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Taking the Confusion Out of Rate Setting

Taking the Confusion Out of Rate Setting. 2011 Minnesota Age & Disabilities Odyssey Training Sessions Wednesday, June 22, 2011 . Background/Impetus for Rate Setting Project.

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Taking the Confusion Out of Rate Setting

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  1. Taking the Confusion Out of Rate Setting 2011 Minnesota Age & Disabilities Odyssey Training Sessions Wednesday, June 22, 2011

  2. Background/Impetus for Rate Setting Project To meet the Centers for Medicare and Medicaid Services (CMS) requirements, the Department of Human Services (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 • Continuing Care Administration (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 • Findings 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 Medicaid Management Information Systems (MMIS) data with the provider data by individual recipient’s 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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