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Healthcare Financial Management Association Northeast Ohio Chapter OHA Update Charles Cataline

Healthcare Financial Management Association Northeast Ohio Chapter OHA Update Charles Cataline Senior Director, Health Policy Ohio Hospital Association charlesc@ohanet.org www.ohanet.org. Agenda. Ohio 2012/2013 State Budget How did it pan out for hospitals? What’s next? Medicaid

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Healthcare Financial Management Association Northeast Ohio Chapter OHA Update Charles Cataline

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  1. Healthcare Financial Management Association Northeast Ohio Chapter OHA Update Charles Cataline Senior Director, Health Policy Ohio Hospital Association charlesc@ohanet.org www.ohanet.org NE Ohio HFMA

  2. Agenda • Ohio 2012/2013 State Budget How did it pan out for hospitals? What’s next? • Medicaid • RAC • MITS • Other Medicaid • Medicare • MAC Conversion Update • ACO Final Rule • 2012 OPPS Final Rule & Others • BWC • Other?! NE Ohio HFMA

  3. OHA Budget Goals • Minimize Losses on Hospital Franchise Fee Program • Maintain Medicaid Funding • Preserve Base • Keep 5% Payment Update From 2009 • Preserve HCAP for Hospitals • Reduce Regulatory Burden NE Ohio HFMA

  4. Hospital Franchise Fee • H.B. 153 (state budget) Extends Franchise Fee for Two Years – Now Sunsets 10/1/13 • Fee Rate & Timeline to be Determined in Administrative Code Rules • Preliminary Rates (SFY ’10 Cost Reports) 2.562% in 2012; 2.722% in 2013 • Preliminary Timeline: Equal Installments Nov. 30, Jan. 15, Mar. 15, and May 15 • Supplemental Payments Under UPL Expanded & Managed Care Incentive Payment Created NE Ohio HFMA

  5. Hospital Franchise Fee NE Ohio HFMA

  6. Supplemental Payments • Existing Supplemental Payments Continued • Children’s, Public/State/Private UPL Programs • Paid Semiannually • ~$128M per year • New Supplemental Payments Created • Inpatient - 4 Payments • Across the Board; Private Teaching, Specialty & Magnet; CAH/Rural • $215M in 2012; $260M in 2013 • Outpatient - 4 Payments • Across the Board • $67M in 2012; $98M in 2013 NE Ohio HFMA

  7. Managed Care Incentive Payments • Response to “Non-Contracting” Budget Debate • $162M Per Year - Starting Oct. 2011 • Hospital Must Contract With at Least One MCP • Lump Sum Payment 4/5 Times Per Year Based on Contracted Inpatient Business • Process/Policies Still in Development; OHA Negotiating Details with OAHP • OHA Serves as Conduit - Hospital Must Authorize OHA to Receive Funds • Goal is to Ease Administrative Burden and Ensure All Funds are Distributed NE Ohio HFMA

  8. Looking Ahead NE Ohio HFMA

  9. “Modernizing” Hospital Payments * In managed care section NE Ohio HFMA

  10. State Budget: The Bottom Line • Franchise Fee Extension: ~$1 Billion in Fees • Will Fund ~$1.5B in Enhanced Hospital Payments • $530M “Net Gain” for Ohio Hospital Industry • 172 Hospitals Gain While 38 are Negatively Impacted • State gets $1.2B to support Medicaid program • Medicaid “Modernizations” Reduced From As-Introduced State Budget Projections • Original Fiscal Impact of $557M Reduced to $376M NE Ohio HFMA

  11. Medicaid RAC • CMS Final Rule Out • ODJFS Contract Awarded to CGI • Few Details so Far – Intro at Nov. 16 Ohio RAC Summit • Watch for Public Rules • Actual Start Date Will be Fall 2011 or Later • Will Not Replace MIP or PERM Programs • OHA Will Seek Program Like Medicare RAC but ODJFS Will Take the FI/MAC Role • State-Specific Standards • Timelines • Medical Records • Audit • Appeal & Recoupment Policies NE Ohio HFMA

  12. Medicaid Information Technology System • Overall, MITS is working • Hospital Payments are Lower than MMIS but Not at Crisis Level • Biggest Problems • Software is Not User Friendly; Learning Curve is Steep • MITS Edits are Causing Unexpected Rejections and Payment Shifts • ODJFS / HP Helpdesk is Overwhelmed • Cost of Vendor Eligibility Verification is Way Up! • Pre-Cert Issues Causing Additional Headaches • OHA & LMPG Working with ODJFS NE Ohio HFMA

  13. Other Medicaid • Medicaid Managed Care RFA Delayed • RFA Now Due 1/1/12; New MPC Contracts Effective 1/1/13 • Medicaid Cost Report UC Data Expansion • Required by Feds; Myers & Stauffer • Three New Schedules for SFY 2011; UC Data Broken into CR Revenue Areas • Additional SFY 2011 Data Due When M&S Audits in 2013 • Required with Annual Medicaid CR Thereafter • SFY 2011 CR Delayed 30 Days • Expect Hospital Charge Audits From Permedion • OHA Finance Committee Discussing Expanded HCAP-Related Free Care Eligibility Timelines NE Ohio HFMA

  14. MAC Conversion • So Far so Good • CGS Website Under Expansion • Note Contact List at http://www.cgsmedicare.com/parta/help/contact_info.html • No Noted Problems with “Pay Forward” • No Date for End of RAC Brownout Set Yet • Be Prepared for Months of RAC Reviews to Move Quickly • Demand Letters could be a Problem, too! • CGS LCDs go Into Effect on DOS 10/17/11 • Final MAC Jurisdictions Announced NE Ohio HFMA

  15. Other Medicare • Final Rules Season! • Accountable Care Organizations • Significant Moderation To Address Industry Concerns • CY 2012 Outpatient PPS/ASC • 1.9% Hospital Update; 1.6 % for ASCs • Supervision and Wage Index Still an Issue • Quality Reporting for ASCs Implemented • Value Based-Purchasing Updates Included • CY 2012 ESRD PPS • 2.1% Update; 2nd Year of Transition for Many • CY 2012 Physician Fee Schedule • CY 2012 Home Health • Provider Revalidation Coming NE Ohio HFMA

  16. Bureau of Workers’ Compensation • Outpatient Medicare-based PPS in Transition • 198% Medicare 1/1/11 – 3/31/12 (Childrens = 253% / CAH Exempt) • 181% Medicare 4/1/12 – 3/31/13 • 166% Medicare After • 2011 Medicare OPPS Pricer Factors in Place Until 3/31/12 • Annual OPPS Pricer Update April 1 Thereafter • Medicare v. BWC PPS Chart Available at http://www.ohanet.org/Issue/BWC • FFY 2012 Inpatient PPS Effective 2/1/12 • 2011 Medicare IHPPS GROUPER In Place Until 1/31/12 • BWC Proposes Partial Return of CMS Coding Improvement Cuts, No ACA Return • OHA Still in Negotiations; Public Hearing Nov. 15 NE Ohio HFMA

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