The Hilltop Institute
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Rate Setting

What We Do: The Hilltop Institute works with the Maryland Department of Health and Mental Hygiene to monitor the financial position of HealthChoice, Maryland's Medicaid managed care program. This involves designing incentive payment methodologies, forecasting enrollment, projecting and monitoring the HealthChoice budget, and monitoring the financial performance of managed care organizations (MCOs).

Using The Johns Hopkins University Adjusted Clinical Group (ACG) Case Mix System, Hilltop has designed a risk-adjusted payment methodology for HealthChoice. Hilltop has successfully transitioned to payments based on MCO encounter data, as opposed to historical fee-for-service data. Hilltop works with the state of Maryland to establish a rate methodology each year, and then collaborates with actuaries to set the rates.

With grants from the Centers for Medicare and Medicaid Services, Hilltop has written an instructional manual for states interested in implementing a risk-adjusted payment system. Most recently, Hilltop developed a rate setting methodology for the Primary Adult Care Program (PAC), which provides a limited benefit package to adults with low income in Maryland.

Hilltop develops Medicaid payment rates for Maryland's nursing homes and other programs such as PACE (Program of All-Inclusive Care for the Elderly). Hilltop is currently working with the Maryland State Department of Education to develop payment rates for school health programs.

How We Can Help: Hilltop provides technical assistance to states and federal agencies in applying ACG methodology to managed care rate-setting for acute care and long-term care services provided through Medicaid and other publicly financed health insurance programs. Hilltop also assists states with Medicaid fee-for-service rate setting.

For more information, contact:
Duane Glossner
Director, Rate Setting