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FY 2013 Medicaid Budget Overview

FY 2013 Medicaid Budget Overview. Medicaid Advisory Committee January 23, 2012. FY 2013 Medicaid Budget Allowance. Provider Reimbursement …. $7 B ($2.5B GF, .9M SF) MCHP ………………………. $200 M ($ 64.2M GF) Kidney ………………………. $11.9 M ($8.5M GF) Administration ……….…….. $103 M ($ 24.9M GF)

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FY 2013 Medicaid Budget Overview

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  1. FY 2013 Medicaid BudgetOverview Medicaid Advisory Committee January 23, 2012

  2. FY 2013 Medicaid Budget Allowance • Provider Reimbursement …. $7 B ($2.5B GF, .9M SF) • MCHP ………………………. $200 M ($ 64.2M GF) • Kidney ………………………. $11.9 M ($8.5M GF) • Administration ……….…….. $103 M ($ 24.9M GF) • Total ………………….....….. $7.3 B ($2.6B GF, .9M SF) 3% increase or $ 238M TF increase over FY 2012 appropriation

  3. FY 2013 Allowance Additions (GF) • Increase in funding for OAW slots …………..……….. $4.5M • Increase in funding for LAHW slots …………..……… $4.5M • Increase in NH rates by 1% …………………………….$5.5M • Increase in Community Provider rates by 1.5% ………..$2.8M • Physician fee increase to bring E&M codes up to………$17M Medicare levels per Federal guidelines • Allocation of funds for internal staff to support implementation of a new MMIS system ………............ $0.5M

  4. FY 2013 Allowance Additions (GF) cont’d • Additional funds for MHCC’s Primary Care …………$.7M Medical Home project • Fund the Chronic Health Home project …………...… $1.5M • Additional funds for personal care services………... ..$2.6M through use of funding available from eliminating the Nursing Facility bedhold payments • Keep PAC open……………………………………….$7.4M

  5. Cost Containment and Adjustments Included in FY 2013 Allowance (GF) • MCO 1% reduction ……………………………..… $15.9 M • Accelerate the MCO MLR recovery to 100% ……. $3M • Reduce the medically needy inpatient hospital benefit package …………………………………. $36M • Implement tiered outpatient rates which means different rates for different types of services …… $30M • Implement a DSH pool …………………………... $9.1M • Continue freeze in rates for DC and non HSCRC hospitals ………………………………………… $1.5M

  6. Cost Containment and Adjustments Included in FY 2013 Allowance (GF) cont’d • Eliminate NH communicable disease ………………. $5.8M care payments • Reduce durable medical equipment payments to 90% of Medicare …………………………………$1M • Implement the In Home Supports Assurance Program. $2.8M • Move ESRD to Medicare ……………………………..$1M • Identify dual eligibles and apply for Medicare ………. $1M • Review denied Medicare services which should not be billed to Medicaid ………………………... $1M

  7. Cost Containment and Adjustments Included in FY 2013 Allowance (GF) cont’d • Move MCHP eligible children from Medicaid ……. $1.5M • Continue SSI project with DHR which compares SSI recipients with the federal approved lists ………………………………… $3.6M • Pharmacy initiatives in the area of antipsychotic medications (i.e., improve use of generics; dose optimization; and new peer to peer UR) ………..….. $5M

  8. Increase in Provider Assessment Rates • Nursing Home increased from 5.5% to 6% …………………………. $5.5 M • New Medical Day Care of 5.5% ……………………………… $3.4 M

  9. Thank you, members of MAC • Your work, last fall, directly led to: • Major rebalancing initiatives • Savings in areas of DME, DMS • Improved approach to hospital OPD • Elimination of communicable disease add-on • Protecting PAC eligibility • Investment in Chronic Health Home • Accountability of ISAS

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