D.C. Mun. Regs. tit. 27, r. 27-1611

Current through Register Vol. 71, No. 43, October 25, 2024

Rule 27-1611 - PRICES FOR SERVICES PROVIDED UNDER THE DISTRICT'S MEDICAID MANAGED CARE PROGRAM

1611.1

Notwithstanding the requirements of § 1612.1, for services provided under the District's Medicaid Managed Care Program, for the period of October 1, 2018, through September 30, 2019, the Director sets the following monthly capitation rates per person enrolled in a contractor's MCO to be paid to contractors selected through the solicitation, and no price evaluation factor will be required for procurement of these services:

CLIN	Rate Cohort	DHCF Actuarially Sound Lower Bound Rates
0001 DC Healthy Families Program (DCHFP)1
0001AA	Under 1 Year of Age	$454.66
0001AB	Delivery Payment	$10,025.57
0001AC	Birth Payment	$6,714.27
0001AD	Children Ages 1 through 12 Years	$196.55
0001AE	Females Ages 13 through 18 Years	$275.74
0001AF	Males Ages 13 through 18 Years	$215.73
0001AG	Females Ages 19 through 36 Years	$313.27
0001AH	Males Ages 19 through 36 Years	$228.08
0001AI	Females Ages 37 through 49 Years	$523.64
0001AJ	Males Ages 37 through 49 Years	$409.94
0001AK	Females Ages 50+ Years	$707.34
0001AL	Males Ages 50+ Years	$751.34
CLIN	Rate Cohort	DHCF Actuarially Sound Lower Bound Rates
0002 DC Healthcare Alliance Program
0002AA	Females Ages 19 through 36 Years	$234.72
0002AB	Males Ages 19 through 36 Years	$186.45
0002AC	Females Ages 37 through 49 Years	$374.22
0002AD	Males Ages 37 through 49 Years	$336.57
0002AE	Females, Ages 50+ Years	$723.97
0002AF	Males, Ages 50+ Years	$828.98
CLIN	Rate Cohort	DHCF Actuarially Sound Lower Bound Rates
0003 271 Population2
0003AA	Females Ages 19 through 36 Years	$228.33
0003AB	Males Ages 19 through 36 Years	$176.77
0003AC	Females Ages 37 through 49 Years	$497.91
0003AD	Males Ages 37 through 49 Years	$331.96
0003AE	Females Ages 50+ Years	$694.63
0003AF	Males Ages 50+ Years	$558.75

D.C. Mun. Regs. tit. 27, r. 27-1611

Emergency Rulemaking published at 52 DCR 10423 (November 25, 2005) [EXPIRED]; as Emergency Rulemaking published at 53 DCR 684 (February 3, 2006) [EXPIRED]; as Emergency Rulemaking published at 54 DCR 6783 (July 13, 2007) [EXPIRED]; as Final Rulemaking published at 55 DCR 12141 (November 28, 2008); as amended by Final Rulemaking published at 60 DCR 1136 (February 1, 2013); amended by Final Rulemaking published at 66 DCR 7157 (6/14/2019)

Authority: Sections 204 and 1106 of the Procurement Practices Reform Act of 2010, effective April 8, 2011 (D.C. Law 18-371; D.C. Official Code §§ 2-352.04 and 2-361.06) (2011 Repl.).