1. Hospital Medicaid Rate Updates HFMA Seminar
February 1, 2017

2. Agenda Hospital Inpatient Medicaid Rate Updates Hospital Quality Pool
February 1,
Agenda
Hospital Inpatient Medicaid Rate Updates
January 1, 2016 Rates
January 1, 2017 Rates
Rebasing of Acute and Exempt Unit/Exempt Hospital Rates
Hospital Quality Pool
Hospital Sole Community Pool
Hospital Outpatient Medicaid Rate Updates
Questions

3. Hospital Inpatient Medicaid Rate Updates
February 1,
Hospital Inpatient Medicaid Rate Updates
January 1, 2016 Inpatient Medicaid Rates
Current Updates:
2016 Budgeted Capital
Actual Capital Updates – prospectively include retros for 12/1/09 – 12/31/13
Eliminate Potentially Preventable Negative Outcomes (PPNO) cuts from acute rates - prospectively include retro for 4/1/15 – 12/31/15)
No changes to the SIWs – continue with July 2014 weights/thresholds with v33 grouper
Medicaid Fee-for-Service rates: rate package currently awaits approval from the Division of the Budget
Medicaid Managed Care rates: still under discussion due to retroactive rate adjustments
Future Updates:
Restoration of Inappropriate Use of Services Reduction for Acute Statewide Base Price Calculation (including retro for 4/1/15 – 12/31/15) – SPA pending approval from the Centers for Medicare and Medicaid (CMS)
Acute Transition %’s – Update to -2.5% floor on losses and recalculate ceiling on gains

4. Hospital Inpatient Medicaid Rate Updates (cont’d)
February 1,
Hospital Inpatient Medicaid Rate Updates (cont’d)
January 1, 2017 Inpatient Medicaid Rates
Current Updates:
2017 Budgeted Capital
Minimum Wage Adjustments
Reconciliation
Eliminate Potentially Preventable Negative Outcomes (PPNO) cuts from acute rates
Continue with July 2014 weights/thresholds with v33 grouper until further notice weights/thresholds are in process and anticipated for release in July 2017 (to be implemented prospectively).
Medicaid Fee-for-Service rates: transmitted to eMedNY in cycle #2058, rates released to hospitals on 1/20/17
Medicaid Managed Care rates: still under discussion due to retroactive rate adjustments
Future Updates:
Restoration of Inappropriate Use of Services Reduction for Acute Statewide Base Price Calculation – SPA pending approval from the Centers for Medicare and Medicaid (CMS)
Acute Transition %’s – Update to -3.5% floor on losses and recalculate ceiling on gains

5. Hospital Inpatient Medicaid Rate Updates (cont’d)
February 1,
Hospital Inpatient Medicaid Rate Updates (cont’d)
Rebasing of Acute and Exempt Unit/Exempt Hospital Rates
Statutory requirement to update the cost base for the acute rates by 2018
Statute allows for exempt unit/exempt hospital rates to be rebased
2014 cost base anticipated for both sets of rates
All rates must be budget neutral
Minimum wage adjustments to continue through 2021

6. Hospital Quality Pool Years 1 and 2 (4/1/15 – 3/31/17)
February 1,
Hospital Quality Pool
Years 1 and 2 (4/1/15 – 3/31/17)
Distribution Methodology:
Year 1: $90.8M, Year 2: $87.8M
Pay for Reporting
Allocated based on 2014 Medicaid Fee-for-Service and Medicaid Managed Care days
$75,000 Minimum
Payment:
Hospitals to be paid by Medicaid Managed Care Health Plans
Payments anticipated for February/March 2017
Dependent upon Division of the Budget approval of the July 2016 premiums
Communications to hospitals will follow
Year 3 (4/1/17 – 3/31/18)
Quality measures and distribution methodology are currently under discussion

7. Hospital Sole Community Pool
February 1,
Hospital Sole Community Pool
Years 1 and 2 (6/1/15 – 3/31/17)
Distribution Methodology:
Year 1: $9M, Year 2: $12M
Pay for Reporting
Allocated based on 2014 Medicaid Fee-for-Service and Medicaid Managed Care days
Minimums vary depending upon total number of Medicaid days
Payment:
Hospitals to be paid by Medicaid Managed Care Health Plans
Payments anticipated for February/March 2017
Dependent upon Division of the Budget approval of the July 2016 premiums
Communications to hospitals will follow
Year 3 (4/1/17 – 3/31/18)
Distribution methodology is currently under discussion

8. Hospital Outpatient Medicaid Rate Updates
February 1,
Hospital Outpatient Medicaid Rate Updates
Ambulatory Patient Group (APG) Rate Updates
The following OASAS rates have been fully transitioned into APGs
OASAS Opiod Treatment Rates – retroactive to 1/3/11
OASAS Alcohol Clinic – retroactive to 10/1/10
OASAS Alcohol Rehab – retroactive to 1/1/11
Future updates
2016 Capital Updates for all Clinic and Emergency Room rates (2014 cost base)
2017 Capital Updates (2015 cost base) for all Clinic and Emergency Room rates– dependent upon completion of 2015 ICR audit
APG Survey (Managed Care Rates)
Both Managed Care Plans and Hospitals were surveyed (2009 – 2015 rate years)
Inconsistent results between the Plan and Hospital surveys
The Department is working with the hospital associations on a resolution

9. Questions?