(a) (1) An allowance within the capitation rates for a risk-based provider organization shall not be less than the amount needed to pay providers the rates arrived at through a rate study to be completed by October 1, 2025.(2) The rates from a rate study as described in subdivision (a)(1) of this section serve as the minimums that risk-based provider organizations may pay for home- and community-based services, as authorized in 42 C.F.R. § 438.6, as existing on January 1, 2025.
(1) An allowance within the capitation rates for a risk-based provider organization shall not be less than the amount needed to pay providers the rates arrived at through a rate study to be completed by October 1, 2025.
(2) The rates from a rate study as described in subdivision (a)(1) of this section serve as the minimums that risk-based provider organizations may pay for home- and community-based services, as authorized in 42 C.F.R. § 438.6, as existing on January 1, 2025.
(b) The rate study under subdivision (a)(1) of this section shall:(1) Cover services in the Community and Employment Support Section 1915(c) waiver and the Section 1915(i) state plan amendment for the coverage under this subchapter; and(2) Accurately capture provider costs and other relevant considerations that promote economy, efficiency, quality of care, and equal access as required by the Centers for Medicare & Medicaid Services under 42 U.S.C. § 1396a, as existing on January 1, 2025, and in federal regulations under 42 C.F.R. Part 447, as existing on January 1, 2025.
(1) Cover services in the Community and Employment Support Section 1915(c) waiver and the Section 1915(i) state plan amendment for the coverage under this subchapter; and
(2) Accurately capture provider costs and other relevant considerations that promote economy, efficiency, quality of care, and equal access as required by the Centers for Medicare & Medicaid Services under 42 U.S.C. § 1396a, as existing on January 1, 2025, and in federal regulations under 42 C.F.R. Part 447, as existing on January 1, 2025.
(c) (1) The Department of Human Services shall develop the cost factors and other criteria for the rate study with input from home- and community-based service providers.(2) As no rate study for home- and community-based service providers has been conducted since the risk-based provider organizations began serving the state, if the outcome of the rate study under subdivision (a)(1) of this section produces an increase greater than ten percent (10%), the department may phase in a rate increase across two (2) years as authorized by state appropriations and budgets.(3) The department shall conduct a full provider rate review in accordance with the published rate review schedule to ensure that rates remain adequate and aligned with actual costs.
(1) The Department of Human Services shall develop the cost factors and other criteria for the rate study with input from home- and community-based service providers.
(2) As no rate study for home- and community-based service providers has been conducted since the risk-based provider organizations began serving the state, if the outcome of the rate study under subdivision (a)(1) of this section produces an increase greater than ten percent (10%), the department may phase in a rate increase across two (2) years as authorized by state appropriations and budgets.
(3) The department shall conduct a full provider rate review in accordance with the published rate review schedule to ensure that rates remain adequate and aligned with actual costs.