Independent Annual Development and Certification of Non-Emergency (NET) Services Reimbursement Employ and/or subcontract, at least one (1) certified actuary to perform the Independent annual development and certification of NET service reimbursement. Project Planning Work with the Department to establish the project structure and required meetings, including periodic meetings with Department project leadership, to drive decision-making and planning over the contract period by: Developing a project plan with agreed-upon deliverables and timeline. Setting up project structure, required meetings, status reporting, and review process. Discussing financial status of NET program, including the upcoming fiscal year NET Broker contracting process and anticipated contractual and programmatic changes that may impact the analysis. Confirming rating approach, including eligible populations, covered services, rate cohorts, and Regional rate structure for the effective period. Data Collection, Analysis, Gap Analysis/Rectification, and Preparation (Task 1) Schedule and meet with the Department to discuss the modifications made to the encounter data since the previous rate calculations and any known issues with the data to be provided over the contract period. Submit a data request and perform a review of the data and assist with identification of key elements to be addressed prior to the rate development process for each fiscal year. Gather NET program data from the Department’s MoveIt Secure File Transfer Protocol, including but not limited to: NET-specific encounter data for claims incurred under the full-risk NET Broker program beginning January 1, 2024, through current. NET-specific caseload information, from January 1, 2024, through current, including specific cohorts identified in Table 1. Table 1 – Required Cohorts Members eligible through Children’s Health Insurance Program (CHIP) Members eligible through the CHIP Unborn Child Option Special Benefits Waiver participants MBM Section 18 waiver participants (Home and Community-Based Services) MBM Section 19 waiver participants (HCBS) MBM Section 20 waiver participants (HCBS) MBM Section 21 waiver participants (HCBS) MBM Section 29 waiver participants (HCBS) MaineCare Expansion population All other MaineCare Members eligible for NET Services Federally Non-Qualified Immigrants under age 21
