CO EMS Supplemental Payment Stakeholder Meeting Presented by: The - - PowerPoint PPT Presentation

CO EMS Supplemental Payment

Stakeholder Meeting

Presented by: The Department of Health Care Policy and Financing (Department) and Public Consulting Group (PCG).

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April 4, 2019

Our Mission

Improving health care access and

• utcomes for the people we serve

while demonstrating sound stewardship of financial resources

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Agenda

• Introductions
• CO EMS

S upplemental Payment Overview

• Annual Cost Report Overview
• CO EMS

S upplemental Payment Training Frequently Asked Questions (FAQ)

• Feedback and Discussion

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Introduction: Department

The Department will administer the CO EMS S upplemental Payment, communicating with Centers for Medicare and Medicaid S ervices (CMS ) to disburse supplemental payments to EMS providers.

• S

hannon Huska

• S

hawn S tanifer

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Introduction: PCG

PCG is the third party assisting public EMS providers with CO EMS S upplemental Payment activities on behalf of the Department.

• James Dachos
• Garrett Abrahamson
• Miles Brown
• Damia Mendoza

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CO EMS Supplemental Payment Overview

• Situation of EMS Providers

Typically, the rate at which Medicaid transports are reimbursed is 25%

• r less of the actual cost to the

providers. Payment rates do not recognize the actual costs incurred by providers for the provision of EMS services.

• This requires municipalities and counties to use

alternative funding sources to supplant the costs, such as the allocation of taxes and fees.

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Supplemental Payment Overview

A voluntary, ongoing reimbursement opportunity for public ambulance providers to recover additional payment revenue for EMS delivered to Health First Colorado beneficiaries.

• Created as a means to reduce the gap of low Medicaid

reimbursement rates.

• Providers will prepare and submit a cost report for the

total actual, incurred Medicaid costs/ expenditures annually, for the state fiscal year (July 1 – June 30).

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Federal Medical Assistance Percentage (FMAP)

• S

ince Medicaid is a j oint federal and state program, each entity is responsible for its share of costs. The state share is financed by the provider as expenses already incurred by the provider.

• For example: If it costs a provider $100 to transport a

patient; and the FMAP for the state is 50% , the S tate/ provider is responsible for $50, and the Federal Government is responsible for $50.The state portion ($50) will be financed by the provider as expenses already incurred by the EMS provider through a Certified Public Expenditure (CPE).

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Key Steps to the Supplemental Payment

• Providers complete and certify the Annual Cost Report

that captures the total cost of the providers for providing EMS services.

• The Annual Cost Report calculates the total Medicaid

allowable costs and the federal share of these costs that have not been reimbursed through Health First Colorado billing.

• Department draws FMAP and disburses the calculated

federal share of the settlement to providers.

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Supplemental Payment Estimate

• The following estimate to be presented is j ust an

example of a fire-based EMS provider settlement

• calculation. It should not be used for budgeting.
• Note that several variables will affect the Annual

S ettlement (total Health First Colorado transport percentage is one of them).

• Providers will receive both, the Health First Colorado

Paid Claims and the S upplemental Payment.

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Sample Calculation

Samples Fiscal Year Sample Fire-Based EMS Provider Total Expenditures *Includes appropriation, depreciation and indirect costs $ 8,000,000.00 EMS / Medical Percentage (CAD Allocation) *Not applicable to only EMS providers whose percentage will be 100 75% Total Health First Colorado Transportation S ervices (MTS ) $ 6,000,000.00 Total Transports 5,000 Cost per Transport $ 1,200.00 Total Health First Colorado Transports (5% ) 250 Total Cost of Providing Health First Colorado Transports $ 300,000.00 Health First Colorado Paid Claims $ 75,000.00 FMAP Application (FY 2018-19) 50% Total Computable $ 112,500.00 S tate Administration of Program (10% ) $ 11,250.00 Projected Annual Settlement $ 101,250.00

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Important Dates

Y ear 1 (6 months) Y ear 2 (12 months) Y ear 3 (12 months) Cost Reporting Period Begins 1/ 1/ 2018 7/ 1/ 2018 7/ 1/ 2019 Cost Reporting Period Ends 6/ 30/ 2018 6/ 30/ 2019 6/ 30/ 2020 Timely Filing Limit 6/ 30/ 2019 6/ 30/ 2020 6/ 30/ 2021 Claims Data Reconciliation and Supplemental Payment 9/ 30/ 2019 9/ 30/ 2020 9/ 30/ 2021

The Department allowed for providers to retroactively capture half of the 2018 cost reporting period. For this reason, Year 1 (6 months) has a quick turnaround.

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Annual Cost Report Overview

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Data Collection

The S upplemental Payment data collection requirements are designed to utilize reports and materials that most providers prepare for

• ther purposes.

# Item Description 1 Expenditures (as reported Audited Financial Statements,

• r in most updated financials )

Annual detailed actual expenditures broken

• ut by cost center.

2 Depreciation Asset number, description, date placed in/ out

• f service, useful life, and cost for assets used.

3 Computer Aided-Dispatch System (CAD) Information (other forms of call reporting are acceptable, too) CAD data for medical and fire/ other responses. 4 Indirect Cost Rate Proposal (if applicable) Cost Allocation Plan or Indirect Cost Rate proposal from the provider's county/ city/ town to incorporate additional overhead costs. 5 Summary Billing Gross revenues for all payer types, except Health First Colorado. Total number of trips throughout reporting period. 6 Federal Funds (if applicable) Award documentation and other supporting information regarding federal funds expended.

Cost Report Certification

• Providers need to electronically certify costs at the

bottom of the Final S ettlement tab on the Ambulance S ervice Cost Report (AS CR) portal.

• Participating providers are responsible for the accuracy
• f reported costs and supporting documentation.
• Note that due to timing, providers will not see an

accurate final settlement amount because their Fee- For-S ervice (FFS ) payments will not be incorporated

• yet. The FFS

data will be entered after providers certify their costs.

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Desk Reviews

• In order to ensure accuracy and completeness of each

cost report, desk reviews occur after all cost reports have been certified.

• Desk reviews help protect providers from federal audits

and potential pay-back situations. During the desk review, all provider responses to triggered warnings and thresholds will be reviewed and clarifying follow up questions may occur.

• Once all questions have been resolved, providers will

receive an email indicating that their desk review is complete and no further questions are warranted.

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Certified Public Expenditure (CPE)

• Upon completion of the electronic Cost Report

certification (due April 30th), and the Desk Review process, providers will need to download, sign and upload the CPE form under the Cost Report Certification tab on the AS CR portal.

• The CPE form will contain the Annual Cost S

ettlement.

• Needs to be signed and uploaded on the AS

CR portal in August-S eptember to receive a supplemental payment.

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Year 1 Timeline

JAN 2019

• Program

Kickoff FEB – MAR 2019

• Cost Reporting

Trainings APR 30, 2019

• Providers submit cost

report data

• Providers certify costs

MA Y 2019

• Desk Reviews Occur
• Providers provide

variance explanations JUL- AUG 2019 S EP 2019

• S

upplemental payments dispersed AUG-S EP 2019

• Final signed

CPE reports collected

• Cost Reports

re-released to providers.

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Supplemental Payment Training FAQs

Program Overview

Q: What is the funds limit for the CO EMS S upplemental Payment? A: There is no funding limit. The CO EMS S upplemental Payment will reimburse providers on all actual allowable costs incurred providing EMS to Health First Colorado patients. Q: Can I leave the program at any time? A: Yes, the participation in the CO EMS S upplemental Payment is voluntary and providers can drop out of any reporting year at any point before submitting their CPE.

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Allowable Transport

Q: What constitutes as an EMS transport that a provider can report? A: Any call that results in a medical transport for a Health First Colorado beneficiary.

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Data Collection

Q: If my provider operates on a calendar year, how do I align with the S tate Fiscal Year (S FY)? A: The preferred approach is to use your reporting system and pull reports on the given S

• FY. If this is not possible,

you may pro-rate the two respective calendar years accordingly. Q: For hospital-based EMS providers, do we need to report the entire hospital’ s financials? A: No, hospital-based providers only need to use financials for the actual EMS department or division.

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Expenditure Allowable Categories

Q: What do I do if I have an expenditure that doesn’ t fit in

• ne of the allowable cost categories?

A: The AS CR allows users to manually create a new

• category. This button is found at the bottom of each

category (S alaries, Fringe, Benefits, etc.). Click on “ Add a Row” at the bottom of each table. Additionally, there is a category labeled “ Other” if that is more appropriate. Note that if a user needs to add a row on the Non-MTS Expense and Expense Allocation tabs, it needs to be added under the MTS Expense tab and it will be carried over.

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Expenditures

Q: How can I report expenses related to volunteers? A: Providers can manually create an entry for volunteers

• r include the amount under the salary of the title that

seems most appropriate. Q: Can I still report expenses although they have not yet been audited? A: Yes, providers can use the most up-to-date finances to report expenditures.

Allocation Plan

Q: My hospital has an allocation plan in place for Administrative & General (A&G) Expenses. Can we add those amounts on the MTS Expense tab instead of Expense Allocation? A: Yes. If the actual expenditure amounts incurred by the provider appear on the supporting documentation this is an allowable cost.

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Allocation Statistics

Q: Does Computer Aided Dispatch (CAD) data need to include Fire calls? A: Yes. If you are mixed-use provider that provides both Fire and EMS , you must include ALL calls that took place throughout the reporting period. If a provider is 100% EMS , all calls will be coded as MTS . Q: Is pre- and post-time included in the CAD report? A: No. Only the time spent on the call should be included in the supporting CAD documentation.

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Q: How do we report an instance in which we go out on a Fire call and end up transporting a Health First Colorado patient? A: Your S upplemental Payment final settlement only factors in billable and paid transports for Health First Colorado claims. Q: What if my provider does not use a CAD? A: While CAD system reports is the preferred method, other methods of dispatch reporting can be used to calculate the total amount of time for all calls.

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Allocation Statistics

Depreciation

Q: Can capital purchases made before the first Annual Cost Report period be reported? A: Yes, providers need to report the depreciation leger as it stands and the AS CR portal will calculate the depreciable amount for the current cost reporting period.

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Reporting Grants

Q: Do grants need to be EMS related? A: If your provider received any federal funding (i.e. S AFER, FEMA, AFG, etc.) during the respective cost reporting period, you must make the necessary adj ustment on the Reclass & Adj ustments page. Q: Do I need to include grants that are for Fire only? A: Yes. All federal grants that were awarded to the provider need to be reported.

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Q: Do I need to report state grants on the Reclass & Adj ustments page? A: No. Only federal grants or funds require an adj ustment. Q: Do I need to report amount awarded or spent from grants? A: Providers must report the amount of the Federal grant that was expended in the relevant reporting period.

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Reporting Grants

Revenues

Q: Do I need to report Gross or Net revenue? A: Yes, providers need to report gross revenues. Q: Do I need to report Non-MTS revenue too? A: Yes, all revenues should be reported for transports on the Revenues tab. Any additional revenues received beyond the identified categories can be manually added by creating a new revenue row to capture those.

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Final Settlement

Q: How are the total number of Health First Colorado claims calculated? ? A: The total Health First Colorado claims will come from the Department’ s Medicaid Management Information S ystem (MMIS ) system, and the total number of transports you report on the Final S ettlement page will be subtracted from that.

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Supporting Documentation

Q: What kind of supporting documentation do I need to provide? A: A system generated expenditures file, or a summary of all expenses will suffice. Providers do not need to upload individual files for every expenditure reported.

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Cost Report Certification

Q: Is my Chief the only one who can complete and certify the cost report? A: No. Additional users can be granted access to the AS CR. An authorized signatory should be someone with Medicaid signature authority and is likely a Town Manager/ Administrator, CFO, Treasurer, Fire Chief, EMS Director, and other personnel authorized to enter legal agreements on behalf of the provider or municipality.

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Desk Reviews

Q: Can I edit my reported costs during the Desk Review process? A: The system will not allow users to edit any tabs once costs have been electronically certified on the Final S ettlement tab. However, the system has the ability to re-open cost reports after the Desk Review process ends. This will allow users to make cost report edits. Once all edits are made, the cost report will have to be re- certified.

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Additional Resources

The ARCR portal Dashboard contains the following resources:

• Ambulance S

ervice Cost Report Portal User Guide, along with a list FAQ’ s.

• Power Point presentation from March trainings.

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Contacts

On-Going Cost Reporting Support 877-775-3867 COEMS supplemental@ pcgus.com Shawn Stanifer Rate/Financial Analyst at the Department 303.866.5474 S hawn.S tanifer@ state.co.us

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Thank You!

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