B&A Assisted the Department (under subcontract to Mercer) in investigating replacing its tiered inpatient reimbursement system with an APR-DRG system. Technical activities include: building a hospital features file; conducting preliminary edits on claims and cost data; initiating a hospital-specific claim and cost validation process; costing and grouping claims; developing relative weights and analyzing outliers. Ultimately, the Department opted to implement APR-DRG only for NICU-related cases. This rate development is ongoing and includes all of the tasks above as well as monthly data and policy meetings with the hospital association. Implementation activities will include: assisting in developing the SPA; identifying and testing changes to the MMIS; preparing state and hospital level impact analyses; and negotiating with CMS.
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.
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.