| Project Manager Hybrid--1-day on-site Pierre, SD Local to at Pierre, South Dakota, USA |
| Email: [email protected] |
| From: Subodh Kumar, TEK INSPIRATIONS LLC [email protected] Reply to: [email protected] Job Description - Project Manager Hybrid Duration: 3 years Location: Hybrid 1-day on-site Pierre, SD Local to Interview: Skype Job Description DSS is seeking a qualified individual for the review, analysis, and implementation of changes to Medicaid hospital policies and reimbursement methodologies. The intent of the work is to explore modernization of Medicaids hospital reimbursement methodologies including potentially transitioning hospitals to APR-DRG and more widespread reimbursement of outpatient hospitals through the APC methodology. The qualified individuals will also assist with modernization of Medicaid hospital policies. In addition, the work will also include review, analysis, and recommendations regarding Medicaids ambulatory surgical center reimbursement methodology and policies. The qualified individual will also provide ongoing support to DSS regarding periodic updates to hospital policies and reimbursement methodologies. Desired Outcomes from this Engagement: 1. A comprehensive analysis of South Dakota Medicaids current methodologies for reimbursement in comparison with contemporary practices, including those used by other state Medicaid programs. 2. A recommendation for modernization and level-setting how South Dakota Medicaid resourcing is paid as reimbursement to providers. 3. A workplan for how to success fully achieve the recommended change in methodologies. 4. A sistance and guidance with implementation of adopted recommendations. The following is a high-level overview of Medicaids current reimbursement methodologies: Large in-state inpatient hospitals are reimbursed using MS-DRG. Weights are state-specific and the outlier methodology is state-specific, charge-based methodology. For outpatient services these hospitals are reimbursed using the Medicare APC methodology and Medicare weights. DRG and APC base rates for hospital-specific. DRG exempt units and hospitals are generally reimbursed on a per diem basis. Smaller in-state hospitals and out-of-state hospitals are reimbursed based on a percent of billed charges for both inpatient and outpatient services. In limited instances, out-of-state hospitals may be reimbursed at their home state Medicaid reimbursement rate. Dialysis outpatient hospital units are reimbursed using a fee-for- service and percent of billed charges methodology. Dialysis clinics are reimbursed on a fee-for-service methodology. Ambulatory surgical centers are reimbursed using a grouper methodology that is based on a previous Medicare grouper methodology. The activities requested of the successful candidate include, but are not limited to: 1. Develop a work plan for the project that includes target dates, a list of deliverables, opportunities for stakeholder consultation and engagement, and the assignment of responsible parties. The work plan also is to include a recommended implementation date. The work plan must include regular, periodic meetings between the successful candidate and DSS. 2. Conduct a review and analysis regarding South Dakota Medicaids current hospital and ambulatory surgical center reimbursement methodologies and policies and providing a report with recommended changes. The work may include but is not limited to: Desired Outcome #1 a. Analysis and validation of Medicaid claims data. b. Analysis of system considerations and implementation of changes in DSSs MMIS system. Desired Outcome #2 c. Propose a recommendation for a DRG methodology and standard weight set for reimbursing inpatient hospital services. DSS prefers to transition from MS- DRG to a DRG methodology suitable for the Medicaid population such as APR-DRG. d. Proposeoptions and a recommendation for reimbursement methodologies for inpatient and outpatient hospitals that are not currently reimbursed under the DRG or APC methodology such as out-of-state hospitals, smaller rural hospitals, and specialty hospitals or units. e. Propose options and a recommendation for reimbursement methodologies for dialysis services including outpatient hospital units and dialysis clinics. f. Propose options and recommendations for value-based payments for inpatient and outpatient hospital services aligned with industry standards and best practices based on the experience of other state Medicaid agencies and other payers. The proposal may include a phased approach with initial pay for reporting before implementing pay for performance. g. Propose options and a recommendation for a reimbursement methodology for ambulatory surgical centers. h. Propose a system of classifying or grouping like hospitals for purposes of uniform reimbursement methodologies and uniform DRG and APC base rates. i. Propose options for implementation of a DRG outlier methodology that is cost based and aligns with Medicare or standard Medicaid methodologies. DSS prefers an outlier methodology that targets 10 percent or less of overall DRG payments being outlier payments. j. Prepare initial rate modeling calculations for DSS to consider including DRG base rates, revisions to the DRG outlier payment methodology, APC base rates, dialysis services, and ambulatory surgical center rates. k. Prepare provider-specific and general Medicaid cost coverage analysis based on Medicaids current reimbursement methodology and the proposed rate modeling calculations. l. Propose recommended ongoing monitoring and maintenance of the reimbursement methodologies that may be conducted by DSS, the successful candidate, or another vendor. Desired Outcome #3 m. Provide a written report of recommended changes to Medicaid policies and reimbursement methodologies based on industry standards, best practices, and State-specific factors. Recommendations must be provided in writing and must include associated estimated fiscal impacts. The successful candidate will also provide DSS with a briefing on recommended changes and incorporate DSS feedback regarding the recommended changes. n. Provide other research and analysis to DSS related to the Scope of Work as requested by DSS. 3. Assistance with implementing proposed recommendations and other provider policy and reimbursement-related changes. The work may include but is not limited to: a. Implement changes recommended by the successful candidate and adopted by DSS in the above-referenced report including developing final reimbursement rates. b. Assist DSS with stakeholder communication and implementation activities including preparing presentations, calculation, exhibits, and other materials for communicating project details to hospitals. c. Attend stakeholder meetings virtually or in person as determined by DSS as necessary. d. Assist DSS with go-living planning and claims system testing if needed. e. Assist DSS with drafting policy changes including administrative rules,state plan amendments, and provider manuals as well as any associated public notice documents. f. Assist DSS with other implementation work related to the Scope of Work as requested by DSS. 4. The successful candidate may provide ongoing support for periodic changes to reimbursement methodologies and policy after the implementation of recommended changes. The work may include but is not limited to: a. Assist with the implementation of updated DRG versions and weights. b. Assist with implementation of updates to base rates including implementation of inflationary rate increases appropriated by the State legislature. c. Assist with updates to the DRG outlier methodology. d. Assist with ongoing monitoring and analysis of claims payments. e. Provide a report of recommended reimbursement methodology and policy changes on at least an annual basis. f. Provide other ongoing support to DSS related to the Scope of Work as requested by DSS. Keywords: golang microsoft South Dakota |
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| Thu Jan 11 01:04:00 UTC 2024 |