Funder: West Health Policy Center
Author: Michelle Herman Soper, Center for Health Care Strategies
August 2016 | Technical Assistance Brief
By engaging managed care plans in rate development activities for Medicaid managed care programs, states can gain information to refine their rate-setting models and better support the populations served. As part of a multi-state initiative on managed long-term services and supports (MLTSS) program rate setting supported by the West Health Policy Center, we interviewed managed care plans and states to inform state approaches for working with managed care plans on MLTSS rate-setting methodologies. This brief examines strategies for communicating with managed care plans during rate-setting activities, common concerns raised by managed care plans and how states might address them, and opportunities for managed care plans to support information collection and other rate-setting efforts.
Recommendations for state communication approaches with managed care plans included starting the engagement process well before the effective date of new rates, being transparent in goals and methods and holding face-to-face meetings with plans. Managed care plans can support states’ rate-setting activities by providing additional data that provide more detail on plan operations and members’ functional assessment status, among other elements. Interviewees also cautioned about the potential impacts that MLTSS rate-setting policy decisions could have on participating managed care plans and other stakeholders.