CC/CCEC STAKEHOLDER MEETING Friday, September 1, 2017 1:00 PM 2:00 - - PowerPoint PPT Presentation

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CC/CCEC STAKEHOLDER MEETING

Friday, September 1, 2017 1:00 PM – 2:00 PM

Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 11th Floor Rooms A&B.

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Overview of Meeting

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GROUND RULES FOR WEBINAR

• WE WILL BE RECORDING THIS WEBINAR
• We are going to try to avoid muting the phone lines to encourage

conversation, so please don’t:

• Put us on hold
• Drive in your car w/window open while listening
• Sit in a noisy location
• Please speak clearly when asking a question and give your name and

hospital

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Welcome & Introductions

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Purpose of Meeting

The purpose of this meeting is to share information regarding upcoming changes to how the Department will classify medical providers that are licensed by CDPHE as a Community Clinic or a Community Clinic with Emergency Centers (CC/CCEC).

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Purpose of Meeting

• Make you aware of planned creation of a new provider type
• Share our expectations of providers once the new provider type takes effect
• Provide you with time and opportunity to suggest, for example, additional

non-claims-based data sets the Department should consider evaluating post-change

• Solicit from you data sets that may assist us in creating an appropriate

provider payment methodology post-change

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Background

• Currently CC/CCEC entities are allowed to bill for services as a

hospital under the ID of the hospital with which they are associated.

• CDPHE licenses these entities separately from a hospital.
• Those entities that are not associated with a hospital may bill as

Clinics.

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New Provider Type

• The Department plans to create a provider type specifically for Hospital

Affiliated/CMS Certified CC/CCEC entities that may then participate in the Medicaid program.

• The Department will gather data post-change in order to create a

payment methodology that differs from the current hospital methodology.

• The proposed provider type will be paid using the Enhanced

Ambulatory Patient Grouper payment methodology similar to the way

• utpatient hospital services are paid (UB-04 claim type)
• Independent professionals that provide professional services will be

paid separately (CMS 1500 claim type)

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Regulatory Steps

• The Department must submit a State Plan Amendment to the Centers

for Medicare and Medicaid Services (CMS) ➢ CMS has 90 days to either approve, deny, or request additional information

• Once the SPA is approved, new Department rules that define the

provider type and scope of services will be submitted to the Medical Services Board (MSB) for approval ➢ The MSB meets on the second Friday of each month. ➢ Usually, a rule is approved upon second reading and becomes effective the last day of the month following the approval date.

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Provider Payment

• For the time being, you are going to be reimbursed at the same rates as

hospitals. ➢ In the future, we will be looking at a different reimbursement methodology that reflects actual services provided at these facilities and the costs incurred in providing this care. ➢ This will be a data-driven process, during which we will need your participation and input.

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Ask

• Please provide us with the names, locations and affiliations of all those

CC/CCEC entities you represent, and whether those entities are Medicare certified to be recognized as part of a hospital. ➢ If you are able to collaborate to create a single list prior to sending, we welcome that approach. ➢ Please email Ana Lucaci, ana.lucaci@state.co.us with this information.

• Please provide any additional non-claims-based data sets you believe reflect

actual services provided at these facilities and the costs incurred in providing this care, for Department consideration when developing a reimbursement methodology.

Questions and Discussion

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Thank You!

Ana Lucaci Hospital Policy Specialist Ana.Lucaci@state.co.us Richard Delaney Physician Services Policy Specialist Richard.Delaney@state.co.us Kevin Martin Fee for Service Rates Manager Kevin.Martin@state.co.us Kimberley Smith Compliance & Stakeholder Relations Unit Manager Kimberley.Smith@state.co.us