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Published byJocelin Watkins Modified over 10 years ago
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May 10, 2012
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Committee charter Understand waiver funds flow IGT fundamentals UC pool payments DSRIP pool payments Timeframes Begin work on RHP budget 2
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Intergovernmental Transfer (Public Funds) Uncompensated Care Pool (UC) RHP Membership Required Each Provider’s Costs * Uninsured * Medicaid Shortfall Reduced by payments Cost Based Payment Delivery System Reform Incentive Payment Pool (DSRIP) RHP Membership Required Each Provider’s Projects Chosen from Menu Performance Metrics Met Incentive Payment State/Local Funds (42%) Federal Match (58%) 3
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Intergovernmental Transfers ◦ Federal Government matches state/local funds spent on the Medicaid program Approximately 42% state/local Approximately 58% federal Expect that FMAP rate changes over the life of the waiver IGT providers ◦ Hospital districts ◦ Counties ◦ MHMRs ◦ Medical schools ◦ Other government? 4
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State/local share must be public funds ◦ Taxes ◦ Commercial insurance receipts ◦ Investment income ◦ Qualified donations ◦ Other non-Federal ◦ Other? Cannot be receipts from delegation of a governmental duty Spreadsheet available for use by potential IGT entities 5
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Eligibility for pool payments ◦ RHP membership ◦ UC application filed Eligible entities ◦ Hospitals ◦ Physician practices ◦ Government ambulance providers ◦ Governmental dental providers ◦ Other providers in rural RHPs with no public hospital IGT must be provided by governmental entity 6
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Qualified amounts – based on data from 2 years prior to payment year ◦ Costs related to providing care to persons with no third party coverage ◦ Medicaid shortfall For services covered by Medicaid ◦ Inpatient/outpatient (DSH cap calculation) ◦ Physician and mid-level services ◦ Outpatient drugs ◦ Physician practices 7
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Necessary data elements ◦ Medicaid and uninsured charges by Medicare cost center ◦ Medicaid and uninsured days by Medicare cost center ◦ Medicaid cost to charge ratios ◦ Medicaid payments DSH FFS and managed care ◦ Patient payments ◦ Any other payment made on behalf of the patient 8
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UC payments classified as Medicaid payments Total payments received for uninsured and Medicaid cannot exceed costs for providing services Process description document at end of this document Spreadsheets we used are available 9
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Payment is incentive based – unrelated to cost Eligibility for pool payments ◦ RHP membership ◦ Participation in transformation projects Eligible entities – any health care entity participating in DSRIP projects 10
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IGT must be provided by governmental entity Performance metrics must be met in order to receive payment Not considered a Medicaid payment 11
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UC Tool completion ◦ Contracted services issue ◦ Tobacco funds ◦ Adjustments to cost report numbers Pool allocations IGT – conversion of private funds to public funds ◦ Provider donation limitations DSRIP project pricing 12
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June 15: ◦ Finalize UC and IGT numbers June 30: ◦ Finalize DSRIP pricing strategy ◦ Plan for 2012 DSRIP August 31: RHP plan due to HHSC October 31: RHP plan to CMS 13
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Begin work on budget ◦ Identification of available IGT ◦ Put together actual UC numbers Assist in developing pricing model for DSRIP projects Continue to monitor and impact waiver issues with HHSC and CMS 14
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