HOSPITAL ENGAGEMENT MEETING Friday, September 7, 2018 9:00 AM 10:30 - - PowerPoint PPT Presentation

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HOSPITAL ENGAGEMENT MEETING

Friday, September 7, 2018 9:00 AM – 10:30 AM

Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 7th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us

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Welcome & Introductions

• Thank you for participating today!
• We are counting on your participation to

make these meetings successful

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GROUND RULES FOR WEBINAR

• WE WILL BE RECORDING THIS WEBINAR
• ALL LINES ARE MUTED. PRESS *6 IF YOU WISH TO UNMUTE.

PARTICIPANTS CAN ALSO UTILIZE THE WEBINAR CHAT WINDOW

• Please speak clearly when asking a question and give your

name and hospital

• If background noise and/or inappropriate language occurs all

lines will be hard muted. Thank you for your cooperation

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• 1/12/2018
• 3/2/2018
• 5/4/2018
• 7/13/2018
• 9/7/2018
• 11/2/2018

Dates for Future Hospital Engagement Meetings in 2018

The agenda for upcoming meetings will be available on our external website in advance of each meeting. https://www.colorado.gov/pacifi c/hcpf/hospital-engagement- meetings

EAPG Monthly Meetings

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2018 Meetings, Conference Room 7B, 11:00am-12:30pm 07/13/2018 09/07/2018 11/2/2018

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Overview of Today’s Meetings

• General Hospital Meeting

9:00-10:30

• Break

10:30-11:00

• EAPG Engagement Meeting

11:00-12:30

**Special Note: The webinar room will change for the EAPG meeting. The link to EAPG Webinar room is shared under ‘Shared Links’ on the right side of this webinar room. Please log in during the break if you wish to stay for the EAPG portion of the day.

End of the Meeting

• Recording and Audio will stop at the end of the

meeting.

• The Webinar room will remain open for

participants wishing to attend the EAPG Meeting can select the shared link

• The Webinar room will close at 10:50am.

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Colorado Department of Health Care Policy and Financing

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HOSPITAL ENGAGEMENT MEETING TOPICS 9/7/2018 9am-10:30am

• LTAC and Rehabilitation Hospitals Per Diem Rate Update (formerly Specialty Hospital)
• Items Pending Additional Research/Action
• CC/CCEC Rule Update
• 12X Crossover and Medicare Part A Exhaust/Part B Only Quick Update
• IPP-LARC Carveout Update
• FY 2018-19 Hospital Base Rates Update
• Inpatient Future Plans/Goals
• Staff Update

Agenda Items

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If you wish to request a topic for our next meeting. Please submit the request by the week prior to the meeting to ensure enough time is allowed to gather correct personnel and information on the topic. If a topic is submitted the week of the meeting, we cannot guarantee enough research will be completed to present at the meeting. However it will be carried over to the following meeting and any actionable items will be followed up with the Provider as soon as possible. Send all requests to Elizabeth Quaife at elizabeth.quaife@state.co.us The Meeting Agenda is posted on Monday the week of the meeting to

• ur Hospital Engagement Meeting Website.

Inpatient Hospital Per Diem Rate Group

(formerly Specialty Hospital)

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To better align with existing language, we are removing the ‘Specialty Hospitals’ term and referring to this group as ‘Inpatient Hospital Per Diem Rate Group’. This group includes:

• 1. Freestanding Long Term Acute Care Hospital
• 2. Freestanding Rehabilitations Hospital
• 3. Spine/Brain Injury Treatment Specialty Hospital *NEW*
• 4. State Owned Psychiatric Hospitals
• 5. Privately Owned Psychiatric Hospitals

A new webpage to house the rates for the Per Diem Hospitals is currently underway and will be similar format as the Inpatient Hospital Rates Page

Inpatient Hospital Per Diem Rates Rule Status

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Go Live for the new Per Diem has moved from July 1, 2019 to January 1, 2019.

• State Plan Amendment (SPA) is pending internal Clearance

and Public/Tribal Notice

• SCR (System Update) has been submitted
• State Rule Changes are being finalized prior to entering internal

Clearance *SPA and State Rule changes impact Freestanding Long Term Acute Care Hospitals, Freestanding Rehabilitation Hospitals and Spine/Brain Injury Treatment Specialty Hospital Only. **Psychiatric Hospitals currently have a per diem and no changes to these rates or definitions are being made.

Pending Additional Research and/or Actions

The following items have been discussed at previous meetings and are pending while additional research and/or processes are being completed.

• Observations over 24 hours
• Observation 24-48 hours prior to Inpatient

Stay

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Community Clinic and Community Clinic and Emergency Center (CC/CCEC) Rule Update

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The Public Rule Review meeting for the proposed CC/CCEC rule was completed Monday, August 27, 2018. Feedback was documented from the meeting. The rule will be brought to the Medical Services Board for first reading on September 14, 2018. The target implementation date for this rule is December 1, 2018. Details on these meetings and the rule making process can be found on the Medical Service Board page located here.

IPP-LARC Carveout Update

A System Change Request (SCR) has been submitted to DXC. However, due to other priorities related to system changes the project has been suspended. IPP-LARCs will continue to be included in the APR- DRG methodology for the foreseeable future. If resources become available we will bring updates to this forum and other communication avenues. If you have questions/feedback please contact Melanie Reece.

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12X Crossover, Medicare Part A Exhaust and Medicare Part B only Quick Update

• System Change Request (SCR) is pending

prioritization

• Several Department representatives will be

attending the next prioritization meeting to get the SCR into a high priority slot.

• The Department is researching potential

workarounds, however, a workaround will not be solidified until the SCR is prioritized and DXC and the Department have agreed on a final solution.

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• The 30-day review period for informal

reconsideration or appeal of FY2018-19 rates ended 8/12/2018. The finalized rates that are being sent for CMS approval will be posted next week.

• When CMS approval is received, we will mass

adjust all claims from 7/1/2018 to reflect the new rates.

• CMS approval is expected in 4th Quarter 2018.

Hospital Rates Effective 7/1/2018

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• CMS contacted the State for clarification on problems

associated with confirming qualification to receive Low Volume Payments (LVP) for Rural Community Hospital Demonstration participants.

• We discussed with CMS the need to receive some indication

from hospital intermediaries (Novitas & WPS) that confirms or denies LVP qualification for those hospitals as required in Colorado State Plan.

• CMS is working on getting communication out to fiscal

intermediaries (Novitas & WPS) to ensure they provide that notification in some form for this year’s Medicare Rates.

Rural Community Hospital Demonstration Low Volume Payment Update

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Some providers have expressed concerns regarding separating mother and baby claims. Specifically, the concern is the amount

• f time it takes to get a Medicaid ID for the baby.
• Poll: How long does it take to get a Medicaid ID for newborn?
• 1-2 weeks
• 3-4 weeks
• 5-6 weeks
• 7-8 weeks
• 9 weeks or more
• Poll: Do you support separating mother and baby claims?
• Yes, separate them
• No, keep baby on Mother’s birth claim
• Neutral, fine with either option

Separating Baby from Mother’s Claim

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Overview: Differences in weights between Colo and National:

COLORADO APR-DRG Weight (WT) TABLE VS. NATIONAL WT TABLE Ver 33

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TrimPoint differences are slightly lower for birth/neonatal DRGs and are about 5-6 days out from current Colorado TrimPoints. Average length of stay (ALOS) is slightly lower for birth/neonatal DRGs and are very close to current Colorado ALOS.

COLORADO APR-DRG Weight (WT) TABLE VS. NATIONAL WT TABLE Ver 33

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Weight Distribution for Birthing Method APR-DRGs

• Background: The goal of this policy was to reduce unnecessary cesarean

section deliveries, which result in higher costs and more complications.

• Current Methodology: APR-DRG 540 (Caesarean Section Delivery) weights were

calculated by setting SOI 1 at the weighted average of Vaginal Delivery (APR- DRG 560) SOI 2 and SOI 3. APR-DRG 540 SOI 2, 3, and 4 are set with CO-specific

• weight. All severities of APR-DRG 560 (Vaginal Delivery) were increased by 10%

to acknowledge the volume and importance of deliveries to the Medicaid population.

COLORADO SPECIFIC POLICY ADJUSTMENTS

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COLORADO SPECIFIC POLICY ADJUSTMENTS

Weight Increase for Trauma Care APR-DRGs (910, 911, 912, 930)

• Current Methodology: In order to maintain access to high-level trauma

care for Colorado Medicaid patients, all four severity levels had their calculated weight increase by 40%:

• Craniotomy for Multiple Significant Trauma (APR-DRG 910)
• Extensive Abdominal/Thoracic Procedures for Multiple Significant

Trauma (APR-DRG 911)

• Musculoskeletal & Other Procedure for Multiple Significant Trauma

(APR-DRG 912)

• Multiple Significant Trauma w/o O.R. Procedure (APR-DRG 930)

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COLORADO SPECIFIC POLICY ADJUSTMENTS

Youth Recovery Center Weight Adjustment (772)

• Background: APR-DRG 772 (Alcohol & Drug Dependence w Rehab or

Rehab/Detox Therapy) is a unique case in that only one hospital is currently approved for payment of claims grouping to this APR-DRG code.

• Current Methodology: Average Length of Stay (ALOS) and TrimPoint

were changed to national to better reflect standard alcohol and drug dependence therapy lengths of stay across the nation.

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COLORADO APR-DRG WT TABLE VS. NATIONAL WT TABLE

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Our intention is to make the change-over to National Weights budget neutral. However, as we have seen, there will be weights, ALOS and TrimPoints that will move in both directions from where they are now. So budget neutrality will have to be in aggregate. We will go into more detail during our November 2nd Hospital Engagement Meeting.

Moving to 3M National Weight Table

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PROS:

• Will allow department to keep up with version changes year to

year since we don’t have resources to re-weight to Colorado weights each year. 3M has mentioned they have been having more States move to National weights for same reason.

Pros & Cons of Moving to National Weight Table

CONS:

• Will require more direct contact with hospitals to identify where

clinical reality in Colorado differs from national.

FUTURE INPATIENT

➢ Medicaid Base Rate Examples to come in November

meeting.

▪ Please send thoughts/examples ASAP of what kind of base

rate you think would work for inpatient.

▪ Also – any thoughts you have on what should be used to

determine peer groups and urban/rural designations.

▪ National Weights & Separating Baby from Mom’s

Claim

• More detail to be presented in November meeting.

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Staff Updates

Ana Lucaci, Medicaid Policy Specialist, last day is September 7, 2018 (Yes, that is TODAY!) For future questions please direct inquiries to Raine Henry

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Information Resources

• Inpatient Hospital Rates Webpage Link
• Outpatient Hospital Rates Webpage Link
• Hospital Engagement Meeting Webpage Link
• UB-04: IP and OP Billing Manual Webpage Link

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Questions, Comments, & Solutions

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The final poll is now an external survey to provide anonymity, please take a few moments to complete it. Thank you

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Thank You!

Elizabeth Quaife Specialty Hospital Rates Analyst Elizabeth.Quaife@state.co.us Raine Henry Hospital Policy Specialist Raine.Henry@state.co.us Jeremy Oat Operations Section Manager Jeremy.Oat@state.co.us Shane Mofford Payment Reform Section Manager Shane.Mofford@state.co.us Kevin Martin Fee for Service Rates Manager Kevin.Martin@state.co.us Diana Lambe Inpatient Hospital Rates Analyst Diana.Lambe@state.co.us Andrew Abalos Outpatient Hospital Rates Analyst Andrew.Abalos@state.co.us