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Actuary tells welfare committee KanCare rates account for ~5% nonutilizers; projections within 1% of actuals
Summary
A contracted actuary told the Committee on Welfare Reform that KanCare capitation rates prospectively include a built-in allowance for members who do not use services (about 5% of enrollees) and that state projections and plans' incurred payments have matched within roughly 1% in recent years.
Seth Adamson, the state's contracted actuary with CBIZ Optimus, told the Committee on Welfare Reform on Jan. 22 that capitation rates for the KanCare managed-care program are set to reflect both members who use services and those who do not.
Adamson said federal rules require a credentialed actuary certify rates and cited federal oversight by the Centers for Medicare and Medicaid Services. He described capitation as a prospective per-member-per-month (PMPM) payment that transfers financial risk from the state to managed care organizations (MCOs) and said Kansas structures rates so plans'profit margins are tightly…
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