Funder: West Health Policy Center

August 2016 | Webinar

Many states are pursuing Medicaid managed long-term services and supports (MLTSS) programs to improve quality of care while controlling costs. This webinar highlights state approaches for using rate-setting to advance MLTSS program goals, including: (1) helping more people to live in the community; and (2) adjusting risk appropriately based on MLTSS cost drivers, including functional status.

The webinar reviewed key rate-setting considerations, drawing from the Medicaid Managed Long-Term Services and Supports Rate Setting Resource Center developed by the Center for Health Care Strategies, Mathematica Policy Research, and Airam Actuarial Consulting through support from West Health Policy Center. Representatives from Tennessee and Wisconsin shared their experiences in refining MLTSS rate-setting approaches to achieve strategic goals.


I. Introduction to MLTSS and Rate-Setting

Speaker: Michelle Herman Soper, Director of Integrated Care, Center for Health Care Strategies

Ms. Soper provided an overview of state Medicaid MLTSS programs and described state objectives for developing MLTSS rates. She highlighted differences between MLTSS rate setting and rate setting for other Medicaid managed care programs.

II. MLTSS Rate-Setting Incentives to Promote Community-Based Care

Speakers: Jenna Libersky, Health Researcher, Mathematica Policy Research; William Aaron, Chief Financial Officer, Tennessee Health Care Finance & Administration; and Patti Killingsworth, Assistant Commissioner, Chief of Long Term Services & Supports, Bureau of TennCare, Tennessee Health Care Finance & Administration

Ms. Libersky reviewed the fundamentals of MLTSS rate structures including different approaches to incentivize community living and considerations that would influence states’ use of these approaches. Mr. Aaron explained Tennessee’s rate-setting goals and approach in its CHOICES MLTSS program. Ms. Killingsworth described how the state manages functional status data, how those data are validated, and future plans for using such data to refine its MLTSS rate-setting approach.

III. Considerations for Risk Adjustment in MLTSS Programs

Speakers: Maria Dominiak, Managing Partner, Airam Actuarial Consulting and Michael Pancook, Budget and Policy Analyst, Wisconsin Department of Health Services

Ms. Dominiak examined the use of functional status data for risk-adjustment in MLTSS programs. She discussed why many risk adjustment approaches developed for other Medicaid programs will not work for MLTSS, sources of functional status data, and the challenges and opportunities of using risk-adjustment models that recognize functional status. Mr. Pancook described how Wisconsin’s Medicaid MLTSS programs use risk-adjustment, including considerations around model design and stakeholder engagement.