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

2. 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

3. SFY 2016 Medicaid Expenditures

4. SFY 2016 Enrollment- Unique

5. SFY 2016 County Enrollment

6. SFY 2016 Expenditures by Major Service

7. State Fiscal Year 2016 – Annual Report

8. State Fiscal Year Q1

10. SFY 2017 Quarter 1 – Service Date

11. State Fiscal Year 2017 – Q1
Expenditures

12. Monthly Enrollment Through September 2016

13. Medicaid Enrollment by Category

14. Expenditures by Category – SFY 2017 Q1

15. 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)

16. 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%

17. 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

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

19. 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.

20. 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.

21. Access Monitoring Review Plan
Submitted to CMS before July 1, 2016
Full report available at
Updated every 3 years (Medicaid will update select components annually)

23. 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

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