Overview of the Rate Study for Home and Community Based Services Case Management Across Georgia’s Medicaid Waiver Programs

October 5, 2018
The Department of Community Health (DCH) is conducting a cost-based rate study of case management services across all four Medicaid waivers in the Home and Community Based Services (HCBS) Program. The HCBS Program relies on a network of case management providers for coordination of care for Medicaid waiver members. The rate study aims to establish a valid rate methodology and through this effort enhance the overall quality of case management. The Center for Medicare and Medicaid Services (CMS) refers to case management as the “lynchpin of waiver services.” The following information provides additional detail regarding the purpose of the rate study, the scope of the project, and timeline of events.  
 
Background:
 
  • Rates for case management services in Georgia’s four Medicaid Waiver Programs were established over time utilizing information from comparative in state and out of state services and adjusted by legislative initiative.
  • Valid Rate methodology and adjustments per the CMS are based on market trends, cost reports, or comparable Medicare data.
  • CMS noted concern over the lack of a verifiable rate methodology for case management services during recent waiver renewal and amendment processes.
  • A subsequent audit in 2016 by CMS further indicated the need to develop rates and standardize expectations for services across waiver programs.
Scope of Project:
 
  • Myers and Stauffer LC, a national certified public accounting firm specializing in accounting, auditing, consulting, and rate setting services for government health agencies, has been selected to assist the Department of Community Health (DCH) in the following activities:
  • Development of a standardized cost study template to capture cost information
  • Distribution of the cost study template and delivery of provider training on the completion requirements of the cost study template
  • Analysis of the submitted cost studies and development of validated rate model to be considered by DCH Leadership.
  • All case management agencies will be invited and strongly encouraged to submit completed cost surveys for this service. Costs include both the traditional and the intensive or enhanced models currently delivered.  This is an opportunity to ensure that complete and accurate information is evaluated and considered in the rate model development.
  • The submitted cost surveys will not be subjected to a formal audit; however, Myers and Stauffer will review each survey carefully for validity, completeness and reasonableness.  This may necessitate requests for additional or clarifying information from Myers and Stauffer or DCH throughout the survey gathering process.
  • Opportunities for questions and responses from either the vendor or DCH will be available throughout the survey gathering process.
Timeline for the Project:
  • October 2018
  • Distribute cost survey to all case management agencies
  • Conduct two training sessions for case management agencies to include web-based training  in mid to late October
  • November 2018
  • Case management agencies submit completed cost surveys
  • December 2018 – February 2019
  • Review and analyze submitted cost surveys
  • Follow up with any questions regarding submitted information
  • March – April 2019
  • Develop and finalize rate model
  • Provide recommendations to DCH leadership on implementation of the new rate model