QUALITY SERVICE REFORM

INITIATIVE (QSRI)
RATE SETTING OVERVIEW
June 27 & 28, 2023
BACKGROUND &
FRAMING
What is QSRI? What are we trying to achieve?
 Framing the Work of the Quality Service Reform
Initiative (QSRI)
• For more than a decade, Maryland has been reducing the number of children in out-of-home placements as well as those placed in residential
child care (RCC) programs, commonly referred to as group homes.
• However, Maryland continues to have high numbers of children placed in non-family settings.
• At the end of December 2022, 74% of all children in DHS/LDSS out-of-home placements were living in a family setting (including treatment
foster care). 472 children (12%) were living in group homes and 108 children (3%) were living in residential treatment centers. 1 [In
2021, Maryland was 34th in the U.S. for the lowest percentage of youth in group homes.2]
• DJS has seen a significant decline in total number of youth in committed out-of-home placements, including a decline in the number of youth
committed to out-of-home placements (excluding shelter programs), from an average daily population of 395 in March 2019 to 135 in
December 2022. Although there had been a significant decline in the number and percent of youth of color in committed placements, there has
been an increase in the percent of youth committed to out-of-home placements who are youth of color since November 2020. 3

• The placement process is highly variable and relies heavily on the opinions and expertise of LDSS staff members, as well as the availability of
placements and the responsiveness of providers. There is no consistent, standardized approach to referring a child to an RCC.
• There is still a heavy reliance on the use of one-on-ones in RCCs, with the most frequently requested service for “supervision/monitoring.” The
average request for 30 days of one-on-one services cost almost $13,000, with the total cost of all requests during the 17 months $1.5 million. 4

1
Maryland Department of Human Services, 2023.
https://dhs.maryland.gov/documents/Data%20and%20Reports/SSA/Monthly%20Child%20Welfare%20Data/SFY%202023/2022%20-%2012%20December%202022/SFY23_Child%20Welfare%20-%20%20Dec%202022_FINv2.pdf
2
Annie E. Casey Foundation. (2023). https://datacenter.aecf.org/data/tables/6247-children-in-foster-care-by-placement-type?loc=1&loct=1#ranking/2/any/true/2048/2623/12995
3
Maryland Department of Juvenile Services, 2022. https://djs.maryland.gov/Documents/publications/DJS-Performance-Report-December-2022.pdf
 • Residential Child Care Programs (RCC): Defined in COMAR
14.31.06.02, aka Group Homes
• Child Placement Agencies (CPA): Defined in COMAR 07.05
• Independent Living Programs

Current
• Private Treatment Foster Care Programs
• Not including adoption programs

Covered *The term residential intervention is being used as part of the QSRI work,

Services even though the term RCC aligns with statute, regulation, and licensing.
Consistent with current national best practices, residential intervention refers
to a type of out-of-home placement that provides the necessary treatment

Being services and supports to address a clinical and/or behavioral need of a child
that cannot be met in a family setting. A new residential intervention service
will include comprehensive, consistent service descriptions, medical necessity
Discussed criteria (MNC), and provider qualifications.

[Note: In other states, residential intervention is inclusive of PRTF/RTCs and

psychiatric hospitals. However, Maryland is using the term to represent the
interventions that are less intensive and restrictive than a PRTF or psychiatric
hospital.]
What do Maryland’s youth, families,
providers and agencies currently experience?
Inconsistent referrals to
residential child care programs
and treatment foster care, Long lengths of stay in Vacancies and high rates of
Hospital overstays.
sometimes just based on the residential settings. turnover in RCC staff.
lack of an available family
foster home bed.

Significant variation in rates

Lack of federal funds Rates for services do not
for different programs without
Unknown outcomes data. leveraged for federal always align with service
consistent program
reimbursement. delivery expectations.
information.
 QSRI is not just about rates. QSRI is about
• Developing new rates for residential child care programs (RCC), child placement agencies (CPA), and some evidence-based
practices (EBP)
AND
• Developing classes of residential interventions with defined medical necessity criteria, consistent and transparent access and
referral pathways, and a CQI overlay.
• Developing rates for services that
• Compensate the workforce with living and competitive wages consistent with their training and expertise
• Reflect newly defined staffing ratios that support child and worker safety and well-being and an intensity of service
provision not available in a family setting
• Are consistent across programs and agencies

• Designing an approach to be able to leverage Medicaid and Title IV-E funds with classes of rates for direct care and clinical
services, with the ability to integrate services into the larger Public Behavioral Health Service Array.
• Developing clear expectations and accountability for populations of children served, rates paid, and outcomes achieved.
• Designing a model that can support shortened lengths of stay and improved outcomes for children and youth and their
families while children are in the least restrictive setting.
• Aligning and integrating the model with the federal Child Care Institution (CCI) requirements, including Qualified
Residential Treatment Programs (QRTPs).
 Established Maryland’s QSRI vision as one in which:

o All children live in a committed, permanent home that o CQI activities support data collection, analysis, and
preserves, to the fullest extent practicable, the child’s familial,
reporting for data-informed decision-making and
peer/social, educational, and cultural ties;
shared accountability to promote safety, permanency,
o All children receive services and supports are that are and well-being for children, youth, and families;
individualized and trauma-responsive; o Challenges posed by structural and historical inequities
o Residential interventions are short-term interventions that and oppression are recognized and addressed and
meet clinical and behavioral needs while offering services and systems, processes, and services are continually
supports to the child’s caregiver and siblings, consistent with assessed for problems associated with implicit bias and
the child’s permanency plan; disproportionate minority contact, with strategies
o Children access residential interventions through a trauma- designed and implemented to address these issues as
responsive process that is consistent across the state and they arise;
across providers, which focuses on leveraging the strengths of o Providers are partners in the important work of
the children and their families when providing treatment supporting children, youth, and families, provide
interventions that are matched to their identified needs; valuable expertise and services, and are compensated
o No child, youth, or family is refused or ejected from services equitably and consistently for their work; and,
because of the complexity of their history or their current o Children, youth, and families are experts on
behavioral health needs (“no eject, no reject”); themselves and their families and their voice and
experience are valued and prioritized.

•
 QSRI Structures

QSRI Full QSRI Workgroup CQI Workgroup QRTP Workgroup Interagency

Committee Rates Committee
(IRC)
Meets every other Meets as needed Meets weekly Meets monthly or
Meets every other
week, 2nd and 4th Members are UMB and Members are more frequently as
month, 3rd Wed of the
Tuesday, 1-2pm provider DHS/SSA, DJS, UMB, needed
month, 3-4pm
Members are State representatives UConn, & Chapin Hall Members are State
Members are State
Agencies, UMB, Agencies
Agencies, UMB,
UConn, PCG, &
UConn, & PCG
provider Not formally part of the QSRI structure
representatives

DHS-Contracted Partners: The Institute for Innovation & Implementation, University of Maryland School of Social Work
Innovations Institute, UConn School of Social Work (subcontract under UMB)
Public Consulting Group (PCG)
Shifting our Maryland’s Model Continuum of Residential Services for Children and Youth*
model to talk Home- and Community-Based Services (HCBS)
about residential
interventions Services provided in a manner that enable the child to remain with or return to the family whenever possible. Includes individual, family, and group therapies, school-based interventions,
A medication management, intensive in-home services, mobile crisis response services, peer support, and respite care.
HCBS should be the service default service setting.

Family Foster Home Psychiatric Residential

(incl. kin, guardianship, pre- Treatment Foster Residential Hospital
Treatment Facility
adoptive) Care Interventions Setting
& Independent (PRTF; known in Maryland
Living Programs Structured, 24-hour group care as an RTC)
treatment setting for children with Inpatient setting for acute
Short-term care and supportive Short-term placement to behavioral health needs that
serious behavioral health needs. Structured inpatient setting for
services to children who are provide behavioral cannot be met in any other
Appropriate for children who individuals under age 21 with
unable to live at home because interventions and treatment in setting, even with
experience episodes of behavior in SED and/or long-term
of child maltreatment or a stable, family-like setting. individualized interventions,
home, school and/or community psychiatric illness who require
ongoing safety or supervision Developmental and/or including when the
interfering with ability to function in ongoing, active treatment that
needs. Also includes private therapeutic treatment needs individual poses an
multiple areas due to clinical needs. must be provided on an inpatient
independent living programs exceed what can be provided immediate threat to self or
May specialize to serve particular basis under the direction of a
for youth ages 16-20 in foster in a regular foster home but others. May include short- or
populations of youth (e.g. youth who physician. The youth
care. whose needs can still be met in long- term stays for
meet these criteria and are demonstrates clinical evidence
a home-like environment. pregnant/parenting, medically of a serious emotional disorder diagnosis, assessment, and
fragile, or demonstrates sexually and exhibits significant treatment and medical detox
inappropriate behaviors). May include impairment in functioning, when those needs cannot be
Qualified Residential Treatment representing potential serious met in any other setting.
Programs (QRTPs) and/or other harm to self or others.
federal Child Care Institution
Requirements.

Has DSM-5 Diagnosis and requires clinical intervention that cannot be provided within a family setting
due to the intensity of the treatment and 24/7 supervision requirements, which cannot be replicated in a
family setting. Provides trauma-responsive care, includes family participation, has required licensing &
accreditation, and provides 24/7 access to nursing/medical staff.
* This continuum does not include every possible type of setting, including those that are primarily for public safety needs. Children and youth should not be required to progress up or down the
continuum in a linear fashion. Intensity of service need does not always equate to restrictiveness of care and children and youth should receive services and supports in the least restrictive, most home-like
environment as possible to meet their individualized needs. HCBS can be provided in family settings (family foster home, treatment foster home) and may be available in some instances in residential
interventions (e.g., for family members and as after-care supports).
June 2022
 Today’s Focus: Rate-Setting for Residential Interventions

Current Rate Method Proposed Rate Method

• Uses an annual, individual rate-setting methodology • Moves to a class-based model for rates with direct care and
established in 1999 clinical care rates
• Requires providers to submit an annual budget package to the • Providers will not have annual budget submissions
IRC for each program • No preferred or non-preferred providers
• Designates providers as preferred or non-preferred • Does not use Levels of Intensity-uses classes
• Uses Level of Intensity model • Rates are set ahead of time and are adjusted (likely every 2-
• Is subject to adjustment based on the total funding available 3 years) with consideration for inflation and other changes
for the programs • Providers will select their classes based on their staffing
• Typically, rates are based on prior years’ rates, with increases ratios, qualifications, size, expertise, and program model
to rates only as approved and as permissible by State budget. • All providers within a class will have the same rate
• Considerable variation within categories of programs, even
within preferred providers, as seen in the FY2022 rates.
Individual costs create greater variation and impact the ability to equitably compare programs based on performance measures and outcomes. They also
make it more challenging for the State to know which providers will serve which populations of children and harder for providers to know what to
expect, how to budget, and who they should be staffed to serve and support. This model aligns Maryland with many other states that use classes of rates
for residential interventions and bill Medicaid for services, including Louisiana, Massachusetts, Nebraska, New Jersey, and Virginia.
Cost basis for Proposed Classes (combined direct & clinical)
• Pre-QRTP/Legacy Programs
• Class 1:
• QRTPs
• 1:4 staffing during awake hours, 1:5 staffing at night (min 2 awake)
• 1:10 ratio of care manager to youth Draft Medical Necessity
• 8 hours clinical treatment from licensed mental health professionals weekly Criteria and Service
• Includes allied staff (e.g. behavioral specialists, expressive therapies), peer/family specialists, CQI manager Descriptions have been
developed for Class 1 and
• Class 2: Class 2
• QRTPs
• 1:3 staffing during awake hours + 1 floater, 1:5 at night (min 2 awake)
• 1:8 ratio of care manager to youth
• 10 hours of clinical treatment from licensed mental health professionals weekly
• Clinical professionals have at least 2 years of experience in the field; all staff may have specialized qualifications, training, or expertise
• Includes allied staff (e.g. behavioral specialists, expressive therapies), peer/family specialists, CQI manager

• Class 3: Highest Intensity DD Programs

• Class 4: Highest Intensity Medically Fragile Programs
• Class 5: Highest Intensity ECDD Programs
• Class 6: Highest Intensity CSE Programs

NOTE: Cost basis does not mean that each program will provide exactly this model. The actual requirements for each class will be specified in regulations and in the
Medicaid State Plan.
 PROPOSED RATE
METHODOLOGY

Note: This presentation contains information based on preliminary analysis. The information presented today is subject to change
based on stakeholder feedback.
 RCC Inputs (All Models)
• The goal of any effective rate-setting methodology is to allow the provider to
align the actual cost of service delivery with contract requirements.

• Cost-based rates should include all direct and indirect costs related to the
provision of the service by the provider.

Two main cost drivers:

• Personnel Costs: Staffing arrays, salaries, and benefits.

• Operating Costs: Non-personnel such as lease/mortgage, utilities,

training, and travel.

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 Model Example RCC Model Example (Elements and Calculations Vary by Class)
Capacity: 7  Enrollment Days: 2,557
 Salary, Unit or % FTE Expense
Program Personnel        
Calculation Overview Steps Direct Care $##,### 0.00 $XX,XXX
(Example only) Direct Care Supervisors $##,### 0.00 $XX,XXX
Administration $##,### 0.00 $XX,XXX
CQI $##,### 0.00 $XX,XXX
1. Enrollment Days Based on Capacity Dietary $##,### 0.00 $XX,XXX
(In this example 7 x 365.25 = 2,557) Education $##,### 0.00 $XX,XXX
Food Service $##,### 0.00 $XX,XXX
2. Personnel​Needed Intake $##,### 0.00 $XX,XXX
(Salary x FTE = Expense) Life Skills $##,### 0.00 $XX,XXX
Housekeeping/Maintenance $##,### 0.00 $XX,XXX
Management $##,### 0.00 $XX,XXX
3. Coverage Factor (Add coverage to Recreation $##,### 0.00 $XX,XXX
ensure all in-ratio staff are covered) Total Program Personnel $##,### 0.00 $XXX,XXX
Tax and Fringe X.X%   $XX,XXX
4. Tax and Fringe​(Add x% to Total Total Program Personnel Salary & Tax/Fringe     $XXX,XXX
Other Operating Expenses $XX.XX $XX,XXX
Program Staff) Total Program Operating Expenses     $XXX,XXX
TOTAL     $XXX,XXX
5. Other Operating Unit Expenses (Unit TOTAL WITH Cost Adjustment Factor: X.X%   $XXX,XXX
expense x Enrollment Days or Other RATE WITH Cost Adjustment Factor $XXX.XX
Unit) RATE WITH UTILIZATION X.X%   $XXX.XX

6. Markup for Inflation with a Cost

Adjustment Factor (CAF)
The main benefit of the approach is its ability to display and adjust
7. Markup for utilization the data inputs, which can address issues with salaries, FTEs,
operating expenses, utilization, and inflation.

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DATA SOURCES &
ASSUMPTIONS
RCC Model Components/ Data Sources
The model relied heavily on the data provided in the FY 2023 MSDE Model
budgets. Other benchmarks and sources were used to ensure rates include
elements for successful policy transition.

Model Component Source

Position Classifications FY ‘23 MSDE Model Budgets
FTE/Staffing Ratios QRSI Recommendation / FY ‘23 MSDE Model Budgets
Wages Bureau of Labor Statistics / FY ‘23 MSDE Model
Budgets
Operating Expenses FY ‘23 MSDE Model Budgets
Utilization Rate MD Statute
Tax and Fringe PCG Benchmark
Relief Factor PCG Benchmark
Direct Care Supervision Child Welfare League of America Benchmark
Ratio

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RCC Positions
The following are the positions by class rate type. The difference between each
class is the number of FTEs required per child based on recommended ratios.
Positions Used in the Direct Care Classes Positions Used in the Clinical Care Classes
• Direct Care • Medical Director
• Direct Care Supervisors • Nursing
• Administration • Clinical
• CQI • Allied Staff
• Dietary • Case Manager
• Education • CNA
• Food Service • Peer/Family Support Specialist
• Intake
• Life Skills
• Housekeeping/Maintenance
• Management
• Recreation

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 Position Wage Analysis
• For each of 11 Position Weighted AVG Reported Weighted MD BLS AVG
Food Service $ 36,237.21 $ 39,147.50
position types,
Direct Care $ 38,353.29 $ 40,774.19
model uses the
Life Skills Support $ 41,145.91 $ 47,738.60
highest wage - Recreation $ 46,773.67 $ 48,353.22
either market Dietary $ 57,622.73 $ 49,158.82
(average reported) Housekeeping/Maintenance $ 46,403.92 $ 50,282.48
weighted average Nurse $ 64,108.51 $ 52,404.87
or BLS weighted Direct Care Supervisor $ 48,349.91 $ 54,882.91
average. Case Manager $ 52,374.37 $ 60,982.56
Education $ 60,099.89 $ 62,377.28
Admin $ 56,013.25 $ 64,815.42
• Values highlighted CQI $ 60,953.07 $ 67,144.15
in the table below Medical $ 77,096.66 $ 68,560.33
are used in the draft Intake $ 59,647.50 $ 71,625.53
rate methodology. Therapist $ 67,820.68 $ 77,618.49
Clinical $ 78,574.63 $ 86,673.81
Management $ 92,339.96 $ 89,859.40
Psychologist $ 211,998.22 $ 111,350.00
Psychiatrist $ 325,441.54 $ 253,383.54

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 RCC Operating Costs
PCG used the average reported costs of the categories included in the MSDE
Model budgets, based on the class structure.
• Operating Expenses
• Room and Board
• Memberships and Subscriptions
• Travel and Transport
• Training
• Contracted Services
• Other

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RATE CLASS
STRUCTURE
 Rate Class Structure
The class structure was developed by examining the natural breakouts of the current
provider population, in conjunction with staffing ratios recommended by the QSRI
subgroup. Includes an element for smaller providers in Direct Care Classes 1b and 2b.
Class 1 - Direct Care Costs using QSRI determined ratios and benchmarked to QRTP average.

Class 1b: ≤ 6 Cap., Direct Care +1 FTE @ night to meet “2 Awake”

Class 2 - Direct Care Costs using QSRI determined ratios and benchmarked to QRTP average.

Class 2b: ≤ 6 Cap., Direct Care + 1 FTE @ night to meet “2 Awake”

Class 3 - Direct Care Costs benchmarked to highest intensity DD Programs.

Class 4 - Direct Care Costs benchmarked to highest intensity Medically Fragile Programs.

Class 5 – Direct Care Cost benchmarked to highest intensity ECDD Programs.

Class 6 – Direct Care Costs benchmarked to CSE Programs

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Rate Class Direct Care Ratios
Est.
Awake Asleep
Class % Notes Source
Ratio Ratio
Pop.
1 58% 4:1 5:1 Subgroup Rec
1b 6% 4:1 5:1 + 1 FTE at night Subgroup Rec
2 23% 3:1 4:1 + 1 Floater Subgroup Rec
2b 2% 3:1 4:1 + 1 FTE at night, + 1 Floater Subgroup Rec
3 2% 1:1 1.5:1 Model Budgets
4 5% 2:1 2.5:1 Model Budgets
5 2% 1:1 1.35:1 Model Budgets
6 2% .55:1 1:1 Model Budgets

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RCC FTE Per Youth by Class – Direct Care
Position 1 1b 2 2b 3 4 5 6

Direct Care* 1.13 1.46 1.59 2.13 4.38 2.39 4.55 7.58
Direct Care
0.23 0.29 0.32 0.43 0.30 0.28 0.29 0.49
Supervisors*
Administration 0.14 0.14 0.14 0.14 0.17 0.37 0.27 0.64

CQI 0.02 0.02 0.02 0.02 0.00 0.13 0.03 0.07

Dietary 0.03 0.03 0.03 0.03 0.04 0.00 0.00 0.00

Education 0.08 0.08 0.08 0.08 0.00 0.00 0.00 0.00

Food Service 0.05 0.05 0.05 0.05 0.02 0.00 0.00 0.00

Intake 0.02 0.02 0.02 0.02 0.00 0.00 0.02 0.04

Life Skills 0.08 0.08 0.08 0.08 0.00 0.00 0.00 0.00

Housekeeping/Maint. 0.08 0.08 0.08 0.08 0.18 0.09 0.13 0.19

Management 0.14 0.14 0.14 0.14 0.03 0.21 0.28 0.29

Recreation 0.05 0.05 0.05 0.05 0.03 0.00 0.02 0.08

www.publicconsultinggroup.com *Ratios for these staff were determined by recommended staffing ratios; 23
the rest are proportional to how they were reported in the model budgets.
RCC FTEs Per Youth by Class – Clinical

Position 1 2 3 4 5 6

Medical Director 0.06 0.06 0.00 0.00 0.00 0.03

Nursing 0.04 0.04 0.04 2.36 0.04 0.25

Clinical 0.15 0.15 0.19 0.05 0.30 0.41

Allied Staff 0.10 0.10 0.00 0.00 0.00 0.00

Case Manager 0.13 0.13 0.11 0.12 0.18 0.50

CNA 0.00 0.00 0.00 0.00 4.55 0.00

Peer/Family Support
0.04 0.04 0.00 0.00 0.00 0.00
Specialist

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Draft Rates and Structure

Class 1 - Direct Care Costs using QSRI determined ratios and benchmarked to
Direct Care Classes* Per Diem Rate
QRTP average.
Direct Care Class 1 $ 539.33
Direct Care Class 1b $ 607.62 Class 1b: ≤ 6 Cap., Direct Care +1 FTE @ night to meet “2 Awake”
Direct Care Class 2 $ 656.00
Direct Care Class 2b $ 720.91
Class 2 - Direct Care Costs using QSRI determined ratios and benchmarked to
Direct Care Class 3 $ 1,077.97
QRTP average.
Direct Care Class 4 $ 931.30
Direct Care Class 5 $ 1,165.84
Class 2b: ≤ 6 Cap., Direct Care + 1 FTE @ night to meet “2 Awake”
Direct Care Class 6 $ 1,946.64
Clinical Classes* Per Diem Rate
Class 3 - Direct Care Costs benchmarked to highest intensity DD Programs.
Clinical Class 1 $ 200.55
Clinical Class 1b $ 200.55
Clinical Class 2 $ 235.41 Class 4 - Direct Care Costs benchmarked to highest intensity Medically Fragile
Clinical Class 2b $ 235.41 Programs.
Clinical Class 3 $ 120.46
Clinical Class 4 $ 787.65 Class 5 – Direct Care Cost benchmarked to highest intensity ECDD Programs.
Clinical Class 5 $ 1,076.01
Clinical Class 6 $ 428.36
Class 6 – Direct Care Costs benchmarked to CSE Programs
Potential Non-Class Rates*   Per Diem Rate
Pre-QRTP Direct Care   $ 433.46

*Note: These are not final. There could be more or less rates and any portion of these rates could change.

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 Summary of QSRI Activities
Completed Activities Work in progress & to be Completed
• Obtain baseline information on current experiences of accessing
• Determine referral and care pathways
residential child care programs, use of one-on-ones in residential settings,
and length of stay of children in RCCs currently
• Develop provider qualifications
• Engage providers, agencies, and families in the work • Draft Medicaid State Plan Amendments
• Establish a shared vision • Modify regulations and statute (if needed) for new model
• Determine new rate methodology • Obtain feedback from providers, agencies, families, and
• Develop service description for residential interventions
• Develop medical necessity criteria for clinical classes of residential youth on the approach
interventions • Develop and test new rates
• Develop proposed staffing requirements for classes of residential • Implement CQI approach, including regular data
interventions
collection and analysis
• Develop an application and select Qualified Residential Treatment
Programs (QRTPs), aligned with QSRI activities
• Train providers, agencies, and stakeholders on new model
• Contract for entity to calculate rates • Develop a new rate structure and related documents and
• Develop a logic model for residential interventions and a framework for processes for Child Placement Agencies and selected
the Continuous Quality Improvement activities Evidence-Based Practices
• Develop a transition tool to support residential programs, LDSS/DJS, and
teams to support children and youth to transition from residential settings
Considerations for Maryland’s Work

The focus of the work is on improving outcomes and breaking the link between placement and
services. QSRI is not a cost reduction strategy.

This work intersects with the Family First Prevention Services Act (FFPSA), as well as other child
welfare, juvenile justice, and behavioral health initiatives.

QSRI cannot be successful if Maryland does not continue to develop sustainable, high quality,
effective home- and community-based services, including more family-based resource homes.

The impact of a shift to Medicaid reimbursement and the integration of the Administrative Service
Organization for authorizations should not be underestimated.
2023-2025
• January-December 2023: Maryland statute and regulations are amended to align with new process and enable future Medicaid billing.
• September 2023: Pilot testing of performance measure collection with QRTPs
• November 2023: Rates for RCC providers are shared for testing. Child Placement Agency rate revision work begins (if not sooner). Full
training of RCCs on new rate structure.
• January 2024: Additional statutory and regulatory changes are made, if needed. Rate simulations and projections run to assess impact on
RCC providers.
• July 2024: New rates are implemented for residential childcare providers, with a 1-2 year period of monitoring.  New performance
monitoring begins, with monthly data reporting and quarterly reconciliation.
• Late Fall 2024/Winter 2025: State Plan Amendment submitted to CMS (Pending State Agency agreement), Initial Programming occurs in
the Medicaid Management Information System (pending approval by CMS).
• January 2025: Rates for CPA providers are shared for testing. Modifications made to Medicaid State Plan, if needed, for CPAs.
• July 2025: New rates are implemented for child placement agencies, with a 1-2 year period of monitoring. New performance monitoring
begins, with monthly data reporting and quarterly reconciliation. Providers begin billing through the Administrative Service Organization,
with Medicaid claiming anticipated.