PPT-1 1 Medicaid Cost Drivers

DHMH Presentation Maryland Medicaid Advisory Committee July 2011 2 2 National data taken from the Kaiser Family Foundation Results from a 50State Medicaid Budget Survey for State Fiscal Years 2010 and 2011 September 2010. Examining Children’s Behavioral Health Service Utilization and Expenditures. Made possible through support from the . Centers for Medicare & Medicaid Services..  . Funder Disclaimer. This document was developed in part under grant CFDA 93.767 from the U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services. However, the contents do not necessarily represent the policy of the U.S. Department of Health and Human Services, and you should not assume endorsement by the Federal Government.. More Science, Less Art. COCOMO History. Co. nstructive . Co. st . Mo. del. Dr. Barry Boehm. TRW in 1970s. 1981 - COCOMO81. 1996 - COCOMOII. Modes . (project types). Organic. Relatively small software teams develop software in a highly familiar, in-house environment . Waivers. Seema Verma, MPH. President & Consultant. SVC Inc. Medicaid 50 Year Anniversary. President Johnson & War on Poverty:. “We want to give the forgotten fifth of our people opportunity not doles..”. Cost Report and Settlement. By: Steven W. Garner. Medicaid Regulations. CMS Provider Reimbursement Manual 15-1 2300. Principle:. “Providers receiving payment on the basis of reimbursable cost must provide adequate cost data based on financial and statistical records which can be verified by qualified auditors.”. Joslyn R. Tijerina, MPH. Study Population. December 2015 snapshot of all individuals with an I/O Waiver. 19,371. What is the Individual Options (I/O) Waiver?. Medicaid waiver for people who have developmental disabilities. Michigan Association of Health Plans. Summer Conference. . July 15, 2015 . Presentation Outline. Medicaid MCOs’ pharmacy benefits management acumen – findings from our recent assessment. Dynamics related to Common or Uniform Formulary “Movement”. Principles of Cost Analysis and Management. © Dale R. Geiger 2011. 1. Why did this cost measurement method fail?. Thank You. Fillet and Lobster 35.00. Chicken Kiev 15.00. with . Multiple Cost Pools/Drivers. Principles of Cost Analysis and Management. 1. Why did this cost measurement method fail?. Thank You. Fillet and Lobster 35.00. Chicken Kiev 15.00. Allan Coukell. Senior Director, Health Programs. The Pew Charitable Trusts. Why are pharmaceuticals an issue?. Rising prescription drug costs. Up 8.4% in 2015 ($310B). 16.7% of total health spend. Specialty drugs are key driver. Prescription Drug Alternative Payment Models and Medicaid . National Association of Medicaid Directors. November 8, 2016. Jane Beyer, Program Officer. Milbank Memorial Fund/OHSU Center for Evidence-based Policy. National Hemophilia Foundation 13 th Annual Insurance and Reimbursement Conference Medicaid Drug Reimbursement Methodology Renaissance Baltimore Harborplace Hotel September 29 th , 2016 Michael Sharp, R.Ph. in Hawaii and Maryland. Hawaii Executive Office on Aging- Caroline Cadirao, Debbie Shimizu. Maryland Department of Aging- Ami Patel. Maryland Department of Health and Mental Hygiene- Devon Mayer. Administration for Community Living- Joseph Lugo. 1. Medicaid Administrative Claiming (MAC). All Direct and Administrative staff. Fee For Service. (PT, OT, Speech, Nurse, Psychologist – Care Coordination, Pers. Care 1:1 aide, Specialized Trans.). of Health . (LDH. ) sought to . improve access to care and manage costs by . increasing enrollment in the LaHIPP program. . LaHIPP will be re-launched . April . 2017.. Act 269- “The Baby Bill”. Intended .