Overview
For decades, Medicaid reimbursement in IDD services was primarily based on time and task. Agencies billed according to hours worked or units delivered. That is beginning to change. More states are exploring or piloting outcome based models, tying funding to the progress individuals make, not just the services they receive.
This shift brings both challenges and opportunities. Providers who prepare early will be better positioned to secure funding, meet compliance expectations, and improve the quality of care. Those who wait may find themselves playing catch up.
What is outcome billing?
Outcome based billing focuses on the results of care. Instead of asking, “Did you provide the service?” Medicaid and MCOs are beginning to ask, “Did the service make a meaningful difference?”
Examples of billable outcomes might include improvements in daily living skills, increased independence, reduced hospitalizations, or measurable progress toward ISP goals. The aim is to align funding with impact rather than activity.
This trend is part of a broader move in healthcare toward value based care, and the IDD sector is starting to follow.
Why this shift matters
Agencies that rely only on traditional unit based billing may struggle as payment models evolve. Funders want to see measurable outcomes, not just service delivery. This is especially true in states that are integrating IDD services into managed care or moving toward performance based models.
The ability to track and report on outcomes gives agencies a competitive edge. It shows that services are not just being delivered, but that they are effective.
What data you need to track
To prepare for outcome based billing, agencies need to go beyond basic time in and out tracking. Key data points include:
Progress toward ISP goals
Skill acquisition or regression
Behavior and incident trends
Community participation
Crisis interventions and resolution
Quality of life indicators or satisfaction feedback
Consistent, meaningful data helps demonstrate patterns, improvements, and the value your agency brings.
Best practices for staying ahead
Start with a few key metrics. Choose a handful of outcomes to track consistently before building a full framework.
Train your team. Help DSPs understand how documentation connects to individual progress, not just compliance.
Use goal-focused language. Ensure notes clearly reflect challenges, progress, and the support provided.
Review progress often. Make data review part of supervision and team meetings, not just audits.
Engage with funders. Understand what they are looking for and adjust your documentation and reporting accordingly.
These practices create a stronger foundation for outcomes based care and billing.
Building a culture of outcome tracking
Outcome based care is not just a funding model, it is a mindset. It means asking, “What matters most to this individual?” and tracking how supports are helping them move forward.
This approach requires collaboration across teams, clear goal setting, and systems that make outcome tracking part of the daily workflow. Agencies that embrace this culture now will be more organized, more effective, and better prepared for the future.
Giv for outcome tracking
Tracking outcomes starts with documentation that is aligned, accessible, and tied to the individual’s plan of care. Giv helps agencies connect daily service notes to ISP goals, monitor real time progress, and generate reports that clearly show results.
Staff can document progress as it happens. Supervisors can track trends across individuals and programs. Leadership can access dashboards that support planning, compliance, and funding conversations. As Medicaid continues moving toward value and results, Giv helps agencies lead with both.
