Specifications include, but are not limited to: • Develops Medicaid fee-for-service and managed care equivalent costs. • Develops cost trend factors. • Develops projections of progressive savings models. • Develops utilization rates. • Applies risk-based weights. • Reviews and understands contracted Managed Care Organizations’ (MCO) financial performance under current and proposed rate structures. • Assists Department in development of appropriate administrative loads for cap rates. • Assists Department in meeting all requirements for managed care rate-setting. • Assists DHS in modeling new and innovative methodologies for rate adjustment in a risk-based capitated environment, including analyses such as the impact of changes to base data or other components of rate models. • Assists DHS in analyses of Family Care, Program for All-inclusive Care for the Elderly (PACE), and Family Care Partnership costs compared to other Medicaid long-term care programs (for example, IRIS and CIP/COP waivers). • Assists DHS in analysis of sub-populations (such as high-cost outliers), expenditures, and alternative rate methods for these sub-populations...
