Actuarially Sound Rates
The team at Optumas has over 65 years of experience developing actuarially certified rates for both public and private payers. We have developed actuarially sound rates for the following types of populations:
- Medicaid programs (Temporary Assistance for Needy Families, Aged/Blind/Disabled, General Assistance)
- Children’s Health Insurance Programs (CHIP)
- Medicaid expansion programs
- Large employer groups
- Provider groups
- Health Care Reform programs
These rates can cover all types of services (acute, ambulatory, long-term care, behavioral health, dental, pharmacy) for various types of managed care contractors (HMO, EPO, PPO). Our proven process includes requesting and analyzing data, calculating impact of programmatic changes, deriving trend assumptions, and building estimates for non-medical costs (administration, profit, risk and contingencies).
Our actuaries utilize CMS’s rate development checklist in developing all rates/premiums as well as any applicable actuarial standards of practice and state laws. We also provide an actuarial certification documenting our methodology and final rate ranges that comply with CMS’s requirements for Medicaid and expansion programs.