Medicaid Policy and Operations
We provide a range of policy and operational supports to help states improve and manage long term services and supports. We are experienced at leveraging existing tools and resources and tailoring our work to the unique state policy environment and systems.
We played a central role in the design and development of Maine’s case mix payment system, which determines reimbursement for Maine’s nursing facilities, residential care and adult family care homes. We continue to play an ongoing role in support of this system.
We designed and developed the methodology and reporting for Maine’s Primary Care Provider Incentive Payment (PCPIP), an incentive program administered by Maine’s Medicaid program. In operation since 1998, the PCPIP offers payment incentives to primary care providers and aims to reduce provider disincentives to serve Medicaid patients, curb inappropriate emergency room use, and increase the use of preventive and high quality services. The Muskie School currently maintains the PCPIP and produces quarterly reports.
Quality Assurance Systems
We provided technical assistance with the implementation, integration and system management of the Quality Improvement and Evaluation System (QIES) in Maine. QIES supports quality monitoring in long term care settings. As part of that work, we have developed and manage an integrated survey management system that leverages the infrastructure of the QIES to support Maine’s licensure and certification process.
We also developed a quality assurance system that allows Maine’s case mix staff nurses to review clinical assessments for accuracy for residents in nursing homes, residential care and adult family care homes.
Assessment Systems Analysis and Support
We provide comprehensive and specialized business systems analysis and program support for Maine’s assessment and data systems for long term services and supports, used for eligibility determinations, service authorizations and statewide data collection. Our staff have intricate knowledge of the assessment process, functional eligibility, service plan development and service authorization. We use that expertise to provide testing and training on system enhancements and policy changes and analyze authorization and eligibility data in support of ongoing operations and policy development.
We analyze Medicaid claims data to document service use and expenditures, quality of services and characteristics of Medicaid beneficiaries accessing long term services and supports. We produce chartbooks that provide a comprehensive view of the demographic and other characteristics of older adults and adults receiving long term services and supports, as well as service use, expenditures and quality. Our chartbooks have looked across populations groups and focused in on persons dually eligible for Medicare and Medicaid and persons with developmental disabilities.
We use historical data and demographic trends to help policymakers anticipate the future demand for long term care use. Our analysis incorporates Census Bureau survey data, Medicaid claims data, and a forecasting model.
Policy Research and Analysis and Program Evaluation
Evaluations involving process and outcome analyses are an integral part of program implementation, performance management, continuous quality improvement and program effectiveness. Over the past 25 years, we have developed a national reputation for conduction quality, independent evaluations. Our highly qualified staff has extensive expertise in designing, developing and implementing mixed-methods process and outcome evaluations in both the public and private sector. We specialize in using customized applied research methodologies to evaluate public health and health services initiatives, assess program performance and quality, monitor cost effectiveness and evaluate the quality of healthcare.
We help policymakers better understand public needs by conducting surveys, focus groups, case studies, and data analytics. Recent examples of our work include a needs assessment for persons living with brain injury in Maine; a survey of home care service users; and a survey and personal interviews with individuals accessing long term services and supports. We also fielded an in-person survey on the quality of life and experience of services for older adults and adults with disabilities, as part of HSRI’s test of its National Core Indicators survey for this population.
We help policymakers assess new policies and their potential impact on existing systems and programs and identify and assess policy solutions implemented in other states. Recently, we worked with Maine’s Department of Health and Human Services to guide the design and implementation of a transition plan to put Maine in compliance with new federal regulations governing the delivery of home and community-services.