Section I: Foundational Concepts
Developing and refining MLTSS payment rates requires an understanding of certain foundational concepts. The resources in this section provide general information about state approaches to developing MLTSS payment rates and some of the challenges involved in setting sound rates. Resources address strategies for using MLTSS rates to incentivize community living as well as considerations that would influence states’ use of these approaches.
Medicaid Rate-Setting for Managed Long-Term Services and Supports: Basic Practices for Integrated Medicare-Medicaid Programs (July 2016, Mathematica Policy Research) This report summarizes approaches that states can use to structure payment rates for MLTSS programs and highlights policy considerations that may influence a state’s choice of strategy.
Report to the Congress on Medicaid and CHIP: Chapter 5, Issues in Setting Medicaid Capitation Rate for Integrated Care Plans (March 2013, Medicaid and CHIP Payment and Access Commission) This report provides an overview of the Medicaid capitation rate-setting process for dually eligible individuals, describes states’ rate-setting methods in integrated care programs, highlights the rate-setting approaches in two states, and raises additional considerations in rate development.
Rate Setting for Capitated Medicaid Managed Long-Term Services and Supports (January 2013, Integrated Care Resource Center) This presentation describes the objectives of the rate-setting process in MLTSS programs, including the basic approach, rate structure, and risk mitigation strategies.