Transcript state of Michigan department of community health

STATE OF MICHIGAN
DEPARTMENT OF COMMUNITY
HEALTH
SHERRI GENSTERBLUM
MEDICAL SERVICES ADMINISTRATION
HOSPITAL & CLINIC REIMBURSEMENT DIVISION (HCRD)
September 18, 2013
Overview
MSA Initiatives
HCRD Initiatives
HCRD Highlights
2
MSA Initiatives
• CHAMPS Expansion for Illinois Medicaid
• Medicaid eligibility change to modified
adjusted gross income (MAGI)
• Hospital Reimbursement Initiative (HRI)
• Healthy Michigan Plan (Medicaid Expansion)
3
HRI
• Various options on the table for
consideration
•
•
•
APR DRG model
Capital PPS
Changes to special financing pools
(GME, DSH, HRA, MACI)
• Over 30 participants including
representatives for HMA, MHA, & MCO’s
4
Healthy Michigan Plan
• Health Insurance Marketplace
•
Open enrollment is October 1, 2013 –
March 31, 2014
• Healthy Michigan Plan
•
•
Passed the Senate, expected to be
signed by Gov. Snyder (soon), after
passed back through the house.
The implementation and its affect on
reimbursement are unknown.
5
HCRD Initiatives
•
•
•
•
ICD 10 implementation
Hospital Settlement
Cost Reporting Updates
HCRD Highlights
6
ICD 10
• Progression at the state level is on target
•
•
•
Currently doing scenario based testing
Business to business testing going live
January 2014
The weights, rates, and programming are
on schedule for October 2014
7
Hospital Settlements
• CMS 2552-10 crosswalk is completed
• Conversion of the settlement system
software (HCS) to 2552-10; expected to be
completed by 9/30/2013
• Researching individualized hospital
crosswalks for reimbursement (2014
Implementation)
8
Hospital Settlements (cont’d)
• By 12/31/2013 our goal is to include paid
claims processed post final settlement
•
•
If greater than 5% of the original fiscal
year-end base, the settlement year will
be reopened
If less than 5%, these claims will be
settled within the current year
9
Hospital Settlements (cont’d)
• Final settlement appeal
•
•
•
Hospital has 30 days to contact HCRD
After 30 days, hospital has to request
formal appeal
Medicaid Provider Manual – Hospital
Reimbursement Appendix Section 11.6 &
11.9
10
Cost Reporting Updates
• Reporting bad debt and contractual
allowance
• Retail pharmacy and revenue reduction
form
• QAAP tax costs
11
Hospital Payments FY 2013
$1,220,385,749
33%
$699,375,017
18%
$81,731,311
2%
$560,629,898
15%
$60,000,000
2%
$45,000,000
1%
$915,163,062
24%
FFS & Rural Acess
MCO
Gross MACI
Gross HRA
GME
$45M Regular DSH
Gross OP Uncomp DSH
HCRD Settlements
$915,163,062
24%
Total $3,718,661,792
12
HCRD Highlights
• Site Visits
• Dashboard
• Paperless
13
Site Visits
• September - South Haven Community
• October - William Beaumont
• November - Botsford Hospital
14
Site Visit – McLaren Flint
Proton Therapy Center
15
Site Visit – U of Mich.
Survival Flight
16
Site Visit –Henry Ford
West Bloomfield Campus (greenhouse)
17
Dashboard
Hospital Final Settlements
400
350
300
250
200
Hospital Final
Settlements
150
100
50
0
18
Paperless
• Completely paperless division
•
•
•
File Net
SharePoint
Documents sent through File Transfer
Application
•
File transfer is not used to store
information, only to communicate
19
Contacts
CHAMPS & Provider Hotline (800) 292-2550
HCRD (517) 335-5330
Single Sign On (800) 968-2644
20
QUESTIONS?