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

It’s about the right service at the right time…

Part II of Data Analysis

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)

How Are We Going Analyze All That Data?

• 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!!

The logistic regression equation

0 1 1

0 1 1ˆ

1

b b X

i b b X

e

e

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

Example of Possible Web Based Layout/Design

And now …..

A preview of the web based technology