1. Mar. 22, 2010 MA HDC Meeting1 MA Health Disparities Council Working Group on Interpreter Services Update on ISWG Recommendations for Reimbursement for Medical Interpreters March 22, 2010 Content for this update is from ISWG Presentation by Terri Yannetti, Director Primary Provider Network Office of Acute and Ambulatory Care Georgia Simpson May, Director, MDPH-Office of Health Equity (OHE) James Destine, Coordinator of Interpreter Services, MDPH-OHE Iyah Romm, Intern, MDPH-OHE

2. Mar. 22, 2010 MA HDC Meeting2 The 2007 Massachusetts Legislative Commission to End Racial and Ethnic Health Disparities Recommendations “to expand access to quality health care” Recommendation #3: Reimbursement procedures for interpreter services by all payers, public and private.

3. Mar. 22, 2010 MA HDC Meeting3 MassHealth Reimbursement Principles Encourage efficiency and economy Use sound reimbursement methods to reasonably compensate all hospitals Maintain access and quality of care Comply with all applicable state and federal payment requirements

4. Mar. 22, 2010 MA HDC Meeting4 MassHealth Federal Limitations Upper Payment Limit (UPL) on Medicaid Rates – not to exceed amounts payable using Medicare payment principles Safety Net Care (SNC)– Replaces federal Disproportionate Share Hospital (DSH) Payments and Limits Budget Neutrality – Waiver costs cannot exceed costs absent a waiver

5. Mar. 22, 2010 MA HDC Meeting5 Acute Inpatient Methodology: (Standard Payment Amount per Discharge) SPAD covers a 20 day stay The Hospital–Specific SPAD is based on hospital reported costs (submitted on the DHCFP 403 cost report) and consists of: –Statewide average payment amount per discharge adjusted by an efficiency standard and then for wage area differences, hospital- specific casemix and an operating cost inflation factor –A per discharge payment for hospital-specific expenses for malpractice insurance and organ acquisition –A per discharge payment amount for capital cost, adjusted by hospital-specific casemix and by a capital inflation factor

6. Mar. 22, 2010 MA HDC Meeting6 Acute Hospital Outpatient Methodology

7. Mar. 22, 2010 MA HDC Meeting7 PAPE (Payment Amount Per Episode) Hospital Specific Episodic Payment Methodology –Per Patient/Per Day –Based on 3M Ambulatory Patient Group (APG) bundling –Utilizes cost-based weights that capture resource intensity and applies a forcasted trend to the monthly average PAPE Covers most outpatient services –Outpatient departments (OPDs) –Hospital Licensed Health Centers (HLHCs) –Hospital Satellite Clinics PAPE doesn’t cover –Laboratory services, professional services and other specified services paid though DHCFP fee schedules

8. Mar. 22, 2010 MA HDC Meeting8 PAPE The Statewide Standard is derived from the Total APG payment –For Base Year –Inflated to Hospital Rate Year Based on Ambulatory Patient Group (APG) Payment and Episodes –Exclude Lab Services –Utilize Cost-to-Charge Ratios (CCR) to Price Outliers –1-day Episodes PAPE = Forecasted Average APG Weight x Statewide Standard

9. Mar. 22, 2010 MA HDC Meeting9 Interpreter Services Interpreter Services costs are captured in the payment methodologies, in the same manner as nurses, x-ray technologists, pharmacists, dieticians, and the costs of other hospital personnel, in support of providing patient care services These costs are reported on the hospital cost reports, are in the cost- based weights and are therefore included in the hospital specific payment rates.

10. Mar. 22, 2010 MA HDC Meeting10 Coverage Consistent with other Payers Representatives of the payers in the workgroup also noted that their hospital contracted rates cover the provision of Interpreter services

11. Mar. 22, 2010 MA HDC Meeting11 Future Decision Points for HDC (to-date) Sustainability of effort, ongoing monitoring. Potential for instituting registration process for medical interpreters. Registration would allow us to have, within the state’s domain, a repository of all certified medical interpreters who are practicing in MA, similar to the registry within the Commission for the Deaf and Hard of Hearing. G.L. c.6 s.196. (interpreter referral service).

12. Mar. 22, 2010 MA HDC Meeting12 ISWG Meetings and Tentative Agendas September 23, 2009 √ October 28 th, 2009 √ November 18 th, 2009 (changed from Nov. 25 th ) √ December 16 th, 2009 (changed from Dec. 23 rd ) √ January 27 th, 2010 √ February 24 th, 2010 √ March 24 th, 2010 Location : 250 Washington Street, Boston Commissioner’s Conference Room, 2 nd Floor Time : 3:15 – 4:45

13. Mar. 22, 2010 MA HDC Meeting13 March – April 2010 Agenda March 24, 2010 – Mtg #7 (Reimbursement-Part II) Finalize reimbursement recommendation(s) April 28, 2010 – Mtg #8 Review, modify finalize full set of recommendations