HCBS Rate Setting – PBH

B&A (under subcontract to HSRI) has been assisting Piedmont Behavioral Health (PBH) in assessing its expenditures and operations with respect to its Innovations Waiver. The Innovations Waiver is a combined 1915(b)(c) fully capitated HCBS waiver for developmentally disabled participants in a five county area of North Carolina. The ultimate objective of the engagement is the development of a SIS informed resource allocation model for Innovations participants. However, the project to date has devoted a significant amount of resources to the evaluation of the terms of the 1915(c) component of the waiver, the development and adequacy of the capitation rates determined and paid for the program, and in analyzing the historical patterns and levels of expenditures among the Innovations participants.

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