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HRI Technical Workgroup Technical Workgroup 03/27/2013.

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Presentation on theme: "HRI Technical Workgroup Technical Workgroup 03/27/2013."— Presentation transcript:

1 HRI Technical Workgroup Technical Workgroup 03/27/2013

2 HRI Technical Workgroup Welcome Introduce Packets Housekeeping Agenda 2

3 HRI Technical Workgroup Introduction (10 minutes) A message from the Medicaid Director (10 minutes) Todays 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) 3

4 HRI Technical Workgroup Steve Fitton Medicaid Director 4

5 HRI Technical Workgroup Brian Keisling, Director, Actuarial Division Jason Jorkasky, Manager, Federal Regulation & Hospital Reimbursement Policy Section 5

6 HRI Technical Workgroup Inpatient Operating Rates Inpatient Capital Rates Outpatient Rates Pool Payments o Medicaid Access to Care Initiative o Hospital Rate Adjustment o Rural Access Pool o Graduate Medical Education o Outpatient DSH o Regular DSH 6

7 HRI Technical Workgroup 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 7

8 HRI Technical Workgroup 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 8

9 HRI Technical Workgroup OPPS Rates percentage of Medicare No area wage adjustment 9

10 HRI Technical Workgroup Supplemental FFS payment pool Size established as UPL gap Funded with provider tax Allocation based on historical FFS rate payments 10

11 HRI Technical Workgroup Supplemental payment pool Component of MHP and PIHP capitation rates Funded with provider tax Technical guidance based on historical MHP and PIHP rate payments 11

12 HRI Technical Workgroup 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 12

13 HRI Technical Workgroup 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 13

14 HRI Technical Workgroup Supplemental payment pool 50% split between large urban vs. small or rural hospitals Funded with provider tax Allocation based on outpatient uncompensated care 14

15 HRI Technical Workgroup Supplemental payment pool Allocated to hospitals with significant indigent volume (IV) IV thresholds 20% 50% 15

16 HRI Technical Workgroup 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 16

17 HRI Technical Workgroup CategoryAmount (in millions) Percent FFS & MCO Rates$1, % MACI & HRA$1, % Rural Access$ % GME$ % Outpatient DSH$ % Regular DSH$ % Total$3, % 17

18 HRI Technical Workgroup 18 Dick Miles, Deputy Director Bureau of Medicaid Policy and Health System Innovation

19 HRI Technical Workgroup 19 Guiding Principles State Goals Key Concepts Acknowledge varying interests Obstacles Approach

20 HRI Technical Workgroup 20 More predictability Less volatility Efficiency Cost effectiveness More simplicity

21 HRI Technical Workgroup 21 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

22 HRI Technical Workgroup 22 Fairness Equity Success

23 HRI Technical Workgroup 23 Urban hospitals Rural hospitals Teaching hospitals Non-teaching hospitals Critical access hospitals Large hospitals Small hospitals

24 HRI Technical Workgroup 24 Varying interests Competing systems resources Federal approval

25 HRI Technical Workgroup 25 Define and measure success Reasonable expectations Give process a chance

26 HRI Technical Workgroup Break Time 26

27 HRI Technical Workgroup 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? 27

28 HRI Technical Workgroup Define Success Discussion How will we measure success? Define Key Terms 28

29 HRI Technical Workgroup What would you like to get out of this process? What can you do to make this process better? 29

30 HRI Technical Workgroup Break Time 30

31 HRI Technical Workgroup 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? 31

32 HRI Technical Workgroup 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 32

33 HRI Technical Workgroup What did we accomplish today? Agreements Additional Information? 33

34 HRI Technical Workgroup Technical Workgroup Participants Micheal Brunner Allegiance Health Fred Kagarise MidMichigan Health Mike Tomkovich Trinity Health Scott Flowerday Beaumont Health System Steve Leach Munson Healthcare Michael Klett University of Michigan Health System Kristi Belmore Bronson David Fiero Oaklawn Hospital Marilyn Litka-Klein Michigan Health & Hospital Association Jerry Rivet Covenant Medical Center, Inc. Bob Plaskey Oakwood Vickie Kunz Michigan Health & Hospital Association Debra Hanson Dickinson County Memorial Hospital Connie Downs Pennock Health Services Tom Marks Health Management Associates Carol Bailey Detroit Medical Center Terry Lutz Scheurer Hospital Cheryl Bupp Health Management Associates Mark McIntosh Henry Ford Health System Craig Clarady Sparrow Health System Farah Hanley State Budget Office Tom Crystal Hurley Medical Center Cathy Sinning Spectrum Health Erin Black Department of Community Health Anna Perosky McLaren Health Care Dave Buckley St. John Providence Health System 34

35 HRI Technical Workgroup 35 State Participants Dick Brian Jason Paul Ben Bobby Sherri Steve Craig

36 HRI Technical Workgroup 36 netlogx Participants Nick Dave Melanie Sara Tina

37 HRI Technical Workgroup 37 Questions ?

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