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A. An actuarial analysis. In accordance with 42 Code of | | Federal Regulations, Section 438.6(c), any system design that | | includes capitation, risk-sharing or other significant changes | | in the reimbursement methodology to providers of mental health | | services must be developed with the involvement of independent | | actuarial expertise. A joint committee that includes providers | | and representatives from the appropriate offices of State | | Government, as determined by the Governor, shall oversee the | | development of the rate-setting methodology. Capitation | | reimbursement methodologies must give due consideration to the | | issues of appropriate levels of care and the needs of high- | | cost recipients of services who may need residential treatment | | services; |
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| | | B. A human resources analysis. The department shall | | undertake an independent human resource needs analysis that | | describes what managerial and administrative skills and | | services will need to be purchased in order to carry out the | | design, pricing, implementation and management of any new | | systems design. This analysis must also describe what | | services will be eliminated from direct departmental | | responsibility to allow for administrative savings; |
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| | | C. An administrative burdens review. Identification of | | savings and system efficiencies must begin with a review and | | reduction of administrative burdens and the cost of these | | burdens to direct service agencies. The reductions in both | | administrative burdens and cost must achieve a savings of at | | least 15% in the costs of the system in 2005; |
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| | | D. A data systems readiness review. The department shall | | identify the minimum data set necessary for appropriate | | oversight, management and outcome measurement of the system | | of care. As a part of its plan for system redesign, the | | department shall undertake a review of data requirements and | | the capabilities of existing data systems in order to | | determine, prior to implementation, what, if any, enhanced | | data capacity will need to be purchased from independent | | vendors; |
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| | | E. Development of an outcome measures assessment. In | | consultation with consumers, providers and other stakeholders, | | the department shall develop a manageable, measurable set of | | performance standards and contract outcome measures for the | | regional system. These performance standards and outcome measures | | must be based on existing mandates and developed with due regard | | to available |
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