RCPA - Rehabilitation and Community Providers Association


PCPA HealthChoices Provider Rate Setting Best Practices
February 9, 2011

PCPA members developed The PCPA HealthChoices Provider Rate Setting Best Practices with the assistance of actuarial and reimbursement consultation to create an easy to use, practical, and effective methodology for counties, oversight bodies, and managed care organizations (MCOs) to evaluate and establish provider rates. Tools to help in the process of evaluating costs and submitting rate change requests to counties, oversight bodies, and MCOs going forward are available from the links below. The best practices document will also be sent to counties and oversight bodies in hopes they will consider how the concepts might be applied in the process of rate development.

PCPA believes that county/commonwealth commitments to consumers, quality, and access to care and services is threatened by the lack of a consistent provider rate setting process. An improved process is needed to assure provider rates that offer a sustainable reimbursement level. Today’s pressures of rising costs, increasing acuity of client/consumer needs, and increasing difficulties in recruiting and retaining staff are several issues that threaten the sustainability of services. PCPA understands that funds are limited in this economy. However, capitation and other increases are sometimes provided and, in some cases, reinvestment dollars are available. The association believes that the allocation of available funds should be made to sustain existing services before new services are created or utilization is increased. For more information contact Lynn Cooper (lynn@paproviders.org).

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