Specifications include, but are not limited to: Provide planning, technical, and analytic services related to consulting for Medicaid payment systems. Contractor shall provide analytic support and reimbursement subject matter expertise to State in rate setting and shall deliver rates, fee schedules, and related documents to State in preparation for Vermont Medicaid’s annual update changes that are effective January 1st and October 1st, or other dates as specified by State. Contractor will provide these rates, fee schedules, fiscal impact, and related documents to State at least six (6) weeks prior to the applicable Vermont annual effective date. Contractor shall provide payment modeling and rate setting related to the Vermont Medicaid IPPS. This includes but is not limited to collecting and analyzing claims information, modeling payment scenarios, and advising State of updates or changes resulting from Medicare’s IPPS Final Rule. Contractor shall provide analytic support and reimbursement subject matter expertise to State in updating the hospital-specific cost-to-charge ratios (CCRs), inpatient fixed outlier threshold, outlier payment percentage, inpatient base rates, inpatient psychiatric base rate and additive factors, as well as identify Diagnosis Related Grouper additions or deletions.
