Rate Setting Methodologies Project

Age & Disabilities Odyssey ConferenceTuesday, 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

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

Background / Impetus for Rate Setting Project

DHS sets rates for home care services, day training and habilitation services

and personal care assistant services.

DHS also sets maximum rates for case management

services.

For all other waiver services,

DHS sets a rate file limit.

Counties negotiate service rates with providers based on the enrollee’s need and may negotiate rates that exceed the rate file limits based on

the enrollee’s needs.

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

Data, Data, Data

To inform the payment methodology design process, and ultimately, the rate setting process, the following data sources have been utilized:

Primary data is inclusive of all information, statistics, facts, figures and numbers obtained from national sources; as an example, the Bureau of Labor Statistics, Employee Benefit Research Institute.Secondary data is inclusive of all responses accrued through a scheduled Cost and Wage Survey that was completed by a random sample of Minnesota’s DSD service providers.Provider data request: day and residential providers

Provider Data Request

• Shared staffing• Nursing• Awake night staff• Asleep night staff• Individual staffing

• Information that is not contained in DHS Data Sets

What’s next: the next 18 months:Ju

ne 2

011

Initial budgetimpact analysis

July

201

1Continue to

develop web based technology

Fall

2011

Rollout of training in

various formats such

as:Webinars

ITVOn line

The next 18 months continuedJa

nuar

y 20

12

Implement shadow

rates

Janu

ary

– D

ecem

ber 2

012 On-going

technical support and evaluation during the

year of shadow

rates

Janu

ary

2013

and

on… New rates

fully implemented

On-going technical

support and evaluation

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.

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

CHOICE

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

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

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

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.

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

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

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

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

Information and input

Project web sitehttp://www.dhs.state.mn.us/dhs16_144651You will find:• Policy statements• Rate frameworks• Meeting minutes• Much more

Project E-mail box• DSD.Rates@state.mn.us