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Taking the Confusion Out of Rate Setting

Join us for the "Taking the Confusion Out of Rate Setting" training session on June 22nd. This initiative aims to align with CMS requirements by establishing uniform rate determination methods across waiver services. Our objectives focus on achieving equitable payments throughout the state, utilizing transparent processes, and meeting federal standards. Key components include analyzing individual needs, incorporating extensive data sources, and developing a web-based technology for accurate rate calculations. Together, we can foster quality and choice in services.

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Taking the Confusion Out of Rate Setting

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  1. Taking the Confusion Out of Rate Setting Age & Disabilities Odyssey Training Sessions Wednesday, June 22nd

  2. Background/Impetus for Rate Setting Project To meet CMS requirements, DHS must adopt uniform rate determination methods/standards that apply to each waiver service to ensure: • Equitable payments across all areas of the state • Rate differences based on concrete indicators • Rate variations capture the individualized nature of services

  3. Objectives of the Rate Setting Project • DSD has worked with stakeholder groups to establish rate-setting methodologies that: • Abide by the principles of transparency and equitability across the state • Involve a uniform process of structuring rates for each service • Meet federal requirements for the administration of waiver programs • Promote quality and participant choice

  4. Residential, Day and Hourly Framework Components • Employs assumptions of: • Wages • Types of employees • Estimated staffing level based on individuals’ assessed needs • Employee benefits • Other provider expenses • Incorporates data from statewide, national or industry standard data • Builds rates from the ground up • Recognizes service-specific and participant-specific variations

  5. Data used to populate the rate frameworks Conducted Research for Primary data sources • Identify sources used by states or other programs Conducted MN provider cost and wage survey for secondary data source • Collected wage data • Collected cost data • Collected service data

  6. Analyze the Data – Populate the Frameworks • Identified national and local data sources • Extracted similar data inputs from cost and wage survey to corroborate national and local sources • Incorporated data from cost and wage survey where primary data was not available • CCA Executive Management Team, determines data elements used to populate the framework

  7. Where are we going from here with the Rate Frameworks ? • Provider data request • Budget impact analysis • Budget neutrality • Finding reported back to the Executive Management team for review and action

  8. It’s about the right service at the right time…Part II of Data Analysis

  9. Using data, data, and yes, more data • Individual Assessment • Individual Level of Need • Units Authorized/Paid • Medical Claims • Mental Health Claims • Staffing Ratios (Provider Data Request)

  10. How Are We Going Analyze All That Data?

  11. AHA!! • Merge MMIS data with the Provider data by individual recipients PMI Number (Personal Master Index Number or more commonly known as the MA Number) • The end product data set contains all elements of the rate framework at the individual level.

  12. The logistic regression equation

  13. Develop Rate Setting Web Based Technology Web based technology to calculate rates is in development: • Calculate rates based on frameworks • Establish individual rate ranges for residential and day services • Verify and store rates

  14. Example of Possible Web Based Layout/Design

  15. And now ….. A preview of the web based technology

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