HCA Presentation Ann Foster Division of Finance and Rate Setting - - PowerPoint PPT Presentation

HCA Presentation

Ann Foster Division of Finance and Rate Setting Department of Health

September 9, 2016

• 2015‐16 Global Cap Results
• Overview of 2016‐17 Global Cap Projections
• Results through June 2016
• MLTC Rates
• Minimum Wage
• FLSA Survey

Agenda

September 9, 2016 2

• Global Cap spending was $3 million below target for closeout.

Medicaid Spending (FY 2016) (dollars in millions) Category of Service Estimated Actual Variance Medicaid Managed Care $12,400 $12,466 $66 Mainstream Managed Care $8,760 $8,673 ($87) Long Term Managed Care $3,640 $3,793 $153 Total Fee For Service $9,658 $9,689 $31 Inpatient $2,923 $3,014 $91 Outpatient/Emergency Room $458 $491 $33 Clinic $551 $570 $19 Nursing Homes $3,469 $3,379 ($90) Other Long Term Care $653 $676 $23 Non-Institutional $1,604 $1,559 ($45) Medicaid Administration Costs $498 $504 $6 OHIP Budget / State Operations $257 $271 $14 Medicaid Audits ($358) ($261) $97 All Other $2,502 $2,285 ($217) Local Funding Offset ($7,216) ($7,216) $0 TOTAL $17,741 $17,738 ($3)

2015-16 Closeout Results

September 9, 2016 3

Variance Highlights

• Long Term Managed Care (+$153M)

Timing-related (+$102M): additional Federal receipts and cash advances to several plans. Other (+$51M): due to higher than expected enrollment of approximately 5,400

• recipients. This is in addition to the 6,375 recipients added in the Mid-Year update.
• Long-Term Care (-$67M)

Primarily due to delayed rate packages.

.

September 9, 2016 4

Global Cap for 2016-17 is $18.5 billion

• Reflects annual growth of $771 million (primarily for price and utilization).

Managed Care trends for Mainstream and Long Term Care set by Mercer. Various FFS rate changes (includes increases for case mix, inpatient, and

• utpatient/clinic rates).

Assumes 93,400 new enrollees from March 2016.

September 9, 2016 5

2016-17 Global Cap Projections – DRAFT

• The Global Spending Cap will increase to $18.5 billion in 2016-17, reflects underlying growth
• f $771 million.

Price (+$524 million)

• Trend increases for mainstream managed care and long term managed care; and
• Increases for various FFS rate packages.

Utilization (+$215 million)

• Annualization of 2015-16 new enrollment (194,000); and
• New enrollment for 2016-17 (93,400).

MRT/One- Timers/Other (+$32 million)

• State Contribution for the Essential Plan ($500 million); offset by
• Removal of the 53rd cycle (-$207 million);
• Annualization of CFCO enhanced FMAP (-$130 million); and
• Additional Accounts Receivable collections (-$108 million).

September 9, 2016 6

2016-17 Global Cap Projections – DRAFT

“Online” spending includes health care provider claims reimbursement. “Offline” spending primarily includes grants, DSH/IGT payments and administrative costs. “Offline” offsets primarily include reimbursements from local governments,

• ther state agencies,

pharmacy rebates, cash audits and CFCO.

Medicaid Spending -- 2016-17 (dollars in millions)

Category of Service Online Offline Total Medicaid Managed Care $13,888 ($357) $13,531 Mainstream Managed Care $9,369 ($62) $9,307 Long Term Managed Care $4,519 ($295) $4,224 Fee For Service $7,823 $748 $8,571 Acute Care $2,820 $662 $3,482 Long Term Care $3,627 ($17) $3,610 Non-Institutional $1,376 $103 $1,479 Medicaid Administration Costs $0 $480 $480 OHIP Budget / State Operations $0 $383 $383 Medicaid Audits $0 ($318) ($318) Other State Agency $3,154 ($1,017) $2,137 All Other $0 $884 $884 Local Cap Contribution $0 ($7,157) ($7,157) TOTAL $24,865 ($6,354) $18,511 September 9, 2016 7

Long Term MC ($4.2 billion in 2016-17) – DRAFT

• Projected increases include:
• Other spending primarily reflects the enhanced FMAP for CFCO (-$132

million), recovery of provider cash advances (-$70 million) and removal of the 53rd cycle (-$20 million).

Components ($ in Millions) Price Utilization Base/Trend Update $168

• Annualization of 2015-16 Enrollment
• $256

New Population Shifts – 7,105 individuals

• $98

New Enrollment – 12,000 individuals

• $152

Total Increase $168 $506

September 9, 2016 8

Fee-For-Service Categories – DRAFT

Long Term Care Services ($3.6 billion in 2016-17)

• Projected increases include:

 Price: Primarily represents case mix increases and cash receipts assessment reconciliations, offset by the annualization of CHHA rebasing.  Enrollment/Utilization: Reflects the movement of populations to managed care.

• Other spending reflects the removal of the 53rd cycle (-$65 million), enhanced FFP for

CFCO (-$14 million) and ACA (-$8 million); offset by the restoration of the 2% ATB (+$70 million).

Category of Service ($ in millions) 2015-16 Actual Price Utilization Other 2016-17 Budget Nursing Homes $3,378 $10 ($311) $10 $3,087 Other Long Term Care $675 ($21) ($105) ($26) $523 Total $4,053 ($11) ($416) ($16) $3,610

September 9, 2016 9

Results through June 2016

• Medicaid expenditures through June 2016 are $8 million above estimates

Medicaid Spending (dollars in millions) Category of Service April May June Cumulative Variance

Medicaid Managed Care

$12 ($7) $13 $18

Mainstream Managed Care

$6 ($2) $4 $8

Long Term Managed Care

$6 ($5) $9 $10

Total Fee For Service

$21 $19 ($3) $37

Inpatient

$4 $4 ($5) $3

Outpatient/Emergency Room

$3 $4 $0 $7

Clinic

$1 ($1) $2 $2

Nursing Homes

$6 $1 ($11) ($4)

Other Long Term Care

$4 $6 $5 $15

Non-Institutional

$3 $5 $6 $14

Medicaid Administration Costs

($2) $1 $3 $2

OHIP Budget / State Operations

($9) ($8) ($3) ($20)

Medicaid Audits

($1) $0 $0 ($1)

All Other

($22) $3 ($9) ($28)

Local Funding Offset

$0 $0 $0 $0

TOTAL

($1) $8 $1 $8 September 9, 2016 10

Accounts Receivable Balance as of August 2016

September 9, 2016 11

$28 $74 $18 $32 $9 $0 $50 $100 $150 $200

Inpatient Clinic Home Care Nursing Homes Other

$184 million

• The accounts receivable balance

declined by $64 million from March 2016.

• Global Cap projecting a reduction
• f $140 million in SFY 2016‐17.
• Goal is to eliminate AR balance by

March 2018.

Cost Report Status

Cost Report Status

Due Date Expected Received Long Term Home Health Care August 15 48 48 Personal Care September 15 410 51 CHHA September 15 130 17

September 9, 2016 12

2016 MLTC Partial Capitation Rate Methodology

September 2016 13

• Updated cost report base period data from CY12&13 to CY13&14.
• Continue Wage Parity and FLSA wage adjustments.
• Administrative cost capped at $215 pmpm.
• Rates include a 1% surplus.
• Fraud, Waste and Abuse reduction applied based on legislation for

plans and OMIG to work together to obtain savings.

13

MLTC Pools

September 2016 14

• Quality Incentive Pool Projection – $140 Million

 Funded by Surplus Reduction from 3% to 1%.

• High Cost High Need Risk Pool - $140 million

 2% Withhold and redistribution done simultaneously at the end of SFY16-17.

• Nursing Home Price Mitigation Pool - $22 Million

 Requires accurate encounter data reporting including begin and end service dates.

• Minimum Wage Adjustment – October 2016 .
• New CFCO Services – tentatively December 2016.

14

Anticipated Rate Adjustments

Minimum Wage

• Stakeholder workgroups began in early July:

 Provider Associations  Plan Associations  Joint Meeting of Provider and Plan Associations

• Draft wage increase of $1.33 to worker cost (NYC).
• Draft wage increase of $0.99 to MLTC rates (NYC) in October rate package.
• Next Stakeholder workgroup with DLTC, OMIG and DOL regarding compliance

and enforcement.

• Currently developing fiscal for Upstate Region and subsequent fiscal years.

September 9, 2016 15

FLSA Survey

• DOH and Mercer recently conducted a direct-to-provider survey to assist the

Department in obtaining data on the costs incurred by providers for new FLSA requirements including:  Overtime  Travel  New live-in rules

• 257 surveys were completed.
• Information from survey expected in October to inform future rate adjustments.

September 9, 2016 16

Questions