Transcript Coverage Institute Proposal - Wisconsin Hospital Association

Hospital Rate Setting Methods
for State Fiscal Year 2011
June 15, 2010
Department of Health Services
Division of Health Care Access and Accountability
6/15/2010
1
Agenda
1.
2.
3.
4.
5.
6.
7.
8.
Overview of Rate Methodology and Policy
Decisions
FY 2011 Inpatient Hospital Rates
FY 2011 Outpatient Hospital Rates
FY 2010 Acute Care Hospital Assessment
FY 2011 Acute Care Hospital Assessment
FY 2011 Critical Access Hospital Assessment
Prior Meeting Issues
Agenda for Next Meeting
6/15/2010
2
FY 2011 Policy Decisions
1.
2.
3.
4.
5.
6.
7.
Appeals Policy Limit 5 Year Look Back For Cost Report
–Use of Unaudited Cost Reports When Certain Criteria
Met.
Terminate Critical Access Hospital Settlements
Align Rehab Rates to Psych Per Diem Calculations
Move EACH Payments under the UPL
Reform DSH Methodology to Pay DSH As a Lump Sum
Payment
Revise Rural Hospital Payment Adjustment to Eliminate
Reference to Wisconsin Historical Wage Index
Calculation.
Wage Index Policy – Recommend In State and Out of
State Index
6/15/2010
3
Inpatient Rate Setting
Methodology
1.
2.
Calculate CAH provider specific cost based
rates and project payments to determine
remaining funding
Calculate budget neutral base rate for Acute
Care Hospitals, then apply provider adjustments
1.
2.
3.
4.
5.
3.
Wage Index
Capital
Direct and Indirect Medical Education
Rural Hospital Adjustment
DSH Adjustment
Trim Points
6/15/2010
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Inpatient Rate Setting
Methodology (continued)
4.
5.
6.
7.
Calculate budget neutral per diem rates for
psych and rehab hospitals.
Once rates established, project payments based
upon projected utilization and case mix.
Adjust rates as necessary to remain within
budget.
Project outcomes as a result of rate updates.
6/15/2010
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FY 2011
Inpatient Hospital Rates
(See Handouts)
6/15/2010
6
Outpatient Rate Setting
Methodology
1.
2.
3.
4.
5.
Calculate OP Medicaid cost using the Cost-ToCharge Ratio
Project payments for CAHs.
Determine remaining base funding budget for
Acute Care, Psych, Rehab, Border and Out of
State Hospitals
Apply budget neutral factor to non CAHs.
Project payments using projected volume.
6/15/2010
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FY 2011
Outpatient Hospital Rates
(See Handouts)
6/15/2010
8
FY 2010 and FY 2011
Acute Care Hospital
Assessments
(See Handouts)
6/15/2010
9
Critical Access Hospital
Assessment
(See Handouts)
Prior Meeting Follow-Up
Issues
CAH Settlements
1.


2.
3.
4.
2001-2004
2006-2010
Portal Access for Cost Reporting Info
National Health Care
South-East RFP
6/15/2010
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Agenda for Quarterly Meeting
Future Considerations
1.


2.
3.
Adjusting Trim Points
Pay Labs on Max Fee Schedule
Pay-For-Performance for FY 2011
Review Assessment and Access Payments
Next Meeting: Fall 2010
6/15/2010
12
QUESTIONS??
6/15/2010
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