DSH National Provider Call HFMA Education Session #3 February 21, 2013

1. DSH National Provider CallHFMA Education Session #3February 21, 2013 Presented by: Donna Anglin, FHFMA, MBA Principal Consultant 2552PROplus, LLC

2. 2552PROplus, LLC National Provider Call - Intro • Held January 8, 2013 • Goal • Solicit public comment • Review payment requirements under ACA • Present findings of consultant’s analyses • Presented by Dobson DaVanzo & Assoc. and KNG Health Consulting – consultants commissioned by CMS to provide technical assistance in implementing the new policy

3. 2552PROplus, LLC Scope of Work • Analyses of potential definitions and data sources for measuring the change in the uninsured and levels of uncompensated care

4. Estimates for the Uninsured • For FY 2014-2017, Sec. 3133 prescribes the use of uninsured estimates from the Congressional Budget Office • How good will these estimates be considering the decision of many states to opt out of Medicaid expansion under the ACA • For FY 2018 and onwards, other sources may be used 2552PROplus, LLC

5. Uninsured Data Sources • Five National Surveys were reviewed and compared • Current Population Survey – U.S. Census Bureau and Bureau of Labor Statistics • American Community Survey – U.S. Census Bureau • Survey of Income Program and Participation – U.S. Census Bureau • Medical Expenditure Panel Survey - Agency for Healthcare Research and Quality • National Health Interview Survey - National Center for Health Statistics 2552PROplus, LLC

6. What does “Uncompensated Care” Mean? • A literature review was undertaken as well as stakeholder interviews • As expected, variations were found in how existing programs and entities define uncompensated care • Charity Care and Bad Debt are always included in the definition • Some entities also include payment shortfalls from government funded plans 2552PROplus, LLC

7. Uncompensated Care • The most common definition of uncompensated care is: Bad Debt + Charity Care = Uncompensated Care 2552PROplus, LLC

8. Data Sources • Where can we pull the data? Several data sources were reviewed including: • AHA Annual Survey/TrendWatch • Publicly Available Hospital Financial Data (from State agencies) • Medicaid DSH Audit Data • IRS Form 990 (non-profit hospitals) • 2552-96 Medicare Cost Report • 2552-10 Medicare Cost Report 2552PROplus, LLC

9. 2552-10 • Of the data sources reviewed, the data reported on Worksheet S-10 on CMS 2552-10 is the only publicly available source that contains the Charity Care and Bad Debt data discussed earlier • Of course, improvements could be made - the AHA suggested several in their 10/10/12 comment letter • The S-10 data from the 2552-10 report WILL be available in time for CMS to develop the FY 2014 IPPS Proposed Rulemaking 2552PROplus, LLC

10. How Will the “New” DSH be Paid? • Several listeners on the call questioned how the payments would be made (by what mechanism) • Will the PC Pricerbe updated? • CMS declined to answer • All questions will be answered in the proposed rule 2552PROplus, LLC

11. FY 2014 Proposed Rule • There will be no preview of §3133 DSH policies as they won’t be released until the FY 2014 Proposed Rule is available 2552PROplus, LLC