Amendment #447 to H4000

Ensuring transparency in Medicaid rate devlopment

Mr. Donato of Medford moves to amend the bill by adding the following new section:

Section X. The office of Medicaid shall implement a process for the development of Medicaid managed care capitation rates in a manner that is fair and transparent and provides sufficient detail regarding the development of rate adjustment factors and assumptions. The MassHealth managed care rate setting methodology and assumptions shall be in accordance with sound actuarial methods and processes and shall include at a minimum the following elements: (1) utilize the most current available encounter date, (2) provide a clearly documented summary for developing managed care organization rates, (3) provide information describing the calculations used in calculating trends, (4) provide information describing the calculations used in calculating the maximum allowable cost adjustment, (5) provide detailed information describing the calculation of the managed care organizations risk scores, and (6) provide detailed information describing any adjustments used in developing managed care organization rates. MassHealth shall provide a detailed report to the managed care organizations by June 1 of each year that outlines in detail the calculations, data and methodology used in developing managed care organization rates. The managed care organizations shall provide written feedback to the office of Medicaid within 30 days of receipt of the rate development. The office of Medicaid shall issue the final rate development methodology and rates to the managed care organizations no later than August 1 of each year. The office of Medicaid shall file a report back to the house and senate committees on ways and means by October 1, 2014. The report shall detail the changes made to the managed care organization rate setting methodology and shall compare the Massachusetts methodology to methodologies, assumptions, data, calculations, transparency provisions of states.