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Rate Study Report
The Maryland Department of Health’s Developmental Disabilities Administration released a report on November 3, 2017 following a two-year developmental disabilities service provider rate setting study. The purpose of the study was to establish a fair and equitable rate system for services provided to Marylanders with developmental disabilities.
History of the Rate Setting Study
During the 2014 Legislative Session, the legislature tasked the Developmental Disabilities Administration with developing and implementing a new funding system for the distribution of federal and state funds to community-based service providers. The Administration was required to conduct an independent, cost-driven study, develop and implement a plan, provide for specified payments, develop a billing and payment system, establish a payment schedule, and consult with stakeholders. This was the first time the provider rate structure had been reviewed in at least two decades.
The rate study allowed the Developmental Disabilities Administration to move from a prospective-payment to a reimbursement payment (fee-for-service) model and streamline the payment process. There are four major advantages of the fee-for-service system recommended by the rate study:
- Providers receive the same payment for providing the same level of support.
- Individuals are supported by a flexible system that allows for changes in service authorization to meet needs without requiring a change in contract or rate – allowing for portability so individuals can easily relocate without financial concerns about care.
- Increased accountability in the provider community and within the Developmental Disabilities Administration, including additional rate transparency around the authorization and payment for staffing required for individual care.
- Responsive both to different levels of support needs and local economic conditions through predetermined calculations for adjustment.
Johnston, Villegas-Grubbs and Associates (JVGA) was contracted to facilitate the rate study under the oversight of the Developmental Disabilities Administration. JVGA used the Brick™ Method to design rates for services – a systematic approach to rate setting used by county and state governments, as well as federal programs.
JVGA formed two workgroups. The first focused on technical aspects of the study and included a cross section of community based service providers. The second focused on how the rates can affect the quality of services. Both groups contributed valuable input through face-to-face meetings and conference calls.
The quality workgroup was comprised of family members, persons who have disabilities and advocate for themselves, and Arc Maryland representatives. JVGA used this input to incorporate quality of life concerns into concrete objectives in the rate system. Most significantly, they identified the need for more training for direct support providers. As a result, a rate component was created specifically for training. These findings allow the Administration to be more responsive to the individuals being served.
A series of town hall meetings were held in each of the Developmental Disabilities Administration’s four regions for stakeholders to provide input on the results of the study.
