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Connecticut DSS, Mercer outline PY2 maternity bundle case-rate refresh, phase in clinical and social risk adjustments
Summary
The Department of Social Services and Mercer presented updates to the Husky maternity bundle case-rate methodology—phasing in Johns Hopkins ACG clinical risk and an ADI social-risk add-on, applying credibility blends for low-volume practices, and keeping doula ($14) and lactation ($7) add-ons—while asking providers to submit written feedback by Nov. 21.
The Connecticut Department of Social Services and its vendor Mercer outlined proposed updates to the Husky maternity bundle case-rate methodology during a public forum, saying the changes aim to better align payments with patient acuity while limiting year-to-year disruption.
Fatmata Williams, deputy Medicaid director, opened the session and handed the presentation to Mercer’s technical team. Sean Theal Sachs of Mercer framed the goals as improving maternity health, reducing disparities and tying payments to performance and quality measures. Caroline Scott, Mercer’s case-rate lead, walked attendees through the stepwise PY2 refresh and a multi-year phase-in of risk adjustment.
Scott said the program will move toward a 50/50 risk-adjusted target price over multiple years and that the PY2 implementation will apply one-sixth (1/6) of the budget-neutral risk adjustment, with one-third in PY3 and one-half in PY4. "Our goal is to move towards a 50 50 risk adjusted case rate over 3 years. For year 2, we're going to implement 1 sixth of the rate being…
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