Projects in Financing

Budget Development and Program Financing

Medicaid Shared Saving Program (VMSSP) / Budget Development and Program Financing

Client: Department of Vermont Health Access

B&A designed the financial reporting materials in support the Vermont Medicaid Shared Savings ACO Program including forecasts of the actual and projected per capita spend.

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Development of Children’s Budget

Client: First Things First (Arizona Early Childhood Development & Health Board)

Currently developing a Children’s Budget for Arizona to represent all major public funding for education, health, and safety for children 0-6.

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Operations Fiscal and Budget Monitoring

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

B&A staff have been providing continuous monitoring for the Division of Developmental Disabilities (DDD) program to support operational performance. This has included developing prospective annual services forecasts, developing and maintaining ongoing monitoring reports for service utilization, and members’ access to services.

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Waiver Budget Development

Client: Department of Vermont Health Access

OVHA hired B&A to reformat its budgeting tool to support the Global Commitment for Health waiver. This new design was accompanied by a budget forecast we completed for the coming fiscal year.

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Disproportionate Share and Upper Payment Limit Program Financing

Indigent Care Evaluation

Client: Nevada Legislative Committee on Health Care

Prior to B&A’s formation, Peter Burns conducted a study of indigent health care costs in the state and the existing DSH allocation formula. Recommendations contained in the report included a restructuring of the DSH allocation formula for the hospitals in the state. The project included drafting legislation, subsequently adopted by the Legislature, to implement the recommendations.

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Update DSH Methodology – AHCCCS

Client: Arizona Health Care Cost Containment System

Peter Burns assisted AHCCCS with instituting CPE for DSH. Tasks included reviewing existing DSH for compliance with federal and state law and waiver Terms & Conditions, developing reporting frameworks to allow costing of each uninsured claim, creating reporting schedules for public and private hospitals to supply information for DSH calculations, conducting meeting with hospitals to explain the new reporting requirements, and negotiations with CMS.

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Update DSH Methodology – OVHA

Client: Department of Vermont Health Access

Mark Podrazik assisted Vermont in the redesign and implementation of their disproportionate share program to ensure federal compliance. Alternatives were modeled for the state’s consideration and the change in methodology was implemented in October 2008. A DSH methodology document was delivered to hospitals and procedure manual was produced for OVHA staff to make the DSH calculations going forward.

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UPL Calculations for Rebase Project

Client: Department of Vermont Health Access

As part of the requirements for submitting a state plan amendment to change OVHA’s inpatient and outpatient reimbursement methodologies, B&A calculated the Upper Payment Limit tests for both systems to ensure federal approval. A methodology was written up to accompany the UPL calculations submitted to CMS.

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HIFA and Other Waivers

HIFA Waiver Assistance – NV DHS

Client: Nevada Department of Human Services

B&A provided technical assistance to Nevada to gain approval for their HIFA waiver. Specific activities included performing cost and caseload estimates, designing the methodology for budget neutrality calculations, collecting and preparing data, performing program estimates, and assisting in CMS negotiations.

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Waiver Renewal Assistance

Client: Arizona Health Care Cost Containment System

Peter Burns assisted AHCCCS with their 2006 waiver renewal, particularly with budget neutrality. This included writing the waiver chapter on budget neutrality, creating the design approach, reviewing calculations, negotiating with CMS on the waiver and Terms & Conditions, and responding to CMS questions.

For AHCCCS’s 2001 waiver renewal, Mr. Burns performed these same functions as well as assisting in incorporating all uninsured citizens below 100% FPL (a state ballot initiative) into the waiver. Arizona was the first state to gain approval through the HIFA waiver process.

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Rate Setting

Medical Benefit Payment System Management in Vermont Medicaid

Client: Department of Vermont Health Access

B&A supports Vermont Medicaid maintain payment systems for facilities, professionals, laboratories, durable medical equipment providers, ambulance, and non-emergency transportation services. Highlights include transitioning the state to MSDRGs and APCs and continues to support the state in annual updates to policies, budget and systems.

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Inpatient and Outpatient Hospital Reimbursement Redesign

Client: Department of Vermont Health Access

B&A developed new payment methodologies for inpatient and outpatient hospital services. The previous methodologies had not been substantially updated for 15 years. Activities included developing multiple impacts for hospital CFOs as methodologies developed, facilitating hospital CFO and billing staff meetings on implementation, technical assistance to EDS on pricing algorithms, changes to the state plan and communications with CMS. The inpatient system (DRG) was implemented 1/1/08. The outpatient system (based on Medicare OPPS) was implemented 5/1/08. OVHA recently extended B&A’s contract for an additional year to assist in ongoing maintenance and monitoring.

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EAPG Implementation in Ohio Medicaid

Client: EAPG Implementation in Ohio Medicaid

B&A is supporting the state of Ohio transition to payment of outpatient services using the 3M EAPG grouper. B&A supports Medicaid staff with financial and policy analysis. B&A also engages with stakeholders and partners including the fiscal agent, managed care plans and providers as requested by the state.

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DRG Rebase Technical Assistance

Client: DRG Rebase Technical Assistance

Mark Podrazik is assisting the three hospitals owned by SHW that participate in DC’s Medicaid program navigate changes to the DRG rebase project currently underway. Of importance to SHW is the fact that they own two long term care hospitals which had previously not participated in the DRG payment system.

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Projects in Quality and Planning

Conduct Focus Groups

Conduct Focus Groups – MDH

Client: Minnesota Department of Health

B&A conducted eight focus groups in three cities in Minnesota in November 2007 with small employers and brokers. The purpose was to gain feedback on state reform proposals related to an individual insurance mandate, the concept of a health insurance exchange, and a mandate for small business owners to offer Section 125 plans to their employees. The results from the focus studies were provided in a report to MDH which was used as background to 2008 legislation. The report is shown on the ‘Reports’ tab on this site.

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Conduct Focus Groups – NV DHS

Client: Nevada Department of Human Services

B&A staff facilitated and recorded the findings from focus groups with stakeholders for the six 1915(c) waiver programs to determine gaps in coverage, past achievements, and recommendations for future expansion of services. The purpose of the focus groups was to gain information for completing the Real Choices Systems Change Grant State Profile Tool for all of Nevada’s populations in HCBS Waiver programs.

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Data and Analytics

Medicaid Shared Saving Program (VMSSP) / Data and Analytics

Client: Department of Vermont Health Access

B&A supports monitoring and evaluation efforts in Vermont Medicaid by using claims data to conduct policy analysis and calculate performance metrics.

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Hospital and Managed Care Plan Scorecards

Client: Ohio Department of Medicaid

B&A is supporting Ohio Medicaid produce hospital and managed care scorecards. The scorecards compile metrics on potentially preventable readmissions (PPRs). The scorecards are released twice a year and include aggregate and provider/plan level extracts. B&A also conducts analysis on performance and produces findings for the state.

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Develop and Conduct Member and Provider Surveys

Member Survey

Client: Oklahoma Health Care Authority

As part of its independent evaluation of the Insure Oklahoma program, B&A conducted a survey of over 10,000 members in the ESI portion of the program in the Summer of 2008. Surveys were individually coded so that we could assess representation across demographic criteria. Results were included as a chapter in the evaluation report.

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Provider Survey

Client: Indiana Office of Medicaid Policy and Planning

As part of its evaluation of Indiana’s Care Select program, B&A is conducting a survey of Primary Medical Providers in January 2009 to assess their level of knowledge and participation in the care management of Medicaid members with long term care needs. This survey will not be a traditional CAHPS survey, but rather a survey that will be tailored to the specific needs of the Care Select review.

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External Quality Reviews and Other Independent Evaluations

CMS Redesign Project

Client: County of San Diego

Assisting the County of San Diego’s County Medical Services (CMS) program with their system transformation redesign initiative to improve efficiency and quality of health care services for San Diego’s low income adult populations. The project includes an end to end evaluation of the CMS program. As of this date, this process involved onsite interviews with internal and external stakeholders, including two facilitated meetings with County clinics, hospitals, physicians, and client advocates. The result of these activities is a series of recommendations. The next steps are to conduct an environmental scan of the clinics for medical home readiness, develop a strategic plan for implementing a medical home model, and assess the ASO contract for administering the CMS program.

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Encounter Validation Project

Client: Arizona Department of Health Services, Division of Behavioral Health Services

B&A performed an analysis of the values of encounters submitted by the Regional Behavioral Health Associations (RBHA) to the ADHS/DBHS that support their capitation payments. The results of the independent audit resulted in repayments to the DBHS by one RBHA. B&A also developed a report tracking module for the DBHS to conduct the validations going forward.

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External Quality Reviews

Client: Indiana Office of Medicaid Policy and Planning

B&A serves as the External Quality Review Organization for the Medicaid managed care program, Hoosier Healthwise. An annual evaluation is conducted which includes both a desk review of policies and procedures as well as onsite reviews at the three managed care organizations. B&A conducted reviews in 2007 and 2008 and have been awarded a contract extension through 2012.

Additionally, B&A will be conducting annual reviews beginning in 2009 of OMPP’s other two large-scale Medicaid programs—Care Select (a care management program for clients with long term care needs) and Healthy Indiana Plan (the slimmer package for low-income working uninsured not eligible for Medicaid).

The EQR reports for Hoosier Healthwise in 2007 and 2008 can be found in our Publications section.

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Independent Evaluation of CHIP

Client: Indiana Office of Medicaid Policy and Planning

B&A conducts an annual independent evaluation of Indiana’s Children’s Health Insurance Program. This report includes segments on enrollment trends, access to service, quality indicators and program costs. The report is delivered to the Legislature in April of each year. B&A’s contract began in 2007, but Mark Podrazik has been conducting this annual evaluation for Indiana since 2001. The 2007 and 2008 reports can be found in our Publications section.

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Independent Evaluation of Insure Oklahoma

Client: Oklahoma Health Care Authority

B&A is completing an evaluation of Insure Oklahoma, a state-sponsored program that subsidizes insurance premiums for low-income working uninsured Oklahomans and provides services directly to those that are not offered employer-sponsored insurance. The final report will be delivered in December 2008. Key aspects of the evaluation included face-to-face interviews with over 25 stakeholders involved in the initial design and ongoing operations of the program; a site review of the operations of the state’s fiscal agent for the program; a member survey; an analysis of the program’s budget; and recommendations for improvement, specifically on program operations.

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Strategic Planning

All Payer Models

Client: Department of Vermont Health Access

B&A is one of a team of contractors who provide strategic planning services to state staff in support of the exploration and design of all payer waivers and rate setting models including: universal primary care, global hospital budgets and next generation accountable care organizations (ACOs) with a focus on implications for Medicaid.

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Home Health Payment System

Client: Department of Vermont Health Access

BB&A is providing strategic planning services on the design and implementation of a new value-based home health prospective payment system.

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Medicaid Shared Saving Program (VMSSP) / Strategic Planning

Client: Department of Vermont Health Access

B&A provided strategic planning services to state staff in support of the design and launch of the Vermont Medicaid Shared Savings ACO Program.

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Statewide Strategic Health Plan

Client: Nevada Legislative Committee on Health Care

Peter Burns led the B&A technical assistance team in support of Nevada’s statewide strategic health plan which was produced by the Nevada Legislative Counsel Bureau’s Subcommittee on Health Care. This involved writing seven issue papers on facets of the plan, such as Medicaid coverage, private insurance coverage to small businesses, safety net provider coverage, prevention and wellness, behavioral health, medical education and workforce development, and strategic planning. A summit was convened of more than 100 stakeholders in the state to review and adopt the recommendations presented in the issue papers. B&A also provided technical assistance in quantifying specific strategies that were approved, including the number of uninsured for an ESI program, forecasting budget allotments for Medicaid, LTC and mental health initiatives, and researching costs for prevention and wellness initiatives. The report is in our Publications section.

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Projects in Payment Reform

Budget Development and Program Financing

Medicaid Shared Saving Program (VMSSP) / Budget Development and Program Financing

Client: Department of Vermont Health Access

B&A designed the financial reporting materials in support the Vermont Medicaid Shared Savings ACO Program including forecasts of the actual and projected per capita spend.

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Development of Children’s Budget

Client: First Things First (Arizona Early Childhood Development & Health Board)

Currently developing a Children’s Budget for Arizona to represent all major public funding for education, health, and safety for children 0-6.

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Operations Fiscal and Budget Monitoring

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

B&A staff have been providing continuous monitoring for the Division of Developmental Disabilities (DDD) program to support operational performance. This has included developing prospective annual services forecasts, developing and maintaining ongoing monitoring reports for service utilization, and members’ access to services.

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Waiver Budget Development

Client: Department of Vermont Health Access

OVHA hired B&A to reformat its budgeting tool to support the Global Commitment for Health waiver. This new design was accompanied by a budget forecast we completed for the coming fiscal year.

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Data and Analytics

Medicaid Shared Saving Program (VMSSP) / Data and Analytics

Client: Department of Vermont Health Access

B&A supports monitoring and evaluation efforts in Vermont Medicaid by using claims data to conduct policy analysis and calculate performance metrics.

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Hospital and Managed Care Plan Scorecards

Client: Ohio Department of Medicaid

B&A is supporting Ohio Medicaid produce hospital and managed care scorecards. The scorecards compile metrics on potentially preventable readmissions (PPRs). The scorecards are released twice a year and include aggregate and provider/plan level extracts. B&A also conducts analysis on performance and produces findings for the state.

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Program Design and Operations

Medicaid Shared Saving Program (VMSSP) / Program Design and Operations

Client: Department of Vermont Health Access

B&A provided Vermont Medicaid technical support in the design and implementation of the Vermont Medicaid Shared Savings ACO Program.

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Develop RFP to Procure an EQRO

Client: Georgia Department of Community Health

B&A assisted the DCH in writing an RFP to procure an External Quality Review Organization to review the Medicaid managed care program. Mark Podrazik of B&A also participated in the evaluation of the bids.

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Redesign of the Early Intervention Program

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

B&A assisted the DES/DDD in redesign of the Early Intervention Program. The focus of the redesign was to increase provider capacity and to build a team model for early intervention services. Tasks included conducting focus groups with therapists, rate-setting for the team based model, targeted rate increases by zip codes/regions, and calculation of the fiscal impact.

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RFP Evaluation Assistance – ADEQ

Client: Arizona Department of Environmental Quality

B&A provided technical assistance related to evaluation of proposals from vendors to serve as emissions testing centers in the State of Arizona. Specifically, we evaluated the cost proposals which included capital and operational components. Peter Burns also assisted the ADEQ in the final contracting negotiations with the successful vendor.

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RFQVA Development

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

Prior to B&A’s formation and continuing in recent years, current B&A staff assisted the DES/DDD develop its Requests for Qualified Vendor Application (RFQVA) process, an online procurement system that enables open procurement for specific services. B&A staff assisted in writing the original RFQVA template documents, the specific requirements for indvidual services, and amendments to previously-released RFQVA documents.

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Evaluate Managed Care Contracts

Client: Texas Health and Human Services Commission

Anne Winter of B&A (under subcontract to Bailit Health Purchasing) assisted the Texas Health and Human Services Commission in reviewing the reinsurance practices of one of the Medicaid MCOs. She also assisted the HHSC with an analysis of their MCO contract compliance with federal and state statutes and regulations.

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Vermont Bundled Payment Program

Client: Department of Vermont Health Access

B&A is providing technical support to Vermont Medicaid on the design and implementation of a bundled payment program for a set of priority episodes of care.

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Public/Private Insurance Initiatives

All Payer Models

Client: Department of Vermont Health Access

B&A is one of a team of contractors who provide strategic planning services to state staff in support of the exploration and design of all payer waivers and rate setting models including: universal primary care, global hospital budgets and next generation accountable care organizations (ACOs) with a focus on implications for Medicaid.

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Independent Evaluation of the Healthy NY Program

Client: New York State Insurance Department

B&A was contracted to prepare an annual report that evaluates the impact that Healthy NY has on reducing the adult uninsured population, member satisfaction with the program, and overall operations. For the 2009 and 2010 reports submitted to the Legislature, B&A conducted interviews with health plan representatives and annual mail surveys of individual Healthy NY members as well as enrolled small business employers and their employees. The annual report also includes a financial analysis of the costs of the state funded reinsurance component of the program and an elasticity analysis of the demand for coverage across competing health plans.

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Public/Private Design Concepts

Client: Arizona Health Care Cost Containment System

AHCCCS hired B&A to research options for expanding health insurance through private sector, public sector and public/private mechanisms. Specific policy papers were drafted related to: (1) Identifying populations already eligible for Medicaid that are not enrolled; (2) Options for implementing a premium subsidy program for low-income workers; (3) Developing a high-risk pool product; (4) Options for developing a health insurance exchange; (5) Opportunities for employees if a Section 125 mandate for employers was in place; and (6) Other cost containment strategies designed to lower premium costs.

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Rate Setting

Medical Benefit Payment System Management in Vermont Medicaid

Client: Department of Vermont Health Access

B&A supports Vermont Medicaid maintain payment systems for facilities, professionals, laboratories, durable medical equipment providers, ambulance, and non-emergency transportation services. Highlights include transitioning the state to MSDRGs and APCs and continues to support the state in annual updates to policies, budget and systems.

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Inpatient and Outpatient Hospital Reimbursement Redesign

Client: Department of Vermont Health Access

B&A developed new payment methodologies for inpatient and outpatient hospital services. The previous methodologies had not been substantially updated for 15 years. Activities included developing multiple impacts for hospital CFOs as methodologies developed, facilitating hospital CFO and billing staff meetings on implementation, technical assistance to EDS on pricing algorithms, changes to the state plan and communications with CMS. The inpatient system (DRG) was implemented 1/1/08. The outpatient system (based on Medicare OPPS) was implemented 5/1/08. OVHA recently extended B&A’s contract for an additional year to assist in ongoing maintenance and monitoring.

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EAPG Implementation in Ohio Medicaid

Client: EAPG Implementation in Ohio Medicaid

B&A is supporting the state of Ohio transition to payment of outpatient services using the 3M EAPG grouper. B&A supports Medicaid staff with financial and policy analysis. B&A also engages with stakeholders and partners including the fiscal agent, managed care plans and providers as requested by the state.

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DRG Rebase Technical Assistance

Client: DRG Rebase Technical Assistance

Mark Podrazik is assisting the three hospitals owned by SHW that participate in DC’s Medicaid program navigate changes to the DRG rebase project currently underway. Of importance to SHW is the fact that they own two long term care hospitals which had previously not participated in the DRG payment system.

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Strategic Planning

All Payer Models

Client: Department of Vermont Health Access

B&A is one of a team of contractors who provide strategic planning services to state staff in support of the exploration and design of all payer waivers and rate setting models including: universal primary care, global hospital budgets and next generation accountable care organizations (ACOs) with a focus on implications for Medicaid.

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Home Health Payment System

Client: Department of Vermont Health Access

BB&A is providing strategic planning services on the design and implementation of a new value-based home health prospective payment system.

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Medicaid Shared Saving Program (VMSSP) / Strategic Planning

Client: Department of Vermont Health Access

B&A provided strategic planning services to state staff in support of the design and launch of the Vermont Medicaid Shared Savings ACO Program.

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Statewide Strategic Health Plan

Client: Nevada Legislative Committee on Health Care

Peter Burns led the B&A technical assistance team in support of Nevada’s statewide strategic health plan which was produced by the Nevada Legislative Counsel Bureau’s Subcommittee on Health Care. This involved writing seven issue papers on facets of the plan, such as Medicaid coverage, private insurance coverage to small businesses, safety net provider coverage, prevention and wellness, behavioral health, medical education and workforce development, and strategic planning. A summit was convened of more than 100 stakeholders in the state to review and adopt the recommendations presented in the issue papers. B&A also provided technical assistance in quantifying specific strategies that were approved, including the number of uninsured for an ESI program, forecasting budget allotments for Medicaid, LTC and mental health initiatives, and researching costs for prevention and wellness initiatives. The report is in our Publications section.

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Projects in HCBS Waiver Programs

HCBS Rate Setting

HCBS Rate Setting – DES/DDD

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

B&A staff have been assisting the DES/DDD in setting HCBS rates since 2000. Originally, we were involved in the formulation and adoption of a legislatively mandated rate structure for both agency and independent providers. Responsibilities included developing the methodology and performing the financial analysis of the implementation costs of the rate structure and developing strategies for implementation of the rate structure within budget constraints. Included in the financial estimates were two-year projections of caseload and utilization. The rates were developed using cost information collected from providers in conjunction with the collection of market-based, Arizona-specific costs.

Recently, B&A participated in the rebasing of all HCBS rates (with two other consulting firms). This required detailed, web-available provider cost survey tools and instructions, publication of frequently asked questions, extensive provider briefings on rebasing results and methodology, and fiscal impact analysis.

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HCBS Rate Setting – ADHS/DBHS

Client: Arizona Department of Health Services, Division of Behavioral Health Services

B&A performed an evaluation of the appropriateness of over 40 rates paid to providers by the Division of Behavioral Health Services. B&A conducted ongoing discussions with a multi-disciplinary team to review current independent rate models to modify the design to provide appropriate reimbursement for best practices. A provider cost survey was also conducted and analysis of these costs were used to justify the market-based rate models.

This project represented a rebase of the models originally completed by Gretchen Engquist in 2000-2001 prior to B&A’s formation.

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HCBS Rate Setting – MODDD

Client: Missouri Department of Mental Health Division of Developmental Disabilities

B&A staff are developing Missouri-specific Funding Bands (Missouri Funding Bands or MFBs) based on support need levels determined through the Support Intensity Scale (SIS) tool and “standardized” individual expenditure levels. The MFBs will be based on the SIS and expenditure data derived from the full population of adult Missouri DDD recipients. The MFBs will be designed on a Missouri-wide basis with a review and update to provider reimbursement rates.

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HCBS Rate Setting – NDDDD

Client: North Dakota Department of Human Serices, Developmental Disabilities Division

B&A staff are providing an evaluation on the current reimbursement system features including rates, assessment, the individualized link between assessment and resource allocation/rate adjustment, and response of the system to changes in client acuity. Included in the evaluation is the identification and evaluation of options for the current reimbursement.

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HCBS Rate Setting – NV DHS

Client: Nevada Department of Human Services

Prior to B&A’s formation, Gretchen Engquist and Mark Podrazik completed work for the legislatively mandated Nevada Provider Rates Task Force charged with developing a long-term strategic rate plan for community-based services for seniors, people with disabilities, and people with mental illness. Our team developed community service rates and a strategic transition plan that included service and rate-specific analyses and an overarching section that presented a strategic plan across individual rates for the payment of community services across target populations. Recommendations were also made for the development of a fiscal intermediary program, the creation of a waiver for services for individuals with autism, and a revamping of the delivery and payment of Targeted Case Management.

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HCBS Rate Setting – LA OCDD

Client: Louisiana Department of Health & Hospitals, Office for Citizens with Developmental Disabilities

B&A staff recently developed case management rates for ten (10) programs provided through the Department of Health & Hospitals (DHH). These programs included general State Plan programs and 1915(c) Waiver programs offered through DHH, the Office for Citizens with Developmental Disabilities (OCDD) or the Office of Aging and Adult Services (OAAS). Work included a cost survey of providers, development of independent rate models based on economic and market data, fiscal forecasting, and establishing 15-minute unit rate policies. B&A also helped providers have a clearer understanding of what can and cannot be billed.

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Maine Provider Rate Setting Initiative

Client: Maine Office of Aging and Disability Services

Assisting the Office in developing and implementing provider rates and a resource allocation system for Maine’s 1915(c) waiver for adults with intellectual disabilities. The major components of the work plan include: provider engagement; a provider survey; collecting public input on assessment levels; performing claims and other analyses; rate model and service package development; stakeholder input; and implementation support.

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Mississippi ID/DD Waiver Rate Setting Initiative

Client: Mississippi Department of Mental Health

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My Life, My Community Provider Rate Study

Client: Virginia Department of Behavioral Health and Developmental Services

Assisting the State (in a subcontract to HSRI) to: evaluate the current service delivery system for individuals with intellectual and developmental disabilities; make recommendations to move the system to a more person-focused/needs-based system of care; in conjunction with that evaluation, review (and revise as necessary) the existing rates paid to service providers; and develop a resource allocation system based on Supports Intensity Scale assessments.

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HCBS Rate Setting – PBH

Client: Cardinal Innovations (North Carolina)

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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New Mexico Provider Rate Setting

Client: New Mexico Department of Health, Developmental Disabilities Division

Developed a published rate schedule for existing and new home and community based services covered under DDSD’s 1915(c) waiver extension as well as a resource allocation model based on the SIS assessment. Key activities include assisting DDSD in defining service standards and billing rules, conducting a provider survey and other special studies (focus groups, differences between costs in different regions, and researching external data sources), providing briefings to providers, clients and policymakers, and developing fiscal analyses and implementation strategies. In addition, developed resource allocation model options and led a clinical validation study including national clinical experts (physicians, psychologists, therapists (PT, OT, Speech).

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HCBS Rate Setting – ODHC

Client: Oregon Department of Human Services

B&A (under subcontract to HSRI) assisted in the development of a rate-setting system that serves as a foundation for individual funding levels for people with developmental disabilities. This work required a provider cost survey, development of independent rate models, and fiscal impact analyses.

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Implement Fiscal Intermediaries

Fiscal Intermediary Implementation

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

Prior to B&A’s formation, current B&A staff assisted the DES/DDD implement a fiscal intermediary that enables persons with developmental disabilities to select individuals or agencies to provide services to them in their home. B&A staff assisted in writing the Request for Proposal, conducting the readiness review of the awarded FI, and develop operational flows for the DDD to implement the FI. Arizona was unique in that its FI program was a “turn-key” implementation of over 2,000 at the outset.

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Individualized Budgeting

Develop Individualized Budgets – DES/DDD

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

B&A staff assisted DES/DDD in the conversion to a consumer-directed individualized budget system. Stages in the movement to consumer direction that have been implemented include (a) establishing a rate structure for HCBS providers, (b) streamlining the procurement process, (c) enhancing management information systems, (d) developing consumer assessment tools and (e) retaining a fiscal intermediary.

Peter Burns supervised the development of reporting systems to score clinical/environmental assessments and transform scores into unique consumer rates reflecting each individual’s need. B&A staff maintain the rate assessment tool that is used to tie service needs to rates to set the individual budgets.

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Develop Individualized Budgets – LA OCDD

Client: Louisiana Department of Health & Hospitals, Office for Citizens with Developmental Disabilities

B&A assisted the State in the development and implementation of individual funding levels applicable to home- and community-based waiver populations. The funding levels include regression analysis to determine commonalities among client needs to best assess the proper amount of funding.

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Develop Individualized Budgets – RI DMHH/DDD

Client: Rhode Island Department of Behavioral Health, Developmental Disabilities and Hospitals

B&A (under subcontract to HSRI) is currently evaluating the potential to institute an individual budget system for Rhode Island’s DDD which would use the SIS assessment instrument as the basis for assessing clients.

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Supports Intensity Scale and other Assessment Tools

Community Assessment

Client: City of Phoenix Human Services Department

Prepared a community assessment focused on low-income populations eligible for the City’s Head Start and Community Services Block Grant (CSBG) funded programs. The assessment provided demographic, health, employment, and real estate overviews. The project included an analysis of census data to evaluate neighborhood-by-neighborhood trends, the collection and integration of other data sources, and the development, administration and compilation of bilingual client and staff surveys designed to capture respondents’ opinions regarding the strengths and challenges of their neighborhoods and existing services.

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Development of Assessment Tools

Client: Arizona Health Care Cost Containment System

In the early 1990s, Gretchen Engquist was instrumental in the development of the pre-admission screening tools for the elderly, people with physical disabilities, and people with developmental disabilities for the ALTCS program (Arizona Long Term Care System), the first Medicaid managed long term care program in the country. Since then, she has participated in completing periodic updates of tools for AHCCCS.

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Development of Rate Assessment Tool

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

Prior to B&A’s formation, Gretchen Engquist of B&A designed a rate assessment tool for the DDD to use in determining the rate paid on a statewide basis to independent providers. The rate assessment tool evaluates environmental factors, distance, safety, behaviors, medical needs, activities of daily living (ADLs) and the availability of nonpaid caregivers that can assist the paid independent provider. An automated scoring system and database was also developed as part of this process. B&A staff is currently responsible for the maintenance of the rate assessment tool.

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Projects in Operations

Program Design and Operations

Medicaid Shared Saving Program (VMSSP) / Program Design and Operations

Client: Department of Vermont Health Access

B&A provided Vermont Medicaid technical support in the design and implementation of the Vermont Medicaid Shared Savings ACO Program.

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Develop RFP to Procure an EQRO

Client: Georgia Department of Community Health

B&A assisted the DCH in writing an RFP to procure an External Quality Review Organization to review the Medicaid managed care program. Mark Podrazik of B&A also participated in the evaluation of the bids.

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Redesign of the Early Intervention Program

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

B&A assisted the DES/DDD in redesign of the Early Intervention Program. The focus of the redesign was to increase provider capacity and to build a team model for early intervention services. Tasks included conducting focus groups with therapists, rate-setting for the team based model, targeted rate increases by zip codes/regions, and calculation of the fiscal impact.

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RFP Evaluation Assistance – ADEQ

Client: Arizona Department of Environmental Quality

B&A provided technical assistance related to evaluation of proposals from vendors to serve as emissions testing centers in the State of Arizona. Specifically, we evaluated the cost proposals which included capital and operational components. Peter Burns also assisted the ADEQ in the final contracting negotiations with the successful vendor.

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RFQVA Development

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

Prior to B&A’s formation and continuing in recent years, current B&A staff assisted the DES/DDD develop its Requests for Qualified Vendor Application (RFQVA) process, an online procurement system that enables open procurement for specific services. B&A staff assisted in writing the original RFQVA template documents, the specific requirements for indvidual services, and amendments to previously-released RFQVA documents.

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Evaluate Managed Care Contracts

Client: Texas Health and Human Services Commission

Anne Winter of B&A (under subcontract to Bailit Health Purchasing) assisted the Texas Health and Human Services Commission in reviewing the reinsurance practices of one of the Medicaid MCOs. She also assisted the HHSC with an analysis of their MCO contract compliance with federal and state statutes and regulations.

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Vermont Bundled Payment Program

Client: Department of Vermont Health Access

B&A is providing technical support to Vermont Medicaid on the design and implementation of a bundled payment program for a set of priority episodes of care.

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Program Monitoring

Annual Monitoring Manual

Client: Indiana Office of Medicaid Policy and Planning

B&A produces a monitoring manual for the OMPP each year that addresses access, quality, utilization per 1,000 trends and usage of specific services of Hoosier Healthwise members. With the introduction of the OMPP’s two new programs—Care Select and HIP—the monitoring manual will expand beginning in 2009 to monitor trends across the three programs.

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Focus Studies

Client: Indiana Office of Medicaid Policy and Planning

An annual deliverable of B&A’s contract with the OMPP is to conduct a focus study on an aspect of the Hoosier Healthwise program. In 2007, this study related to the incidence of children utilizing services from Primary Medical Providers that they were not assigned to. In 2008, the study included a profile of high cost members in Hoosier Healthwise and the associated capitation payments that MCOs receive for these members.

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Public/Private Insurance Initiatives

All Payer Models

Client: Department of Vermont Health Access

B&A is one of a team of contractors who provide strategic planning services to state staff in support of the exploration and design of all payer waivers and rate setting models including: universal primary care, global hospital budgets and next generation accountable care organizations (ACOs) with a focus on implications for Medicaid.

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Independent Evaluation of the Healthy NY Program

Client: New York State Insurance Department

B&A was contracted to prepare an annual report that evaluates the impact that Healthy NY has on reducing the adult uninsured population, member satisfaction with the program, and overall operations. For the 2009 and 2010 reports submitted to the Legislature, B&A conducted interviews with health plan representatives and annual mail surveys of individual Healthy NY members as well as enrolled small business employers and their employees. The annual report also includes a financial analysis of the costs of the state funded reinsurance component of the program and an elasticity analysis of the demand for coverage across competing health plans.

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Public/Private Design Concepts

Client: Arizona Health Care Cost Containment System

AHCCCS hired B&A to research options for expanding health insurance through private sector, public sector and public/private mechanisms. Specific policy papers were drafted related to: (1) Identifying populations already eligible for Medicaid that are not enrolled; (2) Options for implementing a premium subsidy program for low-income workers; (3) Developing a high-risk pool product; (4) Options for developing a health insurance exchange; (5) Opportunities for employees if a Section 125 mandate for employers was in place; and (6) Other cost containment strategies designed to lower premium costs.

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Readiness Reviews

Dental Program Readiness Review – NV DHS

Client: Nevada Department of Human Services

Prior to B&A’s formation, Peter Burns and Gretchen Engquist developed and conducted the readiness review for the Nevada Managed Dental program operated through the health plans and the University of Nevada–Las Vegas. The findings from the review concluded that the vendor was not ready. Our team developed corrective action plans and conducted a re-review until compliance was met.

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FI Program Readiness Review

Client: Arizona Department of Economic Security, Division of Developmental Disabilities

Prior to B&A’s formation, Peter Burns and Steven Abele designed and conducted the readiness review of the DDD’s FI selection. In addition to conducting the review and writing up findings, our team worked with the FI and DDD to ensure that the proper systems implementations were in place before the FI went live.

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