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_ 388 Item Details($) Appropriations($) ITEM 288. First Year Second Year First Year Second Year FY2025 FY2026 FY2025 FY2026 high spending as compared to benchmarks. Related-party arrangements shall mean those in which there is common ownership or control between the entities, and shall not include Medicaid payments otherwise authorized in this Item. c. Adjust capitation rates in the Cardinal Care program to account for a portion of expected savings from required initiatives. d. Allow negative historical trends in medical spending to be carried forward when setting capitation rates. e. Annually rebase administrative expenses per member per month for projected enrollment changes. f. Annually incorporate findings on unallowable administrative expenses from audits of MCOs into its calculations of underwriting gain and administrative loss ratios for the purposes of ongoing financial monitoring, including enforcement of the underwriting gain cap. g. Adjust calculations of underwriting gain and medical loss ratio by classifying as profit medical spending that is excessively high due to related-party arrangements. 3. The Department of Medical Assistance Services shall report to the General Assembly on spending and utilization trends within Medicaid managed care, with detailed population and service information and include an analysis and report on the underlying reasons for these trends, the agency's and MCOs' initiatives to address undesirable trends, and the impact of those initiatives. The report shall be submitted each year by September 1. S. The Department of Medical Assistance Services (DMAS) shall amend its July 1, 2016, managed care contracts in order to conform to the requirement pursuant to House Bill 1942 / Senate Bill 1262, passed during the 2015 Regular Session, for prior authorization of drug benefits. T.1. The Department of Medical Assistance Services is authorized to reprocure or amend the Commonwealth's managed care service delivery system through a single managed care contract with the selected managed care organizations with an implementation effective date of July 1, 20242025. 2. In development of a singleThe managed care contract with the selected managed care organizations, the department shall not include the following services, which shall remain in fee-for-service: (i) dental services; (ii) developmental disability waiver services; (iii) and other services currently excluded from the managed care contracts. DMAS shall not include any new services in the contract unless explicitly authorized by the General Assembly. 3. The department shall ensure that the cost of any programmatic and/or contractual changes are fully accounted for in the Appropriation Act. Contract and program changes associated with this reprocurement or amendments shall not create any future funding commitments unless authorized by the General Assembly. 4. The department shall have its contracted actuary review the new managed care contract and report on all program changes as compared to the existing contract and estimate any fiscal impact of such changes no later than 30 days prior to the effective date of the contract. 5. The department shall provide regular updates on implementation of efforts to reprocure the new managed care contracts on a quarterly basis to the the Chairs of the House Appropriations and Senate Finance and Appropriations Committees. 6.a. As part of the reprocured or amended Cardinal Care Managed Care Contracts, DMAS shall be authorized to include the following changes provided such modifications do not alter cost factors, increase costs used in managed care rate development, or add future costs to the Commonwealth. Prior to implementation, DMAS shall have its actuarial contractor review these changes to ensure that the provisions of this paragraph are met. 1) Revise managed care organization staffing requirements. 2) Require DSNPs to operate with exclusively aligned enrollment starting January 1, 2025. 3) Make changes to member intelligent assignment process, however upon contract