Update on Redesign

December 03, 2019

We had the opportunity to hear from the consultants (Mercer) who developed the proposed rates for the six services which are planned for Phase One.  They did an excellent job and clearly explained the very detailed and comprehensive methodology that they use – we will post the documents by noon tomorrow.

  • We still do not have the proposed service descriptions or details of medical necessity, which makes the proposed rates a bit of a mystery.  It is hard to know if the proposed rate is minimal, adequate or even generous if you don’t know exactly what the provider must do to “earn” the rate.

  • There are also any number of details yet to be determined on all issues from how the current crisis services will integrate into the redesigned integrated crisis service to how the transition from MST (contracted with DJJ or CSA) will transition to the new Medicaid funded MST service while protecting the provider’s sustainability in the process.

  • Lastly, while DMAS staff clearly articulated that the Medicaid FFS rates are considered the “floor” for payment and that the MCOs must at pay at least that amount, the assumptions upon which the rates are built do not guarantee any particular pattern of service authorization.


Thanks to Emily Bebber and Kyle McMahon for helping VNPP to be an active participant in this process.