Medicaid GME Payments Steve Owen, Fiscal Research Division - - PowerPoint PPT Presentation

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Medicaid GME Payments Steve Owen, Fiscal Research Division - - PowerPoint PPT Presentation

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Subcommittee on Graduate Medical Education and Medical Residency Programs Medicaid GME Payments Steve Owen, Fiscal Research Division February 12, 2018 Discussion Guide Graduate Medical Education (GME) in North Carolina includes

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Subcommittee on Graduate Medical Education and Medical Residency Programs

Medicaid GME Payments

Steve Owen, Fiscal Research Division

February 12, 2018

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Graduate Medical Education (GME) in North Carolina includes appropriations for AHEC’s, Medical Schools at UNC/ECU and payments through Medicaid

  • Medicaid GME Payments Defined
  • North Carolina Payment Methodology
  • Hospital Payments in Context
  • Legislative Actions

02/09/2018

Discussion Guide

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  • Medicaid GME payments reimburse the

hospital for Medicaid’s share of the direct and indirect cost of participating in the medical education program

  • Direct costs are those directly related to the

residency program

  • Indirect costs represent the impact on services,

supplies, staffing and other spending that results from the residents’ training

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Medicaid GME Payments Defined

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  • Add-on % to Claims for services at

teaching hospitals

ADDITIONALLY GME PAYMENTS ARE A COMPONENT OF:

– Effective Cost Settlement for UNC – Cost Settlement for ECU – Enhanced Payments to Hospitals – Supplemental Equity Payment for Hospitals

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NC GME Payment Methodology

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  • GME add-on represented about

$90 million of the FY 2016-17 claims payments

  • We are working with the

Department to break out the portion of cost and UPL payments that relate to GME

  • Hospital funding is provided

through intergovernmental transfers (IGT) and assessments

  • Assessments also include a

28.85% state retention

  • There are 18 hospitals in NC that

receive GME payments

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Hospital Payments in Context

SOURCE: June 30, 2017 BD 701

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  • Change to Regional Base Rates :

FY 2013-14

  • Change to Single Base Rate :

FY 2014-15

  • Elimination of GME Add-on % :

FY 2015-16

  • Non-Recurring Restoration :

FY 2017-18

  • Cape Fear Appropriation for

Loss in Medicare Reimbursement :

FY 2016-17 eliminated in FY 2017-18

02/09/2018

Legislative Actions

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QUESTIONS

Steve Owen – steve.owen@ncleg.net 919-733-4910

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