I have been through several iterations of rate studies and haven't found them a useful exercise in general.
Maryland had a rate commission that was supposed to look at rates annually. It existed from 2004 to 2014. You can access its historical materials here. Its results were limited by unstandardized reporting by providers and lack of granular cost data. During its decade-long life, providers received a cumulative rate increase of less than 9%, resulting in a dramatic decline in inflation-adjusted purchasing power. Since the commission's abolition, we've secured 14.5% in rate increases through legislative mandates, with another 18% in increases mandated for the next five years.
The state recently launched a cost study to develop a cost-per-CPT-code based on providers' actual costs. The sampling methodology was problematic and the cost template had **basic math errors.** The state's scratched that effort and is going back to the commission's approach of requiring audited financial statements, which do very little to tell you what a service costs.
We've meanwhile used the CCBHC template to develop a unit cost analysis for nine service lines for half of our members, but haven't modelled that into a CPT cost. I think our methodology is more likely to get us to an actual cost per code than anything the state's proposed, but we'll see.
My biggest advice for you is to always double-check the methodology and the math with a fine-tooth comb, even if the state's using a national firm with years of experience. And put your eggs in the advocacy bucket, not the math one, if you want real results. (Full disclosure: I got a D in statistics.)
Shannon Hall
Community Behavioral Health Association of Maryland
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Shannon Hall
Executive Director
Community Behavioral Health Association of Maryland
Catonsville MD
410-788-1865 ext 2
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Original Message:
Sent: 06-06-2019 15:52
From: Mary Windecker
Subject: Rate Commissions
Thanks to everyone who sent your code of ethics. It was extremely helpful and we appreciate it. Now I'm looking for examples of states that have rate commissions that are comprised of the state and providers to look at rates in a proactive manner. In Montana, our rates are set fairly arbitrarily and then there is a rule hearing and the rate is implemented. We'd like to propose a more thoughtful, collaborative model. Do you have examples of rate commissions that have worked well for behavioral health in your state? Thanks! Mary
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Mary Windecker
Executive Director
Behavioral Health Alliance of Montana
Missoula MT
406-532-8996
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