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Taking the Confusion Out of Rate Setting
Age & Disabilities Odyssey Training Sessions
Wednesday, June 22nd
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
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
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
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
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
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
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)
• 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.
AHA!!
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