Provider Rate Setting for Community Services

This document is a guide that outlines the role of Medicaid in supporting populations requiring long-term services and supports, particularly through home and community-based services (HCBS) programs. It details how Mercer assists states in updating or creating fee-for-service (FFS) provider fee schedules for these community services. The guide emphasizes the importance of adhering to Centers for Medicare & Medicaid Services (CMS) requirements and the necessity for states to periodically review their FFS provider fee schedules to ensure compliance with federal regulations. It describes various methodologies for provider rate setting, including the modeling of fees based on service definitions and market data. Additionally, the guide discusses the implications of regulatory changes on provider payments and the importance of stakeholder engagement in the process. Mercer’s expertise in conducting budget impact analyses and developing communication strategies is also highlighted, showcasing their comprehensive support for states in managing HCBS programs effectively.