FFY 2018-19 CHASE Fees and Payments Nancy Dolson, Special Financing - - PowerPoint PPT Presentation

FFY 2018-19 CHASE Fees and Payments

Nancy Dolson, Special Financing Division Director

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Improving health care access

and outcomes for the people we serve while demonstrating sound stewardship of financial

resources

Our Mission

Fee from Hospitals Increased Payment to Hospitals Expanded Coverage to Colorado Citizens Federal Match from CMS

Administrative/Other

Cash Fund (Fee + Federal Match)

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CHASE Goals

• Maximize the inpatient and outpatient hospital

reimbursements to up to the upper payment limits

• Increase hospital reimbursements under the Colorado Indigent

Care Program to up to one hundred percent of the hospital's costs of providing medical care under the program

• Determine changes that increase number of hospitals

benefitting from the fee or minimize number of hospitals that suffer losses as a result of the fee

• Meet federal requirements

FFY 2018-19 CHASE Overview

• $931.4 million CHASE fees

➢ $917.9 million to be collected at 5.47% of the estimated net patient revenue (NPR) ▪ Limited by Upper Payment Limit (UPL) ➢ $13.5 million to be used from the cash fund reserve

• $1.3 billion in hospital supplemental payments including

$90.4 million in quality incentive payments ➢ UPL at 97% ➢ Disproportionate Share Hospital (DSH) Limit

• $410.2 million in net reimbursement

Net reimbursement reflects direct supplemental payments paid to hospitals minus total CHASE fees and does not include revenue received by hospitals via claims paid for expansion populations

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2018-19 CHASE Fees and Payments

Expenditures Cash Fund Federal Fund Total Fund

IP Base Rate Supplemental Payment $236,000,000 $236,000,000 $471,900,000 OP Supplemental Payment $222,400,000 $222,400,000 $444,800,000 Uncompensated Care Supplemental Payment $54,000,000 $54,000,000 $108,000,000 DSH Supplemental Payment $106,400,000 $106,400,000 $212,900,000 HQIP Supplemental Payment $45,200,000 $45,200,000 $90,400,000 Total Supplemental Payment $664,000,000 $664,000,000 $1,328,000,000 MAGI Parents/Caretakers 60-68% FPL $12,500,000 $12,500,000 $25,000,000 MAGI Parents/Caretakers 69-133% FPL $15,400,000 $198,600,000 $214,000,000 MAGI Adults 0-133% FPL $105,000,000 $1,326,700,000 $1,431,800,000 Buy-In for Adults & Children with Disabilities $40,300,000 $40,300,000 $80,700,000 Twelve Month Continuous Eligibility for Children $24,300,000 $24,300,000 $48,600,000 Non-Newly Eligible $11,400,000 $52,900,000 $64,300,000 CHP+ 206-250% FPL $10,700,000 $59,500,000 $70,200,000 Rate Adjustments/BHO Incentive Payments $1,200,000 $2,300,000 $3,500,000 Medicaid Expansion $221,000,000 $1,717,200,000 $1,938,200,000 Administration $30,600,000 $55,900,000 $86,500,000 Transfer to General Fund – 25.5-4-402.4 (5)(b)(VII) $15,700,000 *$0 $15,700,000 Total Other Expenditures $46,300,000 $55,900,000 $102,200,000 Cash Fund Reserve $0 $0 $0 Grand Total $931,400,000 $2,437,100,000 $3,368,500,000 *Federal funds drawn from the transfer to the General Fund are not shown

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Return on CHASE Fee

• $931.4 million generates $2.4 billion in federal funds, a

267% return on investment

• Administrative expenditures ($86.5 million) are 2.6% of total

CHASE expenditures ($3.4 billion)

• Administrative expenditures include the following

➢ Staff costs, legal services, accounting, etc. ➢ Contracted services, including utilization management and external quality review ➢ IT systems (i.e., eligibility and claims) and staffing for the customer contact center for more than 450,000 covered lives

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Net Reimbursement

• Net Reimbursement increase due to:

➢ $27 million in new funds from fee used from the cash fund reserve ➢ Expected caseload decrease offsets increase in expenditure due to a reduction in the expansion federal matching percent from 94% to 93% in January 2019

Item 2017-18 2018-19 Difference Supplemental Payments (Total Funds) $ 1,301,633,071 $ 1,328,099,058 $ 26,465,987 Fee (Cash Funds) $ 894,541,590 $ 917,879,440 $ 23,337,850 Net Reimbursement1 $ 407,091,481 $ 410,219,618 $ 3,128,137

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Net reimbursement reflects direct supplemental payments paid to hospitals minus total CHASE fees and does not include revenue received by hospitals via claims paid for expansion populations

Net Reimbursement Increase

Row Item Value Calculation Row 1 Increase in CHASE Fee $23,337,850 Row 2 Fee from Cash Fund Reserve $13,500,000 Row 3 Total Increase in Additional Funds $36,837,850 Row 1 + Row 2 Row 4 Expansion Expenditure Increase due to FMAP Reduction $27,360,066 Row 5 Expansion Expenditure Decrease due to Caseload Reduction ($19,530,492) Row 6 Administration Expenditure Increase $3,797,072 Row 7 Decrease in Cash Funds Reserved ($5,594,064) Row 8 Fee Adjustments for Hospitals Removed from CHASE $1,514,613 Row 9 Total Increase in Expenditure $7,547,195 Sum Rows 4 - 8 Row 10 Funds Available for Supplemental Payments (Cash Fund) $29,290,655 Row 3 – Row 9 Row 11 Funds Available for Supplemental Payments (Total Fund) $58,581,310 Row 10 * 2 Row 12 DSH Reduction Elimination (from Cash Fund Reserve) $35,304,550 Row 13 Payment Adjustments for Hospitals Removed from CHASE ($3,189,938) Row 14 Remainder of Available Funding $711 Row 15 Net Reimbursement Increase $3,128,137 Row 11 – Row 1 – Row 12 – Row 13 – Row 14 9

Net reimbursement reflects direct supplemental payments paid to hospitals minus total CHASE fees and does not include revenue received by hospitals via claims paid for expansion populations

CHASE Fee

OP NPR Limit IP NPR Limit

IP Fee OP Fee Days Charges CHASE Fees

Payers include: ✓ General Acute ✓ Critical Access ✓ Pediatric Fee exempt: ✓ Rehabilitation ✓ Long Term Care ✓ Psychiatric

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CHASE Fee

• Inpatient fee assessed on managed care & non-managed care

days ➢ Inpatient fee ▪ Per non-managed care day: $416.07 ▪ Per managed care day: $93.07

• Outpatient fee assessed on percentage of total Outpatient

charges ➢ Outpatient fee ▪ Percentage of total charges: 1.8119%

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Supplemental Payment Overview

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Inpatient Base Rate Supplemental Payment

• Increase rates for inpatient hospital services for Medicaid

members

• Total Payments: $471.9 million
• Inpatient Base Rate Payment = Medicaid rate before add-ons

* inpatient percentage adjustment factor * estimated Medicaid discharges * case mix

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Outpatient Supplemental Payment

• Increase rates for outpatient hospital services for Medicaid

members

• Total Payments: $444.8 million
• Outpatient Payment = estimated Medicaid outpatient cost *
• utpatient percentage adjustment factor

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Uncompensated Care Supplemental Payment

• Reimbursement to hospitals providing services to the

uninsured

• Total Payments: $108.0 million

➢ $15.0 million distributed to qualified Essential Access hospitals, based on proportion of beds ➢ $93.0 million distributed to all other qualified Non Essential Access hospitals, based on proportion of uninsured cost

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DSH Supplemental Payment

• Reimbursement to hospitals providing services to the

uninsured

• Total Payments: $212.9 million
• Most qualified hospitals capped at 96% of their estimated DSH

limit ➢ A Pediatric Specialty hospital’s DSH Supplemental Payment equals 45% of their estimated DSH limit ➢ A Respiratory hospital’s DSH Supplemental Payment equals 75% of their estimated DSH limit ➢ A new CICP hospital’s or a low Medicaid hospital’s DSH Supplemental Payment equals 10% of their estimated DSH limit

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HQIP Supplemental Payment

• Reimbursement to hospitals providing services that improve

health care outcomes

• Total Payments: $90.4 million
• Quality measures and payment methodology approval

concluded by the CHASE Board on February 27, 2018

• HQIP Payment = % of normalized eligible points * Medicaid

Adjusted Discharges * dollars per-adjusted discharge point

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UPL Pools

UPL Pools

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IP UPL Pools

68% 57% 47% 1% 1% 3% 4% 9% 5% 6% 13% 5% 17% 17% 37% 3% 3% 3%

STATE NON-STATE PRIVATE IP FFS Base Non-CHASE HQIP UCC IP UPL Gap

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YOY IP UPL Change

17-18 18-19 17-18 18-19 17-18 18-19 IP FFS Base Non-CHASE HQIP UCC IP UPL Gap

State Non-State Private

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State Government IP UPL Pool

Row Description FFY 17-18 FFY 18-19 Unit Change Notes

Row 1 UPL $ 124,200,000 $ 136,340,000 $ 12,140,000 Row 2 IP FFS Base $ 100,500,000 $ 92,250,000 $ (8,250,000) Row 3 Non-CHASE $ 1,330,000 $ 1,650,000 $ 320,000 Row 4 Remaining Funds $ 22,370,000 $ 42,440,000 $ 20,070,000 Row 1 - Row 2 - Row 3 Row 5 UCC $ 8,670,000 $ 8,450,000 $ (220,000) Row 6 HQIP $ 7,530,000 $ 6,060,000 $ (1,470,000) Row 7 IP $ 1,950,000 $ 23,790,000 $ 21,840,000 Row 8 Total $ 119,980,000 $ 132,200,000 $ 12,220,000 Sum Row 2, 3, 5, 6, 7 Row 9 Percent of IP UPL 97.00% 97.00% 0.36% Row 8 / Row 1

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OP UPL Pools

53% 62% 59% 44% 36% 38% 3% 3% 3%

STATE NON-STATE PRIVATE OP FFS Base OP UPL Gap

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YOY OP UPL Change

17-18 18-19 17-18 18-19 17-18 18-19 OP FFS Base OP UPL Gap

State Non-State Private

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Percent Adjustment Changes

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UPL Group UPL Pool 17-18 IP % Adjustment Factor 18-19 IP % Adjustment Factor Unit Change 17-18 OP % Adjustment Factor 18-19 OP % Adjustment Factor Unit Change Rehab/Long Term Acute All 7.00% 5.00%

• 2.00%

7.00% 5.00%

• 2.00%

State Teaching State Gov. 2.02% 24.42% 22.40% 47.72% 48.30% 0.58% Non-State Gov. Rural/CAH Non-State Gov. 101.00% 82.00%

• 19.00%

60.00% 76.25% 16.25% Non-State Gov. Teaching Non-State Gov. 15.45% 3.00%

• 12.45%

15.00% 3.00%

• 12.00%

Non-State Gov. High Volume Medicaid CICP Non-State Gov. 32.00% 44.50% 12.50% 31.90% 35.65% 3.75% Non-State Gov. Non-Denver Metro Non-State Gov. 124.00% 87.52%

• 36.48%

47.25% 55.00% 7.75% Non-State Gov. Non-State Gov. 55.00% 9.30%

• 45.70%

47.60% 10.62%

• 36.98%

Private Self-Reported Private Null 8.00% 0.00% Null 8.00% 0.00% Private Rural/CAH Private 127.51% 127.21%

• 0.30%

49.01% 59.00% 9.99% Private CICP Specialty Private 15.25% 7.00%

• 8.25%

12.00% 8.00%

• 4.00%

Private Heart Institute Private 98.10% 36.00%

• 62.10%

50.00% 42.50%

• 7.50%

Private NICU Private 129.75% 119.00%

• 10.75%

75.50% 70.00%

• 5.50%

Private Non-Denver Metro Private 126.20% 133.83% 7.63% 49.55% 45.00%

• 4.55%

Private Non-Metro Western Slopes Private 40.00% 10.00%

• 30.00%

70.00% 48.00%

• 22.00%

Private Private 60.27% 36.27%

• 24.00%

34.00% 31.00%

• 3.00%

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Relationship between IP supplemental payment + IP MMIS Base payments & IP Medicaid utilization

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Relationship between OP supplemental payment + OP MMIS Base payments & OP Medicaid utilization

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Relationship between UCC/DSH supplemental payments and uninsured cost

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Payment to Cost Ratio

Next Steps

• CHASE fees and supplemental payments have been at interim

levels since October 2018

• Following CHASE Board approval, we will

➢ Seek federal approval from CMS ➢ Present rules to Medical Services Board ➢ Reconcile between the final model and the interim model in Spring 2019 ➢ Notify hospitals and host webinar

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Thank You

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