hri technical workgroup technical workgroup 03/27/2013

HRI Technical Workgroup

Hospital Reimbursement Initiative

Technical Workgroup03/27/2013


WelcomeIntroduce PacketsHousekeepingAgenda

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Introduction


Introduction (10 minutes) A message from the Medicaid Director (10 minutes) Today’s Landscape (20 minutes) Principles, Goals, and Outcomes (15 minutes)

o Break (10 minutes)

Scope (20 minutes) What is Success? (15 minutes) Possible Solutions (50 minutes)

o Break (10 minutes)

Logistics (10 minutes) Wrap Up (10 minutes)

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Agenda


Steve FittonMedicaid Director

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A Message from the Medicaid Director


Brian Keisling, Director, Actuarial Division

Jason Jorkasky, Manager, Federal Regulation & Hospital Reimbursement Policy

Section

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Today’s Landscape


Inpatient Operating Rates Inpatient Capital Rates Outpatient Rates Pool PaymentsoMedicaid Access to Care InitiativeoHospital Rate Adjustmento Rural Access PooloGraduate Medical EducationoOutpatient DSHo Regular DSH

Today’s Landscape

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MS-DRG grouper Hospital-specific rates for non-CAHs Statewide rate for CAHs Outliers

◦ High day◦ Low day◦ High cost

Transplants Transfers Readmissions Rebased every three years w/ annual updates between

Inpatient Operating Rates

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Cost-based reimbursement Full Medicaid share of capital if…

◦Sole Community Hospitals with no exceptions

◦Rural hospitals with 60% occupancy rate◦Other hospitals with 75% occupancy rate

MHP capital is prospective rate

Inpatient Capital Rates

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OPPS Rates percentage of Medicare No area wage adjustment

Outpatient Rates

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Supplemental FFS payment pool Size established as UPL gap Funded with provider tax Allocation based on historical FFS

rate payments

Medicaid Access to Care Initiative

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Supplemental payment pool Component of MHP and PIHP capitation rates Funded with provider tax Technical guidance based on historical MHP

and PIHP rate payments

Hospital Rate Adjustment

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Pool to hospitals that serve low-income rural residents

FFS & MHP component◦OP and IP up to cost + OB pool◦Boilerplate limits hospitals and systems

Reduced FY 2013 MACI by $8.3 M

Rural Access Pool

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Supplemental funding pools for teaching hospitals FFS & MHP components 2 pools

◦ GME Funds – FTEs adjustment for case mix and Medicaid share of days

◦ Primary Care – FTEs adjustment for Medicaid share of outpatient charges

Case mix based on FFS claims

Graduate Medical Education

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Supplemental payment pool 50% split between large urban vs. small

or rural hospitals Funded with provider tax Allocation based on outpatient

uncompensated care

Outpatient DSH

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Supplemental payment pool Allocated to hospitals with significant

indigent volume (IV) IV thresholds◦20%◦50%

Regular $45M DSH

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FFS payment limits: OP = costs & IP = charges◦FFS Payments against limits = operating, capital,

GME, MACI, Rural Access Pool DSH Payment limits: unreimbursed Medicaid and

uninsured cost◦Payments against limits = FFS and MHP operating,

capital, GME, MACI, HRA, Rural Access Pool, payments for uninsured

◦Overpayments recovered w/ FY 2011 audit

Individual Hospital Payment Limits

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Category Amount (in millions)

Percent

FFS & MCO Rates $1,900.5 52.4%MACI & HRA $1,423.7 39.2%Rural Access $35.7 1.0%GME $162.9 4.5%Outpatient DSH $60.0 1.7%Regular DSH $45.0 1.2%Total $3,627.8 100%

Hospital Reimbursement

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Principles, Goals and Outcomes

Dick Miles,Deputy Director

Bureau of Medicaid Policy and Health System

Innovation


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Principles, Goals and Outcomes

Guiding Principles State Goals Key Concepts Acknowledge varying interests Obstacles Approach


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Guiding Principles

More predictability Less volatility Efficiency Cost effectiveness More simplicity


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State Goals

Manageable system Ability to respond to business needs of providers Flexibility to adapt to program and policy changes Access to hospital services for Medicaid

beneficiaries Quality services Desirable health outcomes Adequate funding


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Key Concepts

FairnessEquitySuccess


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Acknowledge Varying Interests

Urban hospitals Rural hospitals Teaching hospitals Non-teaching hospitals Critical access hospitals Large hospitals Small hospitals


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Obstacles

Varying interests Competing systems resources Federal approval


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Approach

Define and measure successReasonable expectationsGive process a chance


Break Time

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Anything is on the table Input to come from the group, not the state Recognition of obstacles previously addressed

◦ Competition for system resources, ◦ Federal approval, ◦ State policy requirements

Project structure ◦ Recommendation and decision process, ◦ Role of Technical Workgroup, ◦ Makeup and Role of Steering Committee,

Constrained time frame◦ Phased Implementation?

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Scope


Define Success Discussion How will we measure success? Define Key Terms

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What is Success?


“What would you like to get out of this process?”

“What can you do to make this process better?”

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Possible Solutions


Break Time

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Big Ideas What problem is this idea/solution trying

to solve?

What is the proposed solution?

What are the barriers to success of the idea/solution?

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Possible Solutions


Future meetings◦ April 11th 9-12 – Already Scheduled◦ May 10th 1-4◦ May 22nd 1-4◦ June 17th 9-12◦ July 16th 1-4

Remote access Possible subgroups

Logistics

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What did we accomplish today? Agreements Additional Information?

Wrap Up

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Technical Workgroup ParticipantsMicheal BrunnerAllegiance Health

Fred KagariseMidMichigan Health

Mike Tomkovich Trinity Health

Scott FlowerdayBeaumont Health System

Steve LeachMunson Healthcare

Michael KlettUniversity of Michigan Health System

Kristi BelmoreBronson

David Fiero Oaklawn Hospital

Marilyn Litka-KleinMichigan Health & Hospital Association

Jerry RivetCovenant Medical Center, Inc.

Bob PlaskeyOakwood

Vickie KunzMichigan Health & Hospital Association

Debra HansonDickinson County Memorial Hospital

Connie DownsPennock Health Services

Tom MarksHealth Management Associates

Carol BaileyDetroit Medical Center

Terry LutzScheurer Hospital

Cheryl BuppHealth Management Associates

Mark McIntoshHenry Ford Health System

Craig ClaradySparrow Health System

Farah Hanley State Budget Office

Tom CrystalHurley Medical Center

Cathy SinningSpectrum Health

Erin BlackDepartment of Community Health

Anna PeroskyMcLaren Health Care

Dave BuckleySt. John Providence Health System

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State ParticipantsDick Miles [email protected] Keisling [email protected] Jorkasky [email protected] Abid [email protected] Ayres [email protected] Becsey [email protected] Gensterblum [email protected] Ireland [email protected] Castagnasso [email protected]

mailto:[email protected]










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netlogx ParticipantsNick Taylor [email protected] Luter [email protected] Hobbs [email protected] Jordan [email protected] Smith [email protected]







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Questions ?