1. RI MEDICAID PRICED BASED PAYMENT METHODOLOGY PRESENTED BY MONICA A. MOTTA, CPA

2. RI MEDICAID PRICED-BASED PAYMENT METHODOLOGY AGENDA 1.Overview of RI Priced Based System 2.Strategic Planning 3.Clinical Planning 4.Financial Planning

3. NEW CATEGORIES 1.Direct Care–Nursing 2.Direct Care-Other Labor 3.Indirect Care 4.Fair Rental Value 5.Real Estate and Property Taxes Health Care Provider Assessment (See handout for crosswalk)

4. NEW CATEGORIES This chart shows that, on average, 51% of each facilitys average daily Medicaid rate is based on their direct care nursing. NEW CATEGORIESAVERAGE NURSING HOME PAYMENT PERCENTAGE Direct Care- Nursing $100.4451.2% Direct Care – Other $23.7412.1% Indirect Care$53.5327.3% Fair Rental Value $15.69 8.0% Property Taxes$ 2.60 1.4% Total$196.00100.0%

5. NEW CATEGORIES Direct Care-Nursing: 101.54% of 2010 statewide median Direct Care-Other: 100% of 2010 statewide median Indirect Care: 93.48% of 2010 statewide median Fair Rental Value: facility specific Real Estate and Property Taxes: facility specific

6. STOP LOSS:DURING PHASE-IN PERIOD 5 YRS Phase-in period applied to policy adjustors There are two policy adjustors: 1 st policy adjustor - hold harmless for direct care 2 nd policy adjustor - cannot increase or decrease rate more than $5.00 per day.

7. STOP LOSS: DURING PHASE-IN PERIOD 5 YRS Facility Direct Care Change Indirect Care Change DC Policy Adjuster Gain/Loss Policy Adjuster Payment Change A ($20) ($3) $20 $0 ($3) B $2 $1 $0 C $2 $7 $0 ($4) $5 D$12 ($1) $0 ($6) $5 E($20) ($6) $20 $1 ($5)

8. PHASE IN PERIOD – THROUGH 9/30/2016 Phase in period 10/1/12-9/30/13 – 100% policy adjustor 10/1/13-9/30/14 – 75% policy adjustor 10/1/14-9/30/15 – 50% policy adjustor 10/1/15-9/30/16 – 25% policy adjustor October 1, 2016 – Fully phased in Inflation Factor

9. GROUPER - HIGHLIGHTS Rhode Island is using the 48 grouper model Grouper weights Rhode Islands weights for the 48 categories exceed the national average by approximately 8.4% We recommend you download the grouper

10. STRATEGIC PLANNING IDEAS Gather your management team Status quo Target specific residents (be careful)

11. STRATEGIC PLANNING IDEAS Number of Bed Facility Occupancy % BDP Medicaid CMI Average Rate Revenue Medicaid A 10092%33,5801.00$207.00$6,950,000 B 10089%32,4851.05$216.00$7,017,000 C 10089%32,4851.10$211.50$6,870,000

12. STRATEGIC PLANNING IDEAS Business Model Repositioning Revenue enhancement Cost containment Long-Range Planning Software Upgrades Physical Upgrades

13. STRATEGIC PLANNING IDEAS Whether you choose to do nothing or change your facilitys focus, the key to success is monitoring … both clinically and financially.

14. CLINICAL PLANNING MDS personnel key Know weights associated with categories Quality incentives are coming Think outside the box MONITORING, MONITORING, MONITORING

15. FINANCIAL PLAN 51% of Medicaid rate is based upon the MDS information and the acuity of resident 49% of Medicaid rate is based upon other factors Know those factors Compare your facility to determine financial plans and goals Every facility is different Utilize financial tools

16. OUR COMMITMENT TO YOU We have developed a RI facility database Reflects new model Annual nursing home analysis

17. WRAP UP There is life after the price-based system! Monica A. Motta, CPA mmotta@SullivanCPA.com