the two percent premium tax. The final adjustment, which is a budget
neutral adjustment, is the risk adjustment factor (in Section X). Appendix I1 contains
the proposed capitation rates and the budget impact for all capitation rates using
projected CYElO member months and actual health plan reinsurance deductible
Risk Ad iustment Factor
For CYE10, AHCCCS will be implementing the same methodology for risk
adjustment as CYE09, except the factor will be fully phased in at 100%.
XI. Maternity Delivery Payment
The methodology followed in developing the Maternity Delivery Payment was
similar to the methodology used in the development of the prospective capitation
rates. This methodology involves updating CYE09 rates with utilization and unit cost
trends and program changes. The impact is a 0.9% increase per delivery to the overall
global maternity payment rate over the CYE09 rate.
XII. Extended Family Planninp Services (FPS)
The methodology followed in developing the FPS rate was similar to the
methodology used in the development of the prospective capitation rates. This
methodology involves updating CYE09 rates with utilization and unit cost trends and
program changes. The impact is an 8.1% decrease to the overall global FPS rate over
the CYE09 rate.
Page 7 of 12
XIII. KidsCare and HIFA Rates
Continuing with the methodology of previous years, AHCCCS contractors will be
paid one blended capitation rate that includes experience from both the traditional
TANF Medicaid population and the Title XXI SCHIP population. In addition the
HlFA I1 Wavier population has been terminated as of October 1, 2009. The rate
cohorts whose experience is blended together are detailed"asfollows:
TANF < 1 and KidsCare < 1;
TANF 1- 13 M&F and KidsCare 1 - 13 M&F;
TANF 45+ M&F
XIV. Prior Period Coverape Rates (PPC)
PPC rates cover the period of time from the first day of retroactive eligibility to the
date of eligibility determination. A similar methodology was followed in developing
the PPC rates as developing the prospective capitation rates. The statewide impact is
-6.8%. The PPC rates are reconciled to a maximum 2.0% profit or loss in CYEIO.
XV. Final Capitation Rates and Their Impact
Table I1 below summarizes the adjustments made to the CYE09 rates. The impact to
contractors ranges from -3.0% to 1.6%. Individual health plan capitation rates will be
impacted as shown in Section B of the contracts.
Table 11: Adjustments to CYE09 Rates
1. Outlier Hospital Reimbursement -2.34%
2. Smoking Cessation nla
3. Dental Service Changes nla
4. Medical Management Changes nla
5. Service Shil€sfrom C RS nla
6. Hemophilia Factor Admin Costs nla
7. Pharmacy Pricing nla
8. H1N l Influenza 0.19% '
1. Administration -0.48% -0.93% -0.54%
2. Risk Contingency -0.98% -1.01%- -0.98%
3. Reinsurance Selection Change -1.09% nla -0.95%
~ o t aPercentage Change -1.40% -6.84% -2.12%1
1) CYEO9 Rate is the capitation rate effective May 1, 2009 Page 8 o
XVI. CMS Rate set tin^ Checklist
1. Overview of rate setting methodology
A.A.l.O: Overview of rate setting methodology
AHCCCS is performing a rate update from the previously approved contract year
ending 2009 (CYE09) under 42 CFR 438.6(c). Please refer to Section 11.
AA.l.l: Actuarial certification
Please refer to Section XVIT.
AA.1.2: Projection of expenditure
Please refer to Appendix 11.
AA.1.3: Procurement, prior approval and rate setting
AHCCCS is operating under the Sole Source contracting method.
AA.1.5: Risk contract
AHCCCS limits risk for the MED to 3% profit or lost and the NonMED and PPC risk
group to 2% profit or loss.
AA.1.6: Limit on payment to other providers
AHCCCS makes no additional payment to providers, except for Disproportionate
Share Hospital (DSH), Graduate Medical Education (GME) and Critical Access
Hospitals. GME is paid in accordance with state plan. DSH and Critical Access
Hospital payments are paid in accordance with the Waiver Special Terms and
Conditions. None of the additional payments to providers were included in the
AA.1.7: Rate modification
Please refer to Sections I through V, VII, VIII, and X through XIV.
Page 9 of 12
XVII.Actuaria1 Certification of the Capitation Rates:
I, Windy J. Marks, am an employee of Arizona Health Care Cost Containment
System (AHCCCS). I am a Member of the American Academy of Actuaries and a
Fellow of the Society of Actuaries. 1 meet the qualification standards established by
the American Academy of Actuaries and have followed the practice standards
established from time-to-time by the Actuarial Standards Board.
The rates were developed using generally accepted actuarial principles and practices
and are considered to be actuarially sound. The rates were developed to demonstrate
compliance with the CMS requirements under 42 CFR 438.6(c) and are in
accordance with applicable laws and regulations. The rates are appropriate for the
Medicaid populations covered and Medicaid services to be furnished under the
contract. The rates may not be appropriate for any other purpose. The documentation
has been included with this certification. The actuarially sound capitation rates that
are associated with this certification are effective for the twelve-month period
beginning October 1,2009.
The actuarially sound capitation rates are a projection of future events. It may be
expected that actual experience will vary from the values in the rates. The rates are
actuarially sound in aggregate by GSA. Given the distribution of the AHCCCS
population, it is not possible to certify that every cell is actuarially sound. Some rate
cells do not contain a large enough base of data from which to derive actuarially
In developing the actuarially sound capitation rates, I have relied upon data and
information provided by the health plans and the AHCCCS internal databases. I have
accepted the data without audit and have relied upon the health plan auditors and
other AHCCCS employees for the accuracy of the data.
This actuarial certification has been based on the actuarial methods, considerations,
and analyses promulgated from time to time through the Actuarial Standards of
Practice by the Actuarial Standards Board.
Fellow of the Society of Actuaries
Member, American Academy of Actuaries
Page 10 of 12
Referral Physician 4.2% 7.4% 6.9% . 3.7%
Other Professional 4.5% 4.8% 4.6% 4.1 %
Pharmacy 0.7% 10.5% 4.8% 3.1%
Other nla nla nla nla
Page 11 of 12
Acute Capitation Rate Analysis (Renewal Rates--pending approval)
Point in Time Comparison--no member growth factor
Cap Rate-May 09 based Total Annual Dollars May Cap Rate-'10 based on Total Annual Dollars CYE
CYE10 Projected on CYE10 Projected 09 Cap rate based on CYE10 Projected '10 based on CYE10
Title XIX Waiver Group Member Months Member Months CYE10 Projected MMs Member Months Prolected MMs ~lfterence % Increase
' Prospective-MED 64,524 $ 1,343.42 $ 86,682,954 $ 1,291.47 $ 83,330,928 $ (3,352,027) -3.9%
' PPC-MED 16.985 $ 7,544.73 $ 128,146,610 $ 7,246.68 $ 123,084,256 $ (5,062,354) -4.0%
Total MED $ 214,829,564 $ 206,415,184 $ (8,414,381) -3.9%
' Prospective-non-MED 2,462,277 $ 557.45 $ 1,372,596,372 $ 523.39 $ 1,288,731,214 $ (83,865,158) -6.1%
' PPC -non-MED 316,223 $ 1,185.39 $ 374,847,901 $ 1,079.51 $ 341,366,181 $ (33,481,720) -8.9%
Total non-MED $ 1,747,444,273 $ 1,630,097.395 $ (117,346,878) -6.7%
Total TWG $ 1,962,273,838 $ 1,836,512,579 $ (125,761,259)- -6.4%
' <I 697,845 $ 509.64 $ 355,649,973 $ 491.52 $ 343,005,013 $ (12,644,960) -3.6%
' 1-13 5,401.371 $ 111.54 $ 602,468,953 $ 112.86 $ 609,598.763 $ 7,129,810 1.2%
' 14-44F 2,517,020 $ 240.28 $ 604,789.569 $ 245.72 $ 618,482,158 $ 13,692.589 2.3%
' 14-44M 1,209,817 $ 144.73 $ 175,096,830 $ 148.11 $ 179,186.012 $ 4,089,182 2.3%
' 45+ 384,344 $ 402.44 $ 154,675.201 $ 407.32 $ 156,550.797 $ 1,875,596 1.2%
' SSl wlMed 769,226 $ 155.02 $ 119,245,365 $ 157.25 $ 120,960,738 $ 1,715,373 1.4%
' SSI WIO 665,912 737.13 490,863,516 753.39 $ 501,691.241 $ 10,827,725 2.2%
' SFP Med 40,248
$ 17.38 $ 699.517 $ (61,983) -8.1 %
Delivery Supplemental Payment 35,232 $ 6,571.97 $ 231,545,602 $ 6,629.40 $ 233,568,993 $ 2,023,391 0.9%
Total Prospective-non-TWG $ 2,735,096,508 $ 2,763,743,232 $ 28,646.723 1.O%
' PPC8<1 24,639 $ 1.21 1.08 $ 29,839,682 $ 1,094.71 $ 26,972,453 $ (2,867,229) -9.6%
' PPC'1-13 320.505 $ 64.24 $ 20,589,236 $ 67.15 $ 21,521,905 $ 932,669 4.5%
' PPC '14-44F 197,778 $ 254.22 $ 50,279,069 $ 244.46 $ 48,348,758 $ (1,930,311) -3.8%
' PPC '14-44M 96.829 $ 217.72 $ 21,081,611 $ 209.64 $ 20,299,233 $ (782,378) -3.7%
' PPC '45+ 28.115 $ 443.87 $ 12,479,200 $ 421.13 $ 11,839.876 $ (639.325) -5.1%
' PPC 'SSI wMed 11,201 $ 133.10 $ 1,490,888 $ 144.87 $ 1,622,727 $ 131.839 8.8%
' PPC 'SSI wlo Med 18,901 $ 418.18 $ 7,903,995 $ 391.59 $ 7,401,419 $ (502.576) -6.4%
PPC All non-TWG rate codes 697,967 $ 143,663,682 $ 138,006,370 $ (5,657,311) -3.9%
Total Title XIX-non-TWG $ 2,878,760,190 $ 2,901,749,602 $ 22,989,412 0.8%
Grand Total Capitation $ 4,841,034,028 $ 4,738,262,181 $ (102,771,847) -2.1%
'~opulationestimates for CYE 2010 are taken from DBF projections.
'One plan switched from a 35,000 reinsurance deductible level to a 20,000 deductible level for CYE10 and two plans.switched from $50,000 deductible level to $20,000. Thus CYEO9 numbers are at the high1
reinsurance deductible levels and CYEIO numbers are at the lower reinsurance deductible levels.
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