Managed Care Capitation Rate Review: Timing of States' Submissions

About This Measure

This measure reports the number of days between a state’s submission of a base capitation certification rate 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 60 days after the rating period begins. Half of the submissions occur more than 60 days after the rating period begins.

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Histogram with a median of 60 days, and the values:

Metric Count
Before Rating Period Begins - 90+ days 7
Before Rating Period Begins - 61-90 days 6
Before Rating Period Begins - 31-60 days 17
Before Rating Period Begins - 0-30 days 33
After Rating Period Begins - 0-30 days 10
After Rating Period Begins - 31-60 days 14
After Rating Period Begins - 61-90 days 18
After Rating Period Begins - 91-120 days 5
After Rating Period Begins - 121-150 days 5
After Rating Period Begins - 151-180 days 15
After Rating Period Begins - 181-210 days 10
After Rating Period Begins - 211-240 days 0
After Rating Period Begins - 241-270 days 10
After Rating Period Begins - 271-300 days 0
After Rating Period Begins - 301-330 days 2
After Rating Period Begins - 331-360 days 1
After Rating Period Begins - 360+ days 15

Source: CMS Office of the Actuary (OACT)

Note: The figure includes the 168 base rate certifications submitted in calendar year 2016. The relevant CMS regulation for this activity is 42 Code of Federal Regulations 438.802 (b)(c).