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RHP DISTRICT 10 Finance Committee. May 10, 2012. Goals for Today. Committee charter Understand waiver funds flow IGT fundamentals UC pool payments DSRIP pool payments Timeframes Begin work on RHP budget. Waiver Funds Flow. State/Local Funds (42%). Federal Match

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Presentation Transcript
goals for today
Goals for Today
  • Committee charter
  • Understand waiver funds flow
  • IGT fundamentals
  • UC pool payments
  • DSRIP pool payments
  • Timeframes
  • Begin work on RHP budget
waiver funds flow
Waiver Funds Flow

State/Local Funds

(42%)

Federal Match

(58%)

igt fundamentals
IGT Fundamentals
  • Intergovernmental Transfers
    • Federal Government matches state/local funds spent on the Medicaid program
        • Approximately 42% state/local
        • Approximately 58% federal
        • Expect that FMAP rate changes over the life of the waiver
  • IGT providers
    • Hospital districts
    • Counties
    • MHMRs
    • Medical schools
    • Other government?
igt fundamentals1
IGT Fundamentals
  • State/local share must be public funds
    • Taxes
    • Commercial insurance receipts
    • Investment income
    • Qualified donations
    • Other non-Federal
    • Other?
  • Cannot be receipts from delegation of a governmental duty
  • Spreadsheet available for use by potential IGT entities
uc pool
UC Pool
  • Eligibility for pool payments
    • RHP membership
    • UC application filed
  • Eligible entities
    • Hospitals
    • Physician practices
    • Government ambulance providers
    • Governmental dental providers
    • Other providers in rural RHPs with no public hospital
  • IGT must be provided by governmental entity
uc pool1
UC Pool
  • Qualified amounts – based on data from 2 years prior to payment year
    • Costs related to providing care to persons with no third party coverage
    • Medicaid shortfall
  • For services covered by Medicaid
    • Inpatient/outpatient (DSH cap calculation)
    • Physician and mid-level services
    • Outpatient drugs
    • Physician practices
uc pool2
UC Pool
  • Necessary data elements
    • Medicaid and uninsured charges by Medicare cost center
    • Medicaid and uninsured days by Medicare cost center
    • Medicaid cost to charge ratios
    • Medicaid payments
      • DSH
      • FFS and managed care
    • Patient payments
    • Any other payment made on behalf of the patient
uc pool3
UC Pool
  • UC payments classified as Medicaid payments
  • Total payments received for uninsured and Medicaid cannot exceed costs for providing services
  • Process description document at end of this document
  • Spreadsheets we used are available
dsrip pool
DSRIP Pool
  • Payment is incentive based – unrelated to cost
  • Eligibility for pool payments
    • RHP membership
    • Participation in transformation projects
  • Eligible entities – any health care entity participating in DSRIP projects
dsrip pool1
DSRIP Pool
  • IGT must be provided by governmental entity
  • Performance metrics must be met in order to receive payment
  • Not considered a Medicaid payment
issues at hhsc update
Issues at HHSC - Update
  • UC Tool completion
    • Contracted services issue
    • Tobacco funds
    • Adjustments to cost report numbers
  • Pool allocations
  • IGT – conversion of private funds to public funds
    • Provider donation limitations
  • DSRIP project pricing
timeframes
Timeframes
  • June 15:
    • Finalize UC and IGT numbers
  • June 30:
    • Finalize DSRIP pricing strategy
    • Plan for 2012 DSRIP
  • August 31: RHP plan due to HHSC
  • October 31: RHP plan to CMS
next steps
Next Steps
  • Begin work on budget
    • Identification of available IGT
    • Put together actual UC numbers
  • Assist in developing pricing model for DSRIP projects
  • Continue to monitor and impact waiver issues with HHSC and CMS
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