Rate and Payment Methodology Review Project

Summary of Goals

The purpose of this project is to evaluate, recommend, and implement new rates and payment methodologies that will support improved long-term outcomes for adults with I/DD receiving services from BHDDH. BHDDH seeks to shift towards a system of community-based supports that promote individual self-determination, choice, and control. While in practice the system has been moving in that direction, the current rate structure and payment methodology are rooted in more facility-based congregate care not fully aligned with that direction.

A common theme with stakeholders has been that the assumptions and elements of the legacy system should be re-examined if the system is to be able to move forward. Core questions for Rhode Island include how state leaders envision the life possibilities and outcomes for people with I/DD, what the system should look like next, what steps are needed to take to get there, how much needs to be changed, and how much should be built on the current foundation. Many factors will need to be taken into consideration in this effort to undertake a comprehensive restructuring of provider reimbursement rates and payment methodology.

This project will improve the system structure and performance with the following outcomes:

Increasing supports in community settings. Any recommended new rates, payment methodologies, and service structures will promote, engage, and use flexible and responsive community resources in the least restrictive environment to assist individuals to build and maintain relationships, supports, and independence.
Facilitate innovation and flexibility.
Add new services to the available array with appropriate rates for each service.
Generate greater value for taxpayers.
Ensure transparency and accountability.
Transformation of the current system from one that provides services and supports rooted in congregate settings and payments based on units and volume, to a system where the supports and services foster self-determination, choice, independence, and economic self-sufficiency, where payments are based on value and outcomes.

The Vendor will explore, model, and recommend actuarially sound options, including Alternative Payment Methods (APM) and/or Value-Based Payment (VBP) models, that offer financial flexibility, expand access, promote value, quality and cost-effectiveness, foster continued development of community-based supports, including nonmedical interventions that address social determinants of health.

HMA will assist Rhode Island within the Rate and Payment Methodology Change effort through evaluation, stakeholder engagement, analysis including cost analysis, modeling, rate-setting, and policy recommendations.