HFMA Seminar February 1 2017 Agenda Hospital Inpatient Medicaid Rate Updates January 1 2016 Rates January 1 2017 Rates Rebasing of Acute and Exempt UnitExempt Hospital Rates Hospital Quality Pool ID: 633794
Download Presentation The PPT/PDF document "Hospital Medicaid Rate Updates" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Hospital Medicaid Rate Updates
HFMA Seminar
February 1, 2017Slide2
Agenda
Hospital Inpatient Medicaid Rate Updates
January 1, 2016 Rates
January 1, 2017 Rates
Rebasing of Acute and Exempt Unit/Exempt Hospital Rates
Hospital Quality Pool
Hospital Sole Community Pool
Hospital Outpatient Medicaid Rate Updates
Questions
February 1, 2017 2Slide3
Hospital Inpatient Medicaid Rate Updates
January 1, 2016 Inpatient Medicaid Rates
Current Updates:
2016 Budgeted Capital
Actual Capital Updates – prospectively include retros for 12/1/09 – 12/31/13
Eliminate Potentially Preventable Negative Outcomes (PPNO) cuts from acute rates - prospectively include retro for 4/1/15 – 12/31/15)
No changes to the SIWs – continue with July 2014 weights/thresholds with v33 grouper
Medicaid Fee-for-Service rates: rate package currently awaits approval from the Division of the Budget
Medicaid Managed Care rates: still under discussion due to retroactive rate adjustments
Future Updates:
Restoration of Inappropriate Use of Services Reduction for Acute Statewide Base Price Calculation (including retro for 4/1/15 – 12/31/15) – SPA pending approval from the Centers for Medicare and Medicaid (CMS)
Acute Transition %’s – Update to -2.5% floor on losses and recalculate ceiling on gains
February 1, 2017
3Slide4
Hospital Inpatient Medicaid Rate Updates (cont’d)
January 1, 2017 Inpatient Medicaid Rates
Current Updates:
2017 Budgeted Capital
Minimum Wage Adjustments
Reconciliation
Eliminate Potentially Preventable Negative Outcomes (PPNO) cuts from acute rates
Continue with July 2014 weights/thresholds with v33 grouper until further notice. 2017 weights/thresholds are in process and anticipated for release in July 2017 (to be implemented prospectively).
Medicaid Fee-for-Service rates: transmitted to eMedNY in cycle #2058, rates released to hospitals on 1/20/17
Medicaid Managed Care rates: still under discussion due to retroactive rate adjustments
Future Updates:
Restoration of Inappropriate Use of Services Reduction for Acute Statewide Base Price Calculation – SPA pending approval from the Centers for Medicare and Medicaid (CMS)
Acute Transition %’s – Update to -3.5% floor on losses and recalculate ceiling on gains
February 1, 2017
4Slide5
Hospital Inpatient Medicaid Rate Updates (cont’d)
Rebasing of Acute and Exempt Unit/Exempt Hospital Rates - 2018
Statutory requirement to update the cost base for the acute rates by 2018
Statute allows for exempt unit/exempt hospital rates to
be rebased
2014 cost base anticipated for both sets of rates
All rates must be budget neutral
Minimum wage adjustments to continue through 2021
February 1, 2017
5Slide6
Hospital Quality Pool
Years 1 and 2 (4/1/15 – 3/31/17)
Distribution Methodology
:
Year 1: $90.8M, Year 2: $87.8M
Pay for Reporting
Allocated based on 2014 Medicaid Fee-for-Service and Medicaid Managed Care days
$75,000 Minimum
Payment:
Hospitals to be paid by Medicaid Managed Care Health Plans
Payments anticipated for February/March 2017
Dependent upon Division of the Budget approval of the July 2016 premiums
Communications to hospitals will follow
Year 3 (4/1/17 – 3/31/18)
Quality measures and distribution methodology are currently under discussion
February 1, 2017
6Slide7
Hospital Sole Community Pool
Years 1 and 2 (6/1/15 – 3/31/17)
Distribution Methodology
:
Year 1: $9M, Year 2: $12M
Pay for Reporting
Allocated based on 2014 Medicaid Fee-for-Service and Medicaid Managed Care days
Minimums vary depending upon total number of Medicaid days
Payment:
Hospitals to be paid by Medicaid Managed Care Health Plans
Payments anticipated for February/March 2017
Dependent upon Division of the Budget approval of the July 2016 premiums
Communications to hospitals will follow
Year 3 (4/1/17 – 3/31/18)
Distribution methodology is currently under discussion
February 1, 2017 7Slide8
Hospital Outpatient Medicaid Rate Updates
Ambulatory Patient Group (APG) Rate Updates
The following OASAS rates have been fully transitioned into APGs
OASAS Opiod Treatment Rates – retroactive to 1/3/11
OASAS Alcohol Clinic – retroactive to 10/1/10
OASAS Alcohol Rehab – retroactive to 1/1/11
Future updates
2016 Capital Updates for all Clinic and Emergency Room rates (2014 cost base)
2017 Capital Updates (2015 cost base) for all Clinic and Emergency Room rates– dependent upon completion of 2015 ICR auditAPG Survey (Managed Care Rates)Both Managed Care Plans and Hospitals were surveyed (2009 – 2015 rate years)
Inconsistent results between the Plan and Hospital surveysThe Department is working with the hospital associations on a resolution
February 1, 2017
8Slide9
Questions?