Managed Care Capitation Rate Review: Timing of States’ Submissions

VISIT THE PILLAR: State Administrative Accountability

National Context

This measure reports the number of days between a state’s submission of a base capitation rate certification and the start of the managed care contract rating period. CMS conducts actuarial reviews of these rates as part of an approval process. States must submit base capitation rate certifications to CMS for review and approval before the managed care contract rating period starts.

Light-blue bars indicate state submissions that occurred before the rating period began.

The red dashed line represents the median time of submission. Half of the submissions occur before the rating period begins or within 3 days after the rating period begins. Half of the submissions occur more than 3 days after the rating period begins.

Managed Care Capitation Rate Review: Timing of States’ Submissions

This measure reports the number of days between a state’s submission of a base capitation rate certification and the start of the managed care contract rating period.

State Administrative Accountability

Managed Care Capitation Rate Review: Timing of States' Submissions Histogram with Median of 3 Days After the Start of the Rating Period , and the categories and values. Described in table below.

Days	Count of Rate Certifications Submitted
Before the Start of the Rating Period - 90+	3
Before the Start of the Rating Period - 61-90	18
Before the Start of the Rating Period - 31-60	7
Before the Start of the Rating Period - 0-30	36
After the Start of the Rating Period - 0-30	19
After the Start of the Rating Period - 31-60	15
After the Start of the Rating Period - 61-90	10
After the Start of the Rating Period - 91-120	3
After the Start of the Rating Period - 121-150	3
After the Start of the Rating Period - 151-180	5
After the Start of the Rating Period - 181-210	0
After the Start of the Rating Period - 211-240	5
After the Start of the Rating Period - 241-270	3
After the Start of the Rating Period - 271-300	2
After the Start of the Rating Period - 301-330	0
After the Start of the Rating Period - 331-360	3
After the Start of the Rating Period - 360+	7

Source: CMS Office of the Actuary (OACT)

Note: The figure includes the 139 base rate certifications submitted in federal fiscal year 2018. The relevant CMS regulation for this activity is 42 Code of Federal Regulations 438.806 (b) and (c).