Wyoming Medicaid State Fiscal Year 2017 – Q1 HFMA Fall Meeting November 18, 2016

Session Topics State Fiscal Year 2017 Review – Q1 Budget Reductions New Legislation – Implementation Update Access Monitoring Review Plan Final Re-Enrollment and Mandatory ORP Enrollment Update

SFY 2016 Medicaid Expenditures

SFY 2016 Enrollment- Unique

SFY 2016 County Enrollment

SFY 2016 Expenditures by Major Service

State Fiscal Year 2016 – Annual Report

State Fiscal Year 2017- Q1

SFY 2017 Quarter 1 – Service Date

State Fiscal Year 2017 – Q1 Expenditures

Monthly Enrollment Through September 2016

Medicaid Enrollment by Category

Expenditures by Category – SFY 2017 Q1

Budget Reductions Wyoming Department of Health budget reduced $90 SGF million per biennium, or 9.23% (results in additional reduction of $43.4 million in federal and other funds) Medicaid Budget Reduced by 9.25% or $56.3 million SGF (results in additional reduction of $29.9 million Federal and Other Funds) https://wyequalitycare.acs-inc.com/bulletins/WY%20Medicaid%20Budget%20Reduction%20Plan.pdf

Budget Reductions Provider rate reductions Provider rates will be reduced by $9,472,931 per year (state and federal) Hospital- Outpatient Prospective Payment System (OPPS)and Ambulatory Surgical Centers -reduce conversion factors by 3.3% RBRVS & Anesthesia RBRVS conversion factor will be adjusted to $36.86 and the anesthesia conversion factor will be adjusted to $26.50 (approximately 3.3%) Fee Schedule- Individual rates for select codes not paid through RBRVS will be reduced by 3.3%

Budget Reductions Behavioral Health Service Cap Limits Occupational, Speech, and Physical Therapy Cap Limits Non-Payment for Nursing Facility Reserve Bed Days ASC Dental Code alignment into rate method Realigment of Anesthesia Base Units Clinical Lab/Radiology Title 25 Billing to MMIS, and payment by Medicaid if possible

Budget Reductions Medicare Crossover Payment Changes Standardization of payment method for physician administered drugs (J-Codes) Reduction of coverage- Adult Dental PDAP program closure

2016 – Update on Legislation Implementation HB0057 – Upper Payment Limit Program – Private Hospitals Gives Medicaid authority to work with CMS to implement a provider tax program for private hospitals State Plan submitted to CMS and Wyoming is awaiting approval to begin program, and begin payments.

2016 – Update on Legislation Implementation SF0056 – Dietitian Reimbursement Added independently practicing licensed dietitians to Medicaid State Plan Implemented July 1, 2016 HB0074 – Upper Payment Limit Program – Public Nursing Homes Gives Medicaid authority to work with CMS to implement an intergovernmental transfer (IGT) program for non-state owned governmental nursing homes State Plan submitted to CMS and Wyoming is awaiting approval to begin program, and begin payments.

Access Monitoring Review Plan Submitted to CMS before July 1, 2016 Full report available at https://health.wyo.gov/wp-content/uploads/2016/02/Wyoming-AMRP_FINAL.7.1.pdf Updated every 3 years (Medicaid will update select components annually)

2016 Re-Enrollment – Final Report The vast majority of all active WY Medicaid pay-to providers met the 2015 re-enrollment deadline, as well as the July 2016 enrollment deadline for Ordering, Referring, Prescribing (ORP) Providers. THANK YOU for your re-enrollment efforts! If not yet re-enrolled-- All ORP practitioners MUST be enrolled (under an individual NPI) with WY Medicaid – to meet provider screening requirements Website: Wyoming Medicaid @ http://wymedicaid.acs-inc.com/provider_home.html

Questions or Comments? Jesse Springer, MPA Analysis, Information, MMIS, Special Projects (AIMS) Unit Manager Wyoming Department of Health Division of Healthcare Financing jesse.springer@wyo.gov 307.777.8048 *All financial data and graphics from the Medicaid SFY2017 First Quarter Report