Rate Review Reports

Medicaid Provider Rate Review Annual Reports

Use the drop-down menus below to view services reviewed each year and the Department's accompanying Analysis and Recommendation Reports.

How to submit a CORA request for documents that have been archived from our website. 

First Three-Year Cycle Review (2023 - 2025)

2025

• Year Three Services
  • Dialysis and Dialysis - related services
    • Facility
    • Non-Facility
  • Dental for People with Intellectual and Developmental Disabilities (DIDD)
  • Durable Medical Equipment (DME)
  • Prosthetics, Orthotics and Disposable Supplies
    • Prosthetics
    • Orthotics
    • Enteral Formula
    • Other and Disposable Supplies
  • Laboratory and Pathology Services
  • Outpatient PT, OT & ST
    • Physical Therapy
    • Occupational Therapy
    • Speech Therapy
  • Specialty Care Services
  • Early Intervention TCM
  • Targeted Case Management (TCM)
    • Case Management
    • Transition Coordination
  • Vision Services
  • Physician Services
    • Allergy and Immunology
    • Cardiology
    • Dermatology
    • ED and Hospital E&M
    • Ear, Nose and Throat (EMT)
    • Family PLanning
    • Gastroenterology
    • Health Education
    • Medication Injections and Infusions
    • Neuro/Psychological Testing Services
    • Neurology
    • Primary Care Evaluation and Management (E&M)
    • Radiology
    • Respiratory
    • Sleep Study
    • Vaccines Immunizations
    • Vascular

2025 Medicaid Provider Rate Review Analysis and Recommendation Report

• Appendix A - Research Methodology
• Appendix A1 -Base Summary Data
• Appendix A2 - Benchmark Ratio by Code
• Appendix A3 -Duplicate Code List
• Appendix A4 - Excluded Codes
• Appendix B - Access to Care Summaries
• Appendix C - Rate Change Track Document
• Appendix D - Benchmark State Selection Rationale
• Appendix D1 - Dental IDD Benchmarking Crosswork
• Appendix D2 - Specialty Care Skin Substitute Benchmark State Rate Crosswork
• Appendix D3 - Early Intervention TCM Benchmark State Rate Crosswork
• Appendix D4 - TCM - Case Management Benchmark State Rate Crosswork
• Appendix D5 - TCM - Transition Coordination Benchmark State Rate Crosswork
• Appendix E - Optumas Justification of Dialysis Medicare Repriced Methodology
• Appendix F1 - State Plan Version 08.07.25
• Appendix F2 - Recommendation G2211 Services
• Appendix G - Tariff Survey Analysis Results
• Appendix H - Cost of Living Index (Q3 2024)
• Appendix I - Stakeholder Feedback
• Appendix J - Glossary & County Reference Map

 

2024

• Year Two Services:
  • Emergency Medical Transportation (EMT)
  • Non-Emergent Medical Transportation (NEMT)
  • Qualified Residential Treatment Programs (QRTP)
  • Psychiatric Residential Treatment Program (PRTF)
  • Home Health Services
  • Pediatric Personal Care (PPC)
  • Private Duty Nursing (PDN)
  • Physician Services
    • EEG Ambulatory Monitoring Codes
    • Sleep Studies
  • FFS Substance Use Disorder (SUD) Codes
  • Home and Community Based Services (HCBS):
    • ADL Assistance and Delivery Models
    • Behavioral Services
    • Community Access and Integration
    • Community Directed Attendant Support Services (CDASS)
    • Day Program
    • Professional Services
    • Residential Services
    • Respite Services
    • Technology, Adaptations, and Equipment
    • Transition Services 

2024 Medicaid Provider Rate Review Analysis and Recommendation Report

• Appendix A - Research Methodology
• Appendix A1 - Excluded Codes
• Appendix A2 - Base Data Summary
• Appendix A3 - Benchmark Ratios
• Appendix B - Access to Care Metrics
• Appendix C - Rate Change Track Document
• Appendix D - PDN Cross-work of Benchmark Ratios
• Appendix E - Stakeholder Feedback
• Appendix F - Glossary & County Reference Map 

Health Care Policy & Financing MPRRAC Report Presentation to the Joint Budget Committee

• November 19, 2024 2:30pm - 3:00pm

 

2023

Year One Services:

• Anesthesia
• Ambulatory Surgical Centers
• Fee-for-service Behavioral Health
• Pediatric Behavioral Therapy
• Maternity Services
• Abortion Services
• Dental Services
• Surgeries
  • Digestive System
  • Musculoskeletal System
  • Cardiovascular System
  • Respiratory System
  • Integumentary System
  • Eye and Auditory System
  • Other Surgeries
  • Co-Surgeries

2023 Medicaid Provider Rate Review Analysis and Recommendation Report

• Appendix A - Cycle 1 Year 1 Methodology and Data
• Appendix A - Table 2(a)
• Appendix B1 - Base Data Summary
• Appendix B2 - Rate Ratios
• Appendix B2 (2)
• Appendix C - Fiscal Impact
• Appendix D - Stakeholder Feedback
• Appendix E - Glossary and County Reference Map

Health Care Policy & Financing MPRRAC Report Presentation to the Joint Budget Committee

• November 28, 2023 9:00am - 9:30am

Rate Change Tracking Spreadsheet

• 2023 Rate Change Tracking Spreadsheet