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Rate Setting Methodologies Project

Rate Setting Methodologies Project. Age & Disabilities Odyssey Conference Tuesday, June 21, 2011. Topic areas. Background / Impetus for Rate Setting Project Objectives of the Project Activities and Products of the Project Next Steps. Background/Impetus for Rate Setting Project.

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Rate Setting Methodologies Project

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  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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