Medi-Cal Managed Care Capitation Rates - Senior Care Action Network (SCAN)

Medi-Cal Managed Care Capitation Rates for Senior Care Action Network (SCAN) – by Calendar Year 2020 * No MCO Tax * Long-Term Care Rate Changes – Retro & Prospective Combined - Adjustment to take into account the annual LTC rate changes. * Hospice Rate Increase - Retro & Prospective Combined - Adjustment to account for the increase to the hospice services rates, and hospice room and board rates; effective October and August, respectively, each year. * Optional Benefits Restoration - Adjustment to account for certain adult optional benefits, including vision (excluding lens fabrication), audiology, speech therapy, incontinence creams and washes, and podiatry, being restored as Medi-Cal covered benefits. Most of these benefits are already covered under SCAN's Medicare Advantage plans or under LTC. The only exception is the incontinence creams and washes, which are not Medicare Advantage-covered benefits.

Medi-Cal Managed Care Capitation Rates for Senior Care Action Network (SCAN) – by Calendar Year 2019 * Jan 2019 - Jun 2019 - MCO Tax Included * Jul 2019 - Dec 2019 - MCO Tax Excluded * Long Term Care Rate Changes – Retro & Prospective Combined - Adjustment to take into account the annual LTC rate changes. * Hospice Rate Increase - Retro & Prospective Combined - Adjustment to account for the increase to the hospice services rates, and hospice room and board rates; effective October and August, respectively, each year.

Medi-Cal Managed Care Capitation Rates for Senior Care Action Network (SCAN) – by Calendar Year. 2018 * Includes MCO Tax * Long Term Care Rate Changes – Retro & Prospective Combined - Adjustment to take into account the annual LTC rate changes. * Hospice Rate Increase - Retro & Prospective Combined - Adjustment to account for the increase to the hospice services rates, and hospice room and board rates; effective October and August, respectively, each year.

Medi-Cal Managed Care Capitation Rates for Senior Care Action Network (SCAN) – by Calendar Year 2017 * Lower Bound rate percentage changes are based on July - December 2016 rates since the MCO tax for that rate period is similar to the CY 2017 rates. * The Medical Transportation expenditures included in the base costs are overstated due to most capitated expenditures being covered by Medicare. This adjustment removes all capitated expenditures of Medical Transportation expenditures except for some minimal amounts for LTC Certified COA and expenditures reimbursed based on FFS. * Dental Services are mostly covered by Medicare. Thus, an adjustment was made to remove all expenditures of Dental Service except for some minimal amounts for LTC Certified COA. * Long Term Care Rate Changes – Retro & Prospective Combined - Adjustment to take into account the annual LTC rate changes. * Hospice Rate Increase - Retro & Prospective Combined - Adjustment to account for the increase to the hospice services rates, and hospice room and board rates; effective October and August, respectively, each year. * Acupuncture - Effective July 1, 2016, acupuncture services were reinstituted as a Medi-Cal benefit. * Non-Medical Transportation - Non-medical transportation for managed care covered services has become managed care plans' responsibility effective July 1, 2017, and non-medical transportation for managed care not covered services has become managed care plans' responsibility effective October 1, 2017. * Medical Transportation - The Medical Transportation expenditures included in the base costs are overstated due to most capitated expenditures being covered by Medicare. This adjustment removes all capitated expenditures of Medical Transportation expenditures except for some minimal amounts for LTC Certified COA and expenditures reimbursed based on FFS. * Dental Service - Dental Services are mostly covered by Medicare. Thus, an adjustment was made to remove all expenditures of Dental Service except for some minimal amounts for LTC Certified COA.

Medi-Cal Managed Care Capitation Rates for Senior Care Action Network (SCAN) – by Calendar Year 2016: o 3.9375% SB 78 Tax applied to 1/1/16-6/30/16 rates o Enrollment-based MCO Tax applied to 7/1/16-12/31/16 o Includes Acupuncture as of 7/1/2016