STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: Under 1
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: TANF
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
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HOSPITAL INPATIENT 14,139 75,332 1,677 1,962 8,821 6,456,810.99 0.1170 1.1044 731.98 94.659 87.086
HOSPITAL OUTPATIENT 14,139 75,332 4,887 10,062 24,744 976,290.22 0.3284 1.0982 39.45 14.232 13.093
PHYSICIAN SERVICES 14,139 75,332 10,856 112,394 141,001 3,074,189.76 1.8717 1.0248 21.80 41.820 38.474
PRESCRIBED MEDICINE 14,139 75,332 7,064 35,665 35,665 481,178.72 0.4734 1.4321 13.49 9.147 8.415
LAB AND X-RAY 14,139 75,332 305 842 853 6,516.05 0.0113 1.0000 7.63 0.086 0.079
TRANSPORTATION 14,139 75,332 502 970 970 96,537.97 0.0128 1.0000 99.52 1.281 1.178
FAMILY PLANNING 14,139 75,332 115 162 162 1,896.87 0.0021 1.0000 11.70 0.025 0.023
HOME HEALTH SERVICS 14,139 75,332 517 1,641 9,313 112,894.22 0.1236 1.0105 12.12 1.514 1.393
EPSDT SCREENING 14,139 75,332 7,565 16,251 16,251 1,060,756.66 0.2157 1.0000 65.27 14.081 12.954
CHILD DENTAL 14,139 75,332 7 27 27 451.75 0.0003 1.1284 16.73 0.006 0.006
CHILD VISION 14,139 75,332 12 30 37 551.93 0.0004 1.0000 14.91 0.007 0.006
CHILD HEARING 14,139 75,332 133 140 140 5,071.97 0.0018 1.0000 36.22 0.067 0.061
NURSE PRACTITIONER 14,139 75,332 98 405 1,400 7,373.43 0.0185 1.0000 5.26 0.097 0.090
BIRTHING CENTER 14,139 75,332 6 6 6 371.67 0.0000 1.0000 61.94 0.004 0.004
RURAL HEALTH SERVICS 14,139 75,332 1,169 5,168 5,190 344,945.70 0.0688 1.2234 66.46 5.601 5.153
PERSONAL CARE SRVCES 14,139 75,332 1 1 2 77.60 0.0000 1.0000 38.80 0.001 0.000
PHYSICAL THERAPY 14,139 75,332 19 91 162 3,109.19 0.0021 1.0000 19.19 0.041 0.037
SPEECH THERAPY 14,139 75,332 5 5 5 242.50 0.0000 1.0000 48.50 0.003 0.002
OCCUPATIONAL THERPY 14,139 75,332 8 30 53 1,065.88 0.0007 1.0000 20.11 0.014 0.013
FQHC 14,139 75,332 179 407 407 30,297.92 0.0054 1.2351 74.44 0.496 0.457
CLINIC SVCS 14,139 75,332 524 1,011 1,011 63,854.33 0.0134 1.2217 63.15 1.035 0.952
PHYSICIAN ASSISTANT 14,139 75,332 3 14 14 322.35 0.0001 1.0000 23.02 0.004 0.003
DRUG REBATE 14,139 75,332 7,064 35,665 35,665 -72,439.41 0.4734 1.4321 -2.03 -1.377 -1.266
DIALYSIS CENTER 0.041 0.037
TOTAL 14,139 75,332 12,988 187,284 246,234 12,652,368.27 3.2686 1.0889 51.38 182.895 168.263
STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: Under 1
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: SSI - NO MEDICARE
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
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HOSPITAL INPATIENT 223 990 36 44 561 435,121.10 0.5666 1.0896 775.61 478.896 440.585
HOSPITAL OUTPATIENT 223 990 38 86 192 8,357.41 0.1939 1.0763 43.52 9.085 8.359
PHYSICIAN SERVICES 223 990 98 2,721 4,743 139,053.93 4.7909 1.0248 29.31 143.941 132.426
PRESCRIBED MEDICINE 223 990 61 237 237 4,469.02 0.2393 1.2888 18.85 5.817 5.352
LAB AND X-RAY 223 990 4 22 22 113.66 0.0222 1.0000 5.16 0.114 0.105
TRANSPORTATION 223 990 10 44 44 14,740.58 0.0444 1.0000 335.01 14.889 13.698
HOME HEALTH SERVICS 223 990 20 106 1,176 10,217.91 1.1878 1.0002 8.68 10.323 9.497
EPSDT SCREENING 223 990 45 72 72 4,603.24 0.0727 1.0000 63.93 4.649 4.277
NURSE PRACTITIONER 223 990 1 1 1 51.45 0.0010 1.0000 51.45 0.051 0.047
RURAL HEALTH SERVICS 223 990 6 19 19 1,254.93 0.0191 1.2151 66.04 1.540 1.417
PHYSICAL THERAPY 223 990 7 24 42 901.92 0.0424 1.0000 21.47 0.911 0.838
SPEECH THERAPY 223 990 2 7 12 266.70 0.0121 1.0000 22.22 0.269 0.247
OCCUPATIONAL THERPY 223 990 4 4 4 194.00 0.0040 1.0000 48.50 0.195 0.180
CLINIC SVCS 223 990 1 1 1 156.78 0.0010 1.2207 156.78 0.193 0.177
PHYSICIAN ASSISTANT 223 990 1 4 4 84.65 0.0040 1.0000 21.16 0.085 0.078
DRUG REBATE 223 990 61 237 237 -483.93 0.2393 1.2888 -2.04 -0.629 -0.579
DIALYSIS CENTER 1.350 1.242
TOTAL 223 990 167 3,392 7,130 619,103.35 7.2020 1.0740 86.83 671.687 617.952
STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: 1 - 5
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: TANF
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
------
HOSPITAL INPATIENT 32,071 216,183 715 827 1,918 1,280,876.83 0.0088 1.1044 667.81 6.543 6.020
HOSPITAL OUTPATIENT 32,071 216,183 9,329 17,360 46,714 2,081,513.07 0.2160 1.0982 44.55 10.573 9.728
PHYSICIAN SERVICES 32,071 216,183 18,522 95,615 156,721 2,262,393.80 0.7249 1.0248 14.43 10.724 9.866
PRESCRIBED MEDICINE 32,071 216,183 17,039 90,474 90,474 1,558,305.79 0.4185 1.4321 17.22 10.322 9.497
LAB AND X-RAY 32,071 216,183 1,817 3,951 3,994 31,392.75 0.0184 1.0000 7.85 0.145 0.133
TRANSPORTATION 32,071 216,183 1,135 10,148 10,148 296,765.23 0.0469 1.0000 29.24 1.372 1.262
FAMILY PLANNING 32,071 216,183 172 307 307 7,050.77 0.0014 1.0000 22.96 0.032 0.030
HOME HEALTH SERVICS 32,071 216,183 532 1,258 2,964 62,615.16 0.0137 1.0105 21.12 0.292 0.269
EPSDT SCREENING 32,071 216,183 8,602 10,632 10,632 697,994.07 0.0491 1.0000 65.65 3.228 2.970
CHILD DENTAL 32,071 216,183 4,305 33,188 33,475 630,206.30 0.1548 1.1284 18.82 3.289 3.026
CHILD VISION 32,071 216,183 927 2,842 3,275 59,999.10 0.0151 1.0000 18.32 0.277 0.255
CHILD HEARING 32,071 216,183 92 194 195 4,129.39 0.0009 1.0000 21.17 0.019 0.017
NURSE PRACTITIONER 32,071 216,183 161 404 2,591 9,663.58 0.0119 1.0000 3.72 0.044 0.041
RURAL HEALTH SERVICS 32,071 216,183 2,906 9,028 9,033 724,629.12 0.0417 1.2234 80.22 4.100 3.772
PHYSICAL THERAPY 32,071 216,183 39 654 1,282 21,781.53 0.0059 1.0000 16.99 0.100 0.092
SPEECH THERAPY 32,071 216,183 407 9,966 19,415 330,292.53 0.0898 1.0000 17.01 1.527 1.405
OCCUPATIONAL THERPY 32,071 216,183 57 686 1,321 23,764.15 0.0061 1.0000 17.98 0.109 0.101
FQHC 32,071 216,183 409 851 851 63,740.36 0.0039 1.2351 74.90 0.364 0.335
CLINIC SVCS 32,071 216,183 2,441 4,444 4,444 269,250.80 0.0205 1.2217 60.58 1.521 1.399
PHYSICIAN ASSISTANT 32,071 216,183 19 32 32 1,232.97 0.0001 1.0000 38.53 0.005 0.005
DRUG REBATE 32,071 216,183 17,039 90,474 90,474 -248,483.20 0.4185 1.4321 -2.74 -1.646 -1.514
DIALYSIS CENTER 0.041 0.037
TOTAL 32,071 216,183 27,924 292,861 399,786 10,169,114.10 1.8492 1.1265 25.43 52.993 48.754
STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: 1 - 5
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: SSI - NO MEDICARE
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
------
HOSPITAL INPATIENT 788 6,417 53 74 186 128,863.91 0.0289 1.0896 692.81 21.880 20.130
HOSPITAL OUTPATIENT 788 6,417 263 1,073 2,432 119,222.18 0.3789 1.0763 49.02 19.996 18.396
PHYSICIAN SERVICES 788 6,417 426 3,378 7,293 90,462.39 1.1365 1.0248 12.40 14.446 13.291
PRESCRIBED MEDICINE 788 6,417 413 3,666 3,666 88,594.90 0.5712 1.2888 24.16 17.793 16.370
LAB AND X-RAY 788 6,417 53 220 221 2,005.42 0.0344 1.0000 9.07 0.312 0.287
TRANSPORTATION 788 6,417 71 955 955 50,323.95 0.1488 1.0000 52.69 7.842 7.214
FAMILY PLANNING 788 6,417 5 5 5 103.11 0.0007 1.0000 20.62 0.016 0.014
HOME HEALTH SERVICS 788 6,417 50 253 1,272 26,235.42 0.1982 1.0002 20.62 4.089 3.762
EPSDT SCREENING 788 6,417 178 223 223 14,488.12 0.0347 1.0000 64.96 2.257 2.077
CHILD DENTAL 788 6,417 113 839 844 14,252.24 0.1315 1.1298 16.88 2.509 2.308
CHILD VISION 788 6,417 50 167 218 2,929.95 0.0339 1.0000 13.44 0.456 0.420
CHILD HEARING 788 6,417 7 11 11 489.50 0.0017 1.0000 44.50 0.076 0.070
NURSE PRACTITIONER 788 6,417 4 21 109 435.86 0.0169 1.0000 3.99 0.067 0.062
RURAL HEALTH SERVICS 788 6,417 60 127 127 9,144.71 0.0197 1.2151 72.00 1.731 1.593
PERSONAL CARE SRVCES 788 6,417 3 61 120 12,013.45 0.0187 1.0000 100.11 1.872 1.722
PHYSICAL THERAPY 788 6,417 32 845 1,652 27,866.31 0.2574 1.0000 16.86 4.342 3.995
SPEECH THERAPY 788 6,417 95 2,824 5,552 93,822.91 0.8652 1.0000 16.89 14.620 13.451
OCCUPATIONAL THERPY 788 6,417 51 1,379 2,721 46,684.96 0.4240 1.0000 17.15 7.275 6.693
FQHC 788 6,417 22 50 50 3,600.57 0.0077 1.2460 72.01 0.699 0.643
CLINIC SVCS 788 6,417 33 60 60 4,083.24 0.0093 1.2207 68.05 0.776 0.714
DRUG REBATE 788 6,417 413 3,666 3,666 -15,182.30 0.5712 1.2888 -4.14 -3.049 -2.805
DIALYSIS CENTER 1.350 1.242
TOTAL 788 6,417 678 16,231 27,717 720,440.80 4.3193 1.0810 25.99 121.365 111.656
STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: 6 - 13
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: TANF
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
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HOSPITAL INPATIENT 33,332 238,754 397 478 1,624 1,063,410.04 0.0068 1.1044 654.80 4.918 4.525
HOSPITAL OUTPATIENT 33,332 238,754 6,414 10,228 29,347 1,309,483.01 0.1229 1.0982 44.62 6.023 5.541
PHYSICIAN SERVICES 33,332 238,754 14,681 59,807 100,251 1,525,146.10 0.4198 1.0248 15.21 6.546 6.022
PRESCRIBED MEDICINE 33,332 238,754 13,913 72,429 72,429 1,802,674.25 0.3033 1.4321 24.88 10.812 9.947
LAB AND X-RAY 33,332 238,754 1,077 2,996 3,096 24,374.83 0.0129 1.0000 7.87 0.102 0.093
TRANSPORTATION 33,332 238,754 942 4,720 4,720 153,945.25 0.0197 1.0000 32.61 0.644 0.593
FAMILY PLANNING 33,332 238,754 171 328 328 8,262.29 0.0013 1.0000 25.18 0.034 0.031
HOME HEALTH SERVICS 33,332 238,754 260 658 1,294 33,936.61 0.0054 1.0105 26.22 0.143 0.132
EPSDT SCREENING 33,332 238,754 3,829 3,999 3,999 264,518.28 0.0167 1.0000 66.14 1.107 1.019
CHILD DENTAL 33,332 238,754 8,611 84,820 85,094 1,299,003.01 0.3564 1.1284 15.26 6.139 5.648
CHILD VISION 33,332 238,754 3,264 14,294 18,058 205,015.70 0.0756 1.0000 11.35 0.858 0.789
CHILD HEARING 33,332 238,754 41 84 84 2,623.01 0.0003 1.0000 31.22 0.010 0.010
NURSE PRACTITIONER 33,332 238,754 91 223 1,882 7,597.17 0.0078 1.0000 4.03 0.031 0.029
RURAL HEALTH SERVICS 33,332 238,754 2,537 6,438 6,441 500,980.38 0.0269 1.2234 77.77 2.567 2.361
PHYSICAL THERAPY 33,332 238,754 6 120 247 3,813.50 0.0010 1.0000 15.43 0.015 0.014
SPEECH THERAPY 33,332 238,754 28 539 1,040 17,294.26 0.0043 1.0000 16.62 0.072 0.066
OCCUPATIONAL THERPY 33,332 238,754 4 135 273 4,641.14 0.0011 1.0000 17.00 0.019 0.017
FQHC 33,332 238,754 334 702 702 51,965.31 0.0029 1.2351 74.02 0.268 0.247
CLINIC SVCS 33,332 238,754 2,626 4,932 4,932 296,274.74 0.0206 1.2217 60.07 1.516 1.394
PHYSICIAN ASSISTANT 33,332 238,754 26 26 26 1,510.54 0.0001 1.0000 58.09 0.006 0.005
DRUG REBATE 33,332 238,754 13,913 72,429 72,429 -298,643.46 0.3033 1.4321 -4.12 -1.791 -1.648
DIALYSIS CENTER 0.041 0.037
TOTAL 33,332 238,754 27,821 267,956 335,867 8,277,825.96 1.4067 1.1563 24.64 40.091 36.883
STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: 6 - 13
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: SSI - NO MEDICARE
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
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HOSPITAL INPATIENT 2,577 23,734 86 123 812 518,438.46 0.0342 1.0896 638.47 23.800 21.896
HOSPITAL OUTPATIENT 2,577 23,734 718 1,606 4,284 177,754.05 0.1805 1.0763 41.49 8.060 7.416
PHYSICIAN SERVICES 2,577 23,734 1,398 7,926 12,774 209,762.54 0.5382 1.0248 16.42 9.057 8.332
PRESCRIBED MEDICINE 2,577 23,734 1,481 16,370 16,370 586,309.78 0.6897 1.2888 35.81 31.837 29.290
LAB AND X-RAY 2,577 23,734 127 486 493 4,356.41 0.0207 1.0000 8.83 0.183 0.168
TRANSPORTATION 2,577 23,734 209 1,754 1,754 57,382.91 0.0739 1.0000 32.71 2.417 2.224
FAMILY PLANNING 2,577 23,734 19 37 37 1,129.18 0.0015 1.0000 30.51 0.047 0.043
HOME HEALTH SERVICS 2,577 23,734 68 612 6,628 45,156.81 0.2792 1.0002 6.81 1.903 1.750
EPSDT SCREENING 2,577 23,734 383 402 402 26,120.77 0.0169 1.0000 64.97 1.100 1.012
CHILD DENTAL 2,577 23,734 652 6,252 6,279 95,369.85 0.2645 1.1298 15.18 4.539 4.176
CHILD VISION 2,577 23,734 308 1,403 1,762 19,700.06 0.0742 1.0000 11.18 0.830 0.763
CHILD HEARING 2,577 23,734 22 61 61 4,019.96 0.0025 1.0000 65.90 0.169 0.155
NURSE PRACTITIONER 2,577 23,734 8 25 25 769.72 0.0010 1.0000 30.78 0.032 0.029
RURAL HEALTH SERVICS 2,577 23,734 216 572 572 39,917.99 0.0241 1.2151 69.78 2.043 1.880
PERSONAL CARE SRVCES 2,577 23,734 3 195 1,197 20,031.90 0.0504 1.0000 16.73 0.844 0.776
PHYSICAL THERAPY 2,577 23,734 9 112 222 3,629.20 0.0093 1.0000 16.34 0.152 0.140
SPEECH THERAPY 2,577 23,734 46 1,252 2,460 40,929.75 0.1036 1.0000 16.63 1.724 1.586
OCCUPATIONAL THERPY 2,577 23,734 16 349 695 11,233.60 0.0292 1.0000 16.16 0.473 0.435
FQHC 2,577 23,734 52 113 113 8,288.95 0.0047 1.2460 73.35 0.435 0.400
CLINIC SVCS 2,577 23,734 196 501 501 30,270.02 0.0211 1.2207 60.41 1.556 1.432
PHYSICIAN ASSISTANT 2,577 23,734 1 2 2 117.92 0.0000 1.0000 58.96 0.004 0.004
DRUG REBATE 2,577 23,734 1,481 16,370 16,370 -96,255.28 0.6897 1.2888 -5.87 -5.226 -4.808
DIALYSIS CENTER 1.350 1.242
TOTAL 2,577 23,734 2,358 40,153 57,443 1,804,434.55 2.4202 1.1487 31.41 87.339 80.352
STATE OF FLORIDA - AGENCY FOR HEALTH CARE ADMINISTRATION - MEDICAID PROGRAM ANALYSIS
HMO CAPITATION RATE SETTING RESULTS, using 97-98 DATA FOR FY 99-00 06/07/99
AREA DATA (excluding both AIDS WAIVERS and CMS KIDS)
Zone A (district I & II combined) Age group: 14 - 20
COMMUNITY BASED CLIENTS
REGULAR MEDICAID (NOT HMO)
ELIGIBILITY CATEGORY: TANF
UTLIZTN INFLTN 92%
SERVICE CATEGORY ELIGIBLES CASE-MONTHS RECIPIENTS PAID-CLAIMS UNITS AMOUNT PAID RATE FACTOR UNIT-COST CAPITATION CAPITATION
------
HOSPITAL INPATIENT 15,703 91,305 1,093 1,245 3,499 2,432,916.29 0.0383 1.1044 695.31 29.427 27.073
HOSPITAL OUTPATIENT 15,703 91,305 4,106 9,395 31,319 1,211,544.02 0.3430 1.0982 38.68 14.572 13.406
PHYSICIAN SERVICES 15,703 91,305 6,712 43,907 93,990 1,902,975.66 1.0294 1.0248 20.24 21.358 19.650
PRESCRIBED MEDICINE 15,703 91,305 6,182 31,744 31,744 775,495.97 0.3476 1.4321 24.42 12.163 11.190