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A Case-Mix System for Adults with Developmental Disabilities.

Brant E Fries1, Mary L James1, Lynn Martin2

  • 1Geriatrics Center, University of Michigan, Ann Arbor, MI, USA.

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|July 3, 2019
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Summary

A new case-mix system was developed for adults with intellectual disabilities (ID) in Arkansas. This system fairly allocates Medicaid funds based on individual care needs and service costs.

Keywords:
Assessmentintellectual disabilityinterRAIpayment systems

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Area of Science:

  • Health Services Research
  • Intellectual Disabilities
  • Public Health Policy

Background:

  • Effective management of publicly funded services requires aligning service provision with cost-efficient payment methods.
  • Payment systems recognizing varying care needs, such as case-mix systems, enable better fund allocation to providers supporting individuals with higher needs.
  • Arkansas initiated a system-wide Medicaid payment reform for adults with intellectual disabilities (ID).

Purpose of the Study:

  • To describe a novel method for allocating funds for adults with ID within Arkansas's Medicaid payment reform.
  • To develop a case-mix system that standardizes the relative cost of services for individuals with ID.
  • To establish a fair and equitable reimbursement framework for intellectual disability services.

Main Methods:

  • Population-level data for community-dwelling persons with ID were analyzed, linked to paid service claims.
  • The interRAI ID assessment system was used for data collection.
  • Automatic Interaction Detection (AID) was employed to group individuals and measure service costs.

Main Results:

  • A case-mix system comprising 33 distinct groups was developed.
  • The system explains 26% of the variance in service costs, comparable to existing health and social service sector systems.
  • The developed system demonstrated potential for fair reimbursement.

Conclusions:

  • The new case-mix system provides a foundation for future reimbursement strategies in Arkansas.
  • The system is designed to be perceived as fair by diverse stakeholders, including families, advocates, providers, and policymakers.
  • This approach supports efficient and equitable allocation of resources for individuals with intellectual disabilities.