Transcript PACAH FISCAL OFFICERS GROUP MEETING Friday, January …

PACAH Fiscal Officers Group
Meeting
Wednesday, April 29, 2015
Judith Patrick - Policy Manager
Peggy Morningstar - CFO
Office of Long-Term Living
7/17/2015
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Agenda
• OLTL Staffing Changes
• FY 2014-2015 Supplemental Payments
(MDOI, P4P, HAI, County Supplementation)
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•
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April 2015 Budget Adjustment Factor (BAF)
FY 2015-2016 Governor’s Proposed Budget
Nursing Facility Assessment Program Redesign
PSAE Update
Cost Report/Audit Change IT Process
OIG, Medicheck, and the EPLS
Medicaid Expansion to HealthChoices
Managed Long Term Services and Supports (MLTSS)
7/17/2015
2
OLTL Staffing Changes
• Jen Burnett – Deputy Secretary (May 6)
• Kevin Hancock – Chief of Staff (April 13)
• Peggy Morningstar – Chief Financial Officer (April 13)
7/17/2015
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FY 14-15 Supplemental Payments
•
County MDOI
– Public Notice published 6/14/14; SPA approved 8/19/14
– Payments – 1st Qtr. – 11/03/14; 2nd Qtr. – 12/15/14; 3rd Qtr. – 2/16/15; 4th Qtr. –
4/20/15
•
County Supplementation
– Public Notice published 9/13/14; SPA approved 11/21/14; Payment – 12/08/14
•
Nonpublic MDOI
– Public Notice published 9/13/14; SPA approved 11/21/14
– Payments – 1st Qtr. – 12/15/14; 2nd Qtr. – 2/09/15
•
P4P
– Public Notice published 9/20/14, SPA approved 11/21/14
– Payments – 1st Qtr. – 12/15/14; 2nd Qtr. – 2/09/15
•
HAI
– Payments – 12/31/13 filers – 8/25/14; 6/30/14 filers – 3/02/2015
7/17/2015
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April 2015 BAF
Budget Adjustment Factor (BAF) for FY 2014-2015 NF Rates
• Nonpublic NFs
– Base BAF - 0.84265
– April BAF – 0.85297
• County NF BAF – 1.017
• Detailed BAF data is located on the Long Term Care Nursing
Facility Providers website at
http://www.dhs.state.pa.us/provider/doingbusinesswithdhs/lo
ngtermcarecasemixinformation/index.htm.
7/17/2015
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OLTL 2015-2016 Proposed Budget
2015-16 Budget
(In Thousands)
Funding
Source
State
Federal
Other
Total
7/17/2015
Long Term
Care
Budget
Home &
Community
Based
Services
Long Term
Care
Managed
Care
Services to
Persons with
Disabilities
Attendant
Care
Total
OLTL
2015-16
Proposed
Budget
$ 1,357,807
$ 384,890
$ 105,346
$ 302,979
$ 145,131
$ 2,296,153
2,035,872
427,318
116,238
340,036
126,089
3,045,553
480,462
0
0
0
703
481,165
$ 3,874,141
$ 812,208
$ 221,584
$ 643,015
$ 271,923
$ 5,822,871
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OLTL 2015-2016 Proposed Budget
Office of Long Term Living Budgets
(In Thousands)
Funds
State
Federal
Other
Total
7/17/2015
2014-15
Available
2015-16
Proposed
Increase/
(Decrease)
$ 2,209,833
$ 2,296,153
$ 86,320
2,998,312
3,045,553
47,241
481,165
481,165
0
$ 5,689,310
$ 5,822,871
$ 133,561
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OLTL 2015-2016 Proposed Budget
State Funds
(In Thousands)
Funds
2014-15
Available
2015-16
Proposed
$ 1,434,293
$ 1,736,802
$ 302,509
Tobacco Settlement
Funds
278,882
144,602
(134,280)
Lottery Funds
496,658
414,749
(81,909)
2,209,833
$ 2,296,153
$ 86,320
General Fund
Total State Funds
7/17/2015
Increase/
(Decrease)
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OLTL 2015-2016 Proposed Budget
Federal Funds
(In Thousands)
Funds
2014-15
Available
2015-16
Proposed
$ 2,039,066
$ 2,035,872
$ (3,194)
345,827
386,142
40,315
47,638
41,176
(6,462)
MA-LTC Managed Care
125,242
116,238
(9,004)
MA-Services to Persons with
Disabilities
318,899
340,036
21,137
MA-Attendant Care
121,640
126,089
4,449
$ 2,998,312
$ 3,045,553
$ 47,241
MA-LTC (GF)
MA-Home & Community-Based
Services (GF)
MA-Community Services
(Tobacco Settlement Fund)
Total Federal Funds
7/17/2015
Increase/
(Decrease)
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OLTL 2015-2016 Proposed Budget
Long Term Care - Nursing Facility Funding
(Also includes operating contracts & OLTC grants.)
(In Thousands)
Funds
State
Federal
Other
Total
7/17/2015
2014-15
Available
2015-16
Proposed
Increase/
(Decrease)
$ 1,379,587
$ 1,357,807
$ (21,780)
2,039,066
2,035,872
(3,194)
480,462
480,462
0
$ 3,899,115
$ 3,874,141
$ (24,974)
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OLTL 2015-2016 Proposed Budget
Home and Community Based Services
(Aging Waiver)
(In Thousands)
Funds
State
Federal
Other
Total
7/17/2015
2014-15
Available
2015-16
Proposed
Increase/
(Decrease)
$ 330,504
$ 384,890
$ 54,386
393,465
427,318
33,853
0
0
0
$ 723,969
$ 812,208
$ 88,239
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OLTL 2015-2016 Proposed Budget
Long Term Care Managed Care
(LIFE Program)
(In Thousands)
Funds
2015-16
Proposed
Increase/
(Decrease)
State
$ 99,252
$ 105,346
$ 6,094
Federal
125,242
116,238
(9,004)
0
0
0
$ 224,494
$ 221,584
$ (2,910)
Other
Total
7/17/2015
2014-15
Available
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OLTL 2015-2016 Proposed Budget
Services to Persons with Disabilities
(OBRA, COMMCARE & Independence Waivers)
(In Thousands)
Funds
State
Federal
Other
Total
7/17/2015
2014-15
Available
2015-16
Proposed
Increase/
(Decrease)
$ 267,593
$ 302,979
$ 35,386
318,899
340,036
21,137
0
0
0
$ 586,492
$ 643,015
$ 56,523
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OLTL 2015-2016 Proposed Budget
Attendant Care
(Attendant Care Waiver & Act 150 Program)
(In Thousands)
Funds
State
Federal
Other
Total
7/17/2015
2014-15
Available
2015-16
Proposed
Increase/
(Decrease)
$ 132,897
$ 145,131
$ 12,234
121,640
126,089
4,449
703
703
0
$ 255,240
$ 271,923
$ 16,683
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NF Assessment Program
Nursing Facility Assessment Redesign
• NF Assessment funding is used for case-mix rates,
nonpublic NFs’ MA allowable assessment costs and
quarterly supplemental payments, and a portion of the
County MA Day One Incentive Payments.
• Public notice relating to the proposed assessment
methodology and annual rates must be published no
later than June 27, 2015.
• CMS approval needed for waiver.
• Challenge for FY 2015-2016 repeat of FY 2014-2015.
7/17/2015
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NF Assessment Program
• Workgroup began work in November 2014.
• Representatives from the four NF trade associations
(PACAH, LeadingAge PA, PHCA & HAP) participated in
the workgroup.
• Proposed methodology change - lower rate tier will
apply to four categories of NFs:
–
–
–
–
7/17/2015
County NFs
NFs that have 44 or fewer licensed beds
Grandfathered CCRC NFs
NFs with an MA occupancy rate of at least 94% (new)
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Preventable Serious Adverse Events
• Information related to reporting and claims can be found
on the PSAE website:
http://www.dhs.state.pa.us/provider/doingbusinesswithd
hs/preventable/index.htm.
• There have been two PSAEs to date:
– Environmental Events - Burn
– Patient Protection Events - Elopement
7/17/2015
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Cost Report/Audit Change IT Process
• Change IT Workshop completed through Governor’s
Innovation Office August 2014.
• New proposed process hopes to make audit process
paperless.
• A project manager has been assigned.
• A small team looked at different auditing software
packages and selected TeamMate.
7/17/2015
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OIG, Medicheck, and the EPLS
• OMAP Bulletin 99-11-05 issued on August 15, 2011.
• Under both state and federal law, the department and its MA
providers are generally prohibited from paying for any items
or services furnished, ordered, or prescribed by individuals or
entities excluded from the MA Program as well as other
federal health care programs.
• Providers should have policies and procedures for screening
of all employees and contractors (both individuals and
entities),at time of hire or contracting; and, thereafter, on an
ongoing monthly basis to determine if they have been
excluded from participation in federal health care programs.
• Providers should use the following databases to perform
monthly checks.
7/17/2015
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OIG, Medicheck, and the EPLS (cont.)
a.
Pennsylvania Medicheck List: a database maintained by the Department –
http://www.dhs.state.pa.us/publications/medichecksearch/.
If an individual’s resume indicates that he/she has worked in another state, providers should
also check that state’s individual list.
b. List of Excluded Individuals/Entities (LEIE): database maintained by HHS-OIG that
identifies individuals or entities that have been excluded nationwide from participation in any
federal health care program - http://oig.hhs.gov/fraud/exclusions.asp.
c. Excluded Parties List System (EPLS): World wide database maintained by the General
Services Administration (GSA) that provides information about parties
that are excluded from receiving federal contracts, certain subcontracts, and
certain federal financial and nonfinancial assistance and benefits:
https://www.epls.gov/. Note: The GSA site was discontinued on 11/21/12. All exclusions
were consolidated into what is now know as System for Award Management (SAM) a portal
for the Federal Procurement System - https://www.sam.gov/portal/SAM/#1.
OMAP Bulletin 99-11-05 of 2011 can be found at:
http://www.dhs.state.pa.us/cs/groups/webcontent/documents/bulletin_admin/d_005732.pdf.
7/17/2015
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HealthChoices Expansion
• Pennsylvania is pursuing traditional Medicaid
expansion through the existing HealthChoices
program.
• The goal is to provide the least disruption through
an orderly and efficient transition of individuals who
had previously enrolled in HealthyPA.
• HealthChoices streamlines recipients into a single
and more comprehensive benefit package.
• More information and specific timelines for the
transition can be found at:
Healthchoicespa.com
7/17/2015
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MLTSS
Managed Long Term Services and Supports
• DHS is committed to improving the health care delivery
system for Seniors and Persons with Disabilities by
improving health care and long term care services,
advancing program innovation, promoting health,
safety, and well-being of the Pennsylvania constituents,
and ensure efficiency, transparency, accountability, and
effectiveness of DHS Programs.
• As part of this commitment, DHS plans to implement a
managed care delivery system for its Medicaid
recipients currently receiving long-term care services.
This initiative will be identified as MLTSS.
7/17/2015
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MLTSS
• A discussion paper on MLTSS will be distributed in
May, 2015 outlining the goals and the high level
program design requirements.
• Informational meetings will be scheduled from late
May through July, 2015.
• Comments on MLTSS and the discussion paper will
be solicited from May to July, 2015.
• Phase One Implementation is scheduled for
January, 2017.
7/17/2015
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Questions?
7/17/2015
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