ACUITY-BASED MEDICAID REIMBURSEMENT Lessons learned in RI

This is no Ghost Story Patient-specific Medicaid reimbursement started in RI in 2012 There are rumblings that CT could be next 2

Why the change? Risk sharing arrangements are leading the change Goal – To deliver appropriate care in a cost effective manner, while sharing reimbursement in a way that recognizes: Illness and Efficiencies 3

What could change? Current rates: CCNH and RHNS rates Fixed reimbursement rates based on allowable costs In place for an entire rate year Future rates: Multiple rates using various acuity levels 4

48 RI Medicaid RUGs Daily rates varies based on CMI (acuity) Direct care component is the variable Initially based at $ Financial impact: CMI Direct Care Component Per Diem Impact 1.0$ $49.32($51.12) 3.276$329.04$

Focus Areas This will not be business as usual. Impact areas include: Cash flow Development of expectations Review and approval processes Monitoring 6

Focus Areas 7 Need to work collaboratively Interface of clinical record and billing information, coupled with Mid-month acuity changes Leads to proper revenue recognition

MDS data is critical Evaluations Routine – every 92 days Significant change – at the time it occurs Control the process Be aware of upcoming evaluation due dates and post them weekly for nursing awareness Review, revise (and educate staff), approve, submit 8

MDS data is critical Evaluate each result Does it make sense? Does it match expectations? Are there any missed opportunities? If so, make this a focus area. 9

Software Readiness RUGS loaded Clinical interface Mid-month acuity Data accuracy review 10

Software 11 Revenue recognition process Interface of clinical record and billing information Mid-month acuity changes Revenue recognition

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