Transcript Affordable Care Act Section 3133 Medicare DSH

Affordable Care Act
Section 3133 Medicare DSH
HFMA Education Session # 3
February 21, 2013
Sec. 3133. Improvement to medicare disproportionate share hospital (DSH) payments.
Presented by:
Paul Bouganim
Principal Financial Analyst
Cedars-Sinai Medical Center
Agenda
• New DSH Formulas and Projections
• Wkst S-10 and Charity Care
• CMS National Provider Call, January 8, 2013 – Donna Anglin,
2552PROplus, LLC.
• Legal Update and Data Sources – John R. Hellow, Hooper Lundy &
Bookman, Inc.
2
DSH Payment Formula Effective FY 2014
(Discharges on/after 10/01/13)
Base DSH Payment
• 25% of DSH payment computed under existing law – 42 CFR
412.106
Plus
Add-on Payment - Product of three factors:
•
Factor 1 = 75% of national aggregate DSH payments under
existing law
•
Factor 2 = A measure of the percentage change in the uninsured
population age < 65 since 2013 (FY, CY)?
•
Factor 3 = A hospital specific percentage of national aggregate
charity care
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DSH Payment Formula Effective FY 2014
(Discharges on/after 10/01/13)
Add-on Payment:
•
Factor 2 = A measure of the percentage change in the uninsured
population age < 65 since 2013 (FY, CY)?
•
•
Factor 3 = A hospital specific percentage of national aggregate
charity care
•
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1 minus the % change from 2013 to “most recent period”
minus 0.1% in 2014 and minus 0.2% in 2015 through 2019
Period not specified by Section 3133; left to Secretary to
select period
Federal Year 2014
Existing 42 CFR 412.106 DSH:
Reduced by 75%
x
Base:
33,278,652
0.25
8,319,663
FY09 HCRIS Actual
trended to FY14
Plus:
All Factors determined b y the
Secretary (CMS)
Factor 1
11,883,775,132
(2,970,943,783)
8,912,831,349
Factor 2
16.0%
15.0%
6.25%
93.65%
Factor 3
168,162,376
95,541,778,822
0.18%
Add-On (Factor 1 x 2 x 3):
Total DSH Payment FY 2014
Retention % of DSH Payment:
5
< 06/30/12 Actual trended to 06/30/14
< Aggregate national DSH (full amount)
< Aggregate DSH payments reduced to 25% per ACA
< Difference of would be DSH minus DSH paid at 25%
< Percent of < 65 uninsured in 2013
< Percent of < 65 uninsured in "Most Recent Period"
< Percent change
1 minus percent change in < 65 uninsured from 2013 minus 0.1%
< Hospital specific uncompensated care
< Aggregate uncompensated care for all DSH hospitals
14,691,258
8,319,663
14,691,258
23,010,921
69.15%
FY09 HCRIS Actual Wkst S-10
< Base
< Add-On
(-0.2% for FY2015 to FY2019)
Federal Year 2014+
Existing 42 CFR 412.106 DSH:
Reduced by 75%
x
Base:
5.00%
10.00%
20.00%
50.00%
80.00%
Change/Uninsured
Change/Uninsured
Change/Uninsured
Change/Uninsured
Change/Uninsured
33,278,652
0.25
8,319,663
33,278,652
0.25
8,319,663
33,278,652
0.25
8,319,663
33,278,652
0.25
8,319,663
33,278,652
0.25
8,319,663
Plus:
Factor 1
11,883,775,132
(2,970,943,783)
8,912,831,349
11,883,775,132
(2,970,943,783)
8,912,831,349
11,883,775,132
(2,970,943,783)
8,912,831,349
11,883,775,132
(2,970,943,783)
8,912,831,349
11,883,775,132
(2,970,943,783)
8,912,831,349
Factor 2
16.0%
15.2%
5.00%
94.90%
16.0%
14.4%
10.00%
89.90%
16.0%
12.8%
20.00%
79.90%
16.0%
8.0%
50.00%
49.90%
16.0%
3.2%
80.00%
19.90%
Factor 3
168,162,376
95,541,778,822
0.18%
168,162,376
95,541,778,822
0.18%
168,162,376
95,541,778,822
0.18%
168,162,376
95,541,778,822
0.18%
168,162,376
95,541,778,822
0.18%
Huge
Impact
Add-On:
14,887,351
14,102,980
12,534,239
7,828,017
3,121,794
Total DSH Payment:
8,319,663
14,887,351
23,207,013
8,319,663
14,102,980
22,422,643
8,319,663
12,534,239
20,853,902
8,319,663
7,828,017
16,147,680
8,319,663
3,121,794
11,441,457
Retention % of DSH Payment:
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69.74%
67.38%
62.66%
48.52%
34.38%
Charity Care and Wkst S-10 – Nothing Ties!
IRS Form 990
Financial Statements
Worksheet S-10
OSHPD
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Medicare
Charity Care and Wkst S-10
• Financial Statements
• Traditional Charity Care
• Unpaid cost of Medicaid*
• Unpaid cost of Medicare
• Research
• Other Community Benefits
• IRS Form 990 (Schedule H)
• Traditional Charity Care
• Unpaid cost of Medicaid*
• Unpaid cost of Medicare
• Research
• Other Community Benefits
*Including State/Local Government Programs
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Consolidated Financials
•
•
•
Medical Center Only
Excludes GME
Different Community Benefits
Charity Care and Wkst S-10
• Medicare (2552-10, Wkst S-10)
• Traditional Charity Care
• Unpaid cost of Medicaid*
• Non-Medicare Bad Debts
• OSHPD
• Traditional Charity Care
• Reported at gross charges
*Including State/Local Government Programs
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Bonus Slide:
Medicare/Medicaid Electronic Health Record Payments per ARRA
(American Recovery and Reinvestment Act)
$
2,000,000
Base Payment
4,370,000
Discharge Bonus - $200 for each discharge between 1,150 and 23,000
6,370,000
Eligible EHR Payment Pool
(a)
120,866
Medicare Days
(b)
286,054
Total Patient Days
42.25%
Medicare Share
39,052
Medicaid Days (Medi-Cal)
286,054
(c)
13.65%
$
Total Patient Days
Medicaid Share
2,691,506
Medicare Share
869,630
Medicaid Share
3,561,136
Total Eligible EHR Payment (Subject to Transition %)
(a)
Includes HMO and Subprovider (Psych and Rehab) days
(b)
(c)
Charity Care Reduction from Wkst S-10, Line 20
Medicaid Utilization must exceed 10% to qualify
(b) Medicare Share:
IP Part A Days + IP Part C Days
÷
Total IP Days x [ (Total Charges - Charity Care Charges) ÷ Total Charges ]
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Charity Care and Wkst S-10
Unpaid Cost of Medicaid
Overall Facility Cost-to-Charge Ratio, Wkst C, Part I
Gross Medi-Cal and Medi-Cal HMO Charges (Provider Records)
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Charity Care and Wkst S-10
Traditional Charity Care
•
Gross Charges
•
Internal Report of all Accounts with Charity Code Write-Off
•
Separated between Accounts w/ Insurance Pmt and w/o Insurance Pmt
•
Any payments posted to account are offset
•
Charity Write-Off: Formal application and approval for Charity Care
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Charity Care and Wkst S-10
Non-Medicare Bad Debt
•
Non-Medicare Bad Debt
•
End Game:
•
Unpaid Medicaid:
$65,178,384
•
Traditional Charity Care:
$52,438,879
•
Non-Medicare Bad Debt:
$51,105,059
$168,722,322
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