Transcript Document

Medicaid Update
A Presentation to
Healthcare Financial Management Association
September 24, 2014
Jason Jorkasky, Federal Regulation & Hospital
Reimbursement Section, Manager
Steve Ireland, Rate Review Section, Manager
Medical Services Administration
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Topics
• Michigan Medicaid DSH
• Cost Report/MMF Information
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DSH Audits
• December 2008 final rule requires audit of State
Medicaid DSH programs
• Beginning with FY 2011 audit, payments to hospitals in
excess of DSH limit will be recovered
• Audits complete for 2005, 2006, 2007, 2008, 2009 and
2010
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DSH Limits
Hospital-Specific DSH Limit =
Medicaid Cost + Uninsured Cost – Medicaid Payment –
Uninsured Payments
Medicaid cost and payments include FFS,
MCO, in-state, out-of-state, and Medicaid
duals (commercial & Medicare)
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Results from 2010 DSH Audit
• 2010 final DSH audit findings: payments in excess of
limits
– Number of hospitals: 21
– Amount in excess of limits: $54 million
– NO recoveries for this year per federal regulation
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2011 DSH Audit
• Myers & Stauffer is our DSH audit contractor
• FY 2011 DSH Audit Kickoff Session held March 18
• Draft report due to MDCH by 9/30/2014
• Final report due to CMS by 12/31/14
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DSH Process
• MDCH evaluated DSH process
• Goal was to mitigate DSH recoveries
• Policy – MSA 12-49
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DSH Process - Historical
• Old process
• Medicaid DSH eligibility determined
• OB status – annual DSH eligibility form
• Medicaid utilization at least 1% – historical data
• Calculate limits and payment allocations using historical
data
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DSH Process - New
• Step 1: Initial DSH Calculation
• Step 2: Interim DSH Settlement
• Step 3: Final DSH Audit-Related Redistribution
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DSH Process – Step 1
• Step 1: Initial DSH Calculation
• Calculation same as “old” process
• FY 2014 calculated using CRs with FYEs during SFY 2012
• Incorporates hospital feedback process
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DSH Process – Step 2
• Step 2: Interim DSH Settlement
• Medicaid DSH eligibility re-determined
• OB status
• Medicaid utilization at least 1% - updated using newer
data
• Re-calculate limits and payment allocations using
newer data
• Pool-specific character maintained
• FY 2014 calculated using CRs with FYEs during CY 2014
• Includes hospital feedback process
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DSH Process – Step 3
• Step 3: Final DSH Audit-Related
Redistribution
• Reallocate audit-related DSH recoveries
• Based on hospital’s proportion of remaining DSH limit capacity
for all DSH eligible hospitals included in audit
• FY 2014 calculated using results from 2014 final audit
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DSH in FY 2015 – Typical Yearly
Activity
Description
Estimated Timing
FY 2011 Step 3
January – March 2015
FY 2013 Step 2
October 2014 – March 2015
FY 2012 Final Audit
February – December 2015
FY 2015 Step 1
July – September 2015
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DSH Process – For a Single Year
• FY 2014 Timing
• Step 1: July – September 2014
• Step 2: October 2015 – March 2016
• Step 3: January – March 2018
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Cost Report Uses
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Statewide Upper Payment Limit (UPL) & MACI pool size
Outpatient MACI payment allocation
Rural Access Pool payment allocation
GME payment allocation
Hospital Reimbursement Adjustment (HRA) technical
guidance
DSH calculations
EHR calculations
Rate setting
Inpatient and outpatient cost ratios
Provider taxes
Hospital-specific UPL settlements
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Indigent Volume Reporting
• Uninsured charges – collected for DSH purposes
• Patients cannot have any source of third party coverage
• Charges should be accrued, not reported on a cash basis
• Uninsured charges lines
• 6.00-Charity Care: patient meets hospital charity care policy
• 6.10-Patient Pay: patient does not meet hospital charity care
policy
• 6.20-State or Local Government: non-Medicaid payments
made by State or local government (charges for non-Medicaid
CMH patients)
• 6.25-Prisoners: non-Medicaid payments made by State or local
government for prisoner (excluded for DSH purposes)
• Goal is to match what is provided at detail level to Myers &
Stauffer
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Indigent Volume Reporting
• Uninsured payments – collected for DSH purposes
• Patients cannot have any source of third party coverage
• Payments should be reported on a cash basis (similar to
DSH audit)
• Uninsured payment line
• 6.60-Payments from Charges: payments for charges categories
on lines 6.10 (Uninsured Patient Pay) and 6.00 (Uninsured
Charity Care)
• Payment offsets are not required for 6.20 (State or Local
Government) per Federal DSH statute, and 6.25 (Prisoners)
since these are excluded per Federal guidance
• Goal is to match what is provided at detail level to Myers &
Stauffer
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Indigent Volume Reporting
• Adult Benefits Waiver (ABW) ended 3/31/14
• ABW is an Outpatient program only and cannot be reported
as Inpatient on the Indigent Volume. Include those charges
and payments on lines 5.74 and 5.75, Indigent Care Plan
(Non-ABW)
• Psychiatric charges and payments
• 2 options for reporting:
• 6.20-State or Local Government on IV Form: non-Medicaid
State or local government – No payment offsets
• Medicaid MCO Psychiatric sheets: Medicaid charges and
payments should be reported
• Should not be all or nothing in either section if hospital
reports psychiatric data
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Healthy Michigan Plan
• Identifying HMP beneficiary
• Validate patient status in CHAMPS – Benefit Plan MA-HMPMC
• Make (either hospital or Trading Partner/Billing Agent) 270
batch eligibility request; return file will be 271 Eligibility
Response
• Questions to [email protected] (Attention:
Tammie), or via phone at 517-241-5670
• HMP Reporting – Cost Report Changes to MMF
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Qs and As
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Contact Information
Jason Jorkasky
Phone: (517) 335-0215
Email: [email protected]
Steve Ireland
Phone: 517-335-5352
Email: [email protected]
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