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Rate Setting Methodologies Project

The session focuses on the Rate Setting Project aimed at establishing uniform methodologies for determining service rates under the CMS guidelines. Key objectives include ensuring equitable payments, transparency, and promoting quality services. The project outlines its next steps for the coming 18 months, emphasizing the importance of standardized pricing for recipients, providers, and counties. Participants will learn about the core elements of rate architecture and the significance of stakeholder input in shaping effective policies. For more information, visit the project website.

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Rate Setting Methodologies Project

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Presentation Transcript

  1. Rate Setting Methodologies Project Age & Disabilities Odyssey Conference Tuesday, June 21, 2011

  2. Topic areas • Background / Impetus for Rate Setting Project • Objectives of the Project • Activities and Products of the Project • Next Steps

  3. 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

  4. Background / Impetus for Rate Setting Project

  5. 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

  6. Data, Data, Data

  7. Provider Data Request • Shared staffing • Nursing • Awake night staff • Asleep night staff • Individual staffing • Information that is not contained in DHS Data Sets

  8. What’s next: the next 18 months:

  9. The next 18 months continued

  10. Alignment: Provider Enrollment Provider Standards County based contracting will end and DHS will assume the contract function per CMS requirements. • Negotiation of rates at the county and provider level will no longer be necessary – focus on the needs of the person and the services to meet them. • Recipients will have a broader choice of providers. • Providers will be able to provide services statewide. • Implementation is aligned with Rate Setting – January 2013.

  11. Why does rate setting matter to a recipient? Standardized pricing helps recipients make informed decisions about how to get the most for their money from all available resources

  12. CHOICE • Community membership • Health, wellness and safety • Own place to live • Important long-term relationships • Control over supports • Employment earnings and stable income

  13. Why does rate setting matter to providers? • Standardized rates enable providers to spend more time focused on delivering quality services • Providers know exactly what services they are expected to deliver to the individual

  14. Why does rate setting matter to counties? • State-provided tool makes it easier for lead agencies to calculate service rates and to monitor the delivery of purchased services • Consistent rates help lead agencies accommodate individuals who move to other counties to obtain services • Meets CMS requirements for the administration of disability waiver services

  15. Core elements of the rate architecture • Staffing and related expenses • Wages and benefits • Program and recipient support expenses • Program supervision • Program supplies • Community access • General and administrative expenses • Administrative salaries and benefits • Office expenses, advertising, etc.

  16. What about individual needs? Glad you asked !! Takes into consideration the assessed needs of recipients, such as: • Complex medical • Behavioral intensity • Deaf and hard of hearing

  17. What does rate setting have to do with care planning? Again…glad you asked !!! • Spend less time on rate administration and more time focused on serving the individual • Lead agencies can provide individuals with clear information about the prices of services they need • State-provided tool makes it easier for lead agencies to calculate service rates and to monitor the delivery of purchased services   • Consistent rates help lead agencies accommodate individuals who move to other counties to obtain services Planning the services to meet the needs of the individual

  18. Building a Sustainable Service System • Establishes a consistent, equitable process for standardizing rates • Leverages technologies across DHS systems & initiatives • Streamlines administrative processes to keep focus on quality & outcomes

  19. Stakeholder inputWhere we’ve been, and where we’re going • Intensive and Expanded Work Groups completed their work in December, 2010 • DSD has convened an Advisory Committee with a broad base of stakeholders • Committee will consult with staff on a regular basis • Committee will have regular input and gather feedback in the implementation phase of the project

  20. Information and input Project web site http://www.dhs.state.mn.us/dhs16_144651 You will find: • Policy statements • Rate frameworks • Meeting minutes • Much more Project E-mail box • DSD.Rates@state.mn.us

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