Why was the rate study completed?
During the 2014 legislative session, the Maryland General Assembly directed Developmental Disability Administration (DDA) to conduct a rate setting study to establish an equitable rate system by studying the actual costs of providing community based services.
What impact does the rate study have on the Community Pathways Waiver?
Service definitions for the waiver were developed prior to the rate study. The definitions were then used to develop rates. The rate study information was made available in the Application to Centers for Medicare and Medicaid Services (CMS) for the Community Pathways Waiver renewal in Appendix I - Financial Accountability, which establishes rates and Appendix J - Cost-Neutrality Demonstration, which provides projected cost and service utilization that can be amended at any time. Existing rates will continue for DDA core services as reflected in Appendices I and J for year one or from July 1, 2018 to June 30, 2019. The new proposed rates are reflected in year two (July 1, 2019 to June 30, 2020), which will be updated based on the final review by Johnston, Villegas-Grubbs and Associates LLC (JVGA).
Has this rate structure proposed by JVGA been used in other states?
Yes. The rate structure has been approved by the federal government, specifically the Centers for Medicare and Medicaid Services (CMS). Arizona was the first state to implement this rate structure and other participating states include Delaware, Florida, and the District of Columbia.
How was the rate study done?
The consultant, JVGA, collected financial information from 70 community service providers. JVGA analyzed the financial data from providers to understand their costs. Cost data was then categorized as Employment Related Expenditures, Facility Costs, Program Support, or General and Administrative. Also, JVGA collected Direct Support Professional (DSP) hours from providers. JVGA used wage information from the Bureau of Labor Statistics for Maryland to establish the wage for staff for each service type. Draft rates were calculated based on the analysis of actual cost data and direct support staff hours.
Who was involved in rate study?
In addition to feedback from 70 providers and stakeholders, JVGA formed two (2) workgroups – one with six (6) providers and their Maryland provider organization to assist with rate development and the other with Maryland family members, individuals, and advocacy organizations for quality assurances input.
Were the report and the recommendations shared with the public?
Yes. More than 6,000 stakeholders, including DDA service providers and family members on our mailing list, were emailed notice that the rate study report was posted on the DDA website Nov. 3, 2017. The same notice was provided on the DDA Facebook page, and a press release was sent out by the Maryland Department of Health on the same day. All of these included notice that JVGA would hold town hall meetings in each of the four (4) regions during the week of Nov. 13, 2017. The town halls were held in the evenings to allow families to attend. Also, JVGA met with the Maryland Association of Community Services (MACS), the provider organization on Nov. 17, 2017 to discuss more detailed cost data and answer questions from the providers about how JVGA arrived at the assumptions for each rate. Additionally, the information was shared with the legislature that directed the study.
What happens next with the recommendations from the rate study?
Starting in January 2018, JVGA will schedule calls with every DDA service provider in Maryland to review the impact of the new rates on their operation. Issues will be analyzed and possible solutions identified. In the interim, providers are encouraged to submit questions to firstname.lastname@example.org.