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Mercer outlines limited case‑rate refresh for performance year 2; preliminary rates due late fall
Summary
Mercer told providers PY1 case rates were built on Oct. 2022–Sept. 2023 historic episode costs and that PY2 will use a limited refresh (fee‑schedule and acuity updates) with preliminary rates for practice review expected in late fall and a technical assistance window before finalization.
Caroline Scott, an actuary with Mercer, described the plan for refreshing the maternity bundle case rates for performance year 2.
"These p y 1 case rates are based on historic episode costs from October 2022 through September 2023," Scott said, and she noted the current state plan amendment limits rebasing to no more than once every 12 months. For PY2 Mercer proposed a limited refresh that leverages the PY1 development work and applies targeted updates for current Medicaid fee schedules and observed acuity among attributed members.
Scott said Mercer aims to deliver preliminary refreshed case rates to practices for review in the late fall and that DSS and Mercer will host a technical assistance session to walk practices through how rates were updated. Practices will have an opportunity to submit written feedback before rates are finalized.
DSS emphasized the refresh process will be collaborative and that additional changes beyond fee schedules and acuity would be at DSS’s discretion. The presenters cautioned that the program went live in January 2025, so post‑program experience to inform rates is limited and final reconciliations will use fuller runout data.
