Not receiving AFDC, but Under 19, income RAC SSI disabled SSI disabled eligible (parents/ <125% FPL caregivers) Preventive/ Clinical Developmental Mental health: Pregnancy with Admin condition disability neuroses complications encounters PNMI/Waiver Physician/ Provider Waiver services Physician/ Hospital services Hospital type As illustrated in Table 13, spending on developmental disability waiver services is above the Maine’s national average and represents an area for potential cost savings through enhanced management strategies as discussed further in the Recommendations section. Table 13: Intellectual Disability & Development Disability HCBS Waiver Rank Average Expenditures per Waiver Recipient in FY 2009 (State and Federal Expenditures) 25th percentile $31,161 50th percentile $42,155 US average $42,896 75th percentile $51,199 90th percentile $68,478 $77,736 Maine average Current DHHS Management & Administrative Strategies & Options Current MaineCare management and administrative strategies were reviewed by the Task Force. These current initiatives were reviewed against nationwide trends for managing Medicaid populations. The Task Force examined multiple options for long-term management strategies. Management MaineCare’s options were considered based on the analysis of spending patterns in the MaineCare program, separated by eligibility group and clinical diagnoses to determine the appropriate management strategy by population. Recent MaineCare initiatives have centered on value based purchasing strategies. Under value based purchasing, payers reimburse for outcomes and quality versus volume-based reimbursement under traditional fee-for-service arrangements. Additionally, consumers have incentive to become active participants in their healthcare consumption and benefits are designed to provide appropriate intensity and levels of care. Under such strategies, the goal is for providers to better coordinate total care resulting in better outcomes at lower costs. MaineCare value based purchasing initiatives include an Accountable Communities Program, Patient Centered Medical Homes, and a Primary Care Provider Incentive Program. Additionally, MaineCare collaborates with ER departments to identify high utilizers and drivers of utilization and to encourage members to seek care in appropriate treatment settings.
RAC SSI disabled SSI disabled Not receiving AFDC, but eligible (parents/ caregivers) Under 19, income <125% FPL Clinical condition Developmental disability Mental health: neuroses Pregnancy with complications Preventive/ Admin encounters Provider type Waiver services PNMI/Waiver services Physician/ Hospital Physician/ Hospital As illustrated in Table 13, Maine’s spending on developmental disability waiver services is above the national average and represents an area for potential cost savings through enhanced management strategies as discussed further in the Recommendations section. Table 13: Intellectual Disability & Development Disability HCBS Waiver Rank Average Expenditures per Waiver Recipient in FY 2009 (State and Federal Expenditures) 25th percentile $31,161 50th percentile $42,155 US average $42,896 75th percentile $51,199 90th percentile $68,478 Maine average $77,736 Current DHHS Management & Administrative Strategies & Options Current MaineCare management and administrative strategies were reviewed by the Task Force. These current initiatives were reviewed against nationwide trends for managing Medicaid populations. The Task Force examined multiple options for MaineCare’s long-term management strategies. Management options were considered based on the analysis of spending patterns in the MaineCare program, separated by eligibility group and clinical diagnoses to determine the appropriate management strategy by population. Recent MaineCare initiatives have centered on value based purchasing strategies. Under value based purchasing, payers reimburse for outcomes and quality versus volume-based reimbursement under traditional fee-for-service arrangements. Additionally, consumers have incentive to become active participants in their healthcare consumption and benefits are designed to provide appropriate intensity and levels of care. Under such strategies, the goal is for providers to better coordinate total care resulting in better outcomes at lower costs. MaineCare value based purchasing initiatives include an Accountable Communities Program, Patient Centered Medical Homes, and a Primary Care Provider Incentive Program. Additionally, MaineCare collaborates with ER departments to identify high utilizers and drivers of utilization and to encourage members to seek care in appropriate treatment settings.