Rate Setting

The Rate Setting Unit is responsible for determining adequate methods of reimbursement for departmental services provided by designated agencies. The goal is to develop rates for services that will be cost effective and affordable as well as meeting the service delivery system's needs. To achieve this goal Rate Setting staff work with Department program staff to develop and implement financial policies and procedures with regard to rate methodologies to be used to reimburse services. A partial list of other functions Rate Setting performs is:

  • Participation in policy development
  • Prepare reports for legislature
  • Analyze the impact of proposed price changes on providers, state budget, and Medicaid program
  • Assists in standardizing rates for similar services
  • Recommends new methods of reimbursement
  • Works as a resource for other agencies establishing new rates for services
  • Responsible for responding to inquiries from providers, agencies and legislatures on pricing of medical services provided by the Department to members of the Medicaid program

Service Areas of Responsibilty

 

MBM Policy Section
Fee Schedule Rate Setter

S3 AmbulatoryCare.pdf

S14 R09012010.pdf

S14 CRNA Pricing.pdf

Sect. 24:Day Hab Svcs. for Persons with

Mental Retardation   Repealed Eff. 4/1/2010

Sect. 27: Early Intervention

Repealed Eff. 9/1/2010

S31 FQHC.pdf

S31 FQHCProvider.pdf

Sect. 41: Day Treatment Services

Repealed Eff. 7/1/2010

S50 ICFMRSvcs.pdf

S50 FacilitySpecific.pdf

Sect. 62: Genetic Testing & Clin.

Genetic Svc.

Repealed Eff. 10/1/09

S65 BehavHealth.pdf

S65 BehavHealth.pdf

Sharon Stanley

 

S90 Anesthesiology.pdf

S90 Drug Fee Schedule.pdf

S90 ACA PCP.pdf

Sect. 92: Behavioral Health Home Services S92Behavioral Health Home Svcs.pdf Sharon Stanley

Laurie Bailey

Sharon Stanley

 

Sharon Stanley

Sharon Stanley

Sharon Stanley

Sharon Stanley

Sharon Stanley

Sharon Stanley

Sharon Stanley

S103 RHC.pdf

S103 RHCProvider.pdf

Sect. 104: School Based Rehab. Svcs.

Repealed Eff. 9/1/2010

Sect. 150: STD Screening Svcs.

Repealed Eff. 8/30/2012

Laurie Bailey

Sharon Stanley