CC/CCEC STAKEHOLDER MEETING Friday, September 1, 2017 1:00 PM – 2:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 11 th Floor Rooms A&B. 1
Overview of Meeting 2
GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • We are going to try to avoid muting the phone lines to encourage conversation, so please don’t: • Put us on hold • Drive in your car w/window open while listening • Sit in a noisy location • Please speak clearly when asking a question and give your name and hospital 3
Welcome & Introductions 4
Purpose of Meeting The purpose of this meeting is to share information regarding upcoming changes to how the Department will classify medical providers that are licensed by CDPHE as a Community Clinic or a Community Clinic with Emergency Centers (CC/CCEC). 5
Purpose of Meeting • Make you aware of planned creation of a new provider type • Share our expectations of providers once the new provider type takes effect • Provide you with time and opportunity to suggest, for example, additional non-claims-based data sets the Department should consider evaluating post-change • Solicit from you data sets that may assist us in creating an appropriate provider payment methodology post-change 6
Background • Currently CC/CCEC entities are allowed to bill for services as a hospital under the ID of the hospital with which they are associated. • CDPHE licenses these entities separately from a hospital. • Those entities that are not associated with a hospital may bill as Clinics. 7
New Provider Type • The Department plans to create a provider type specifically for Hospital Affiliated/CMS Certified CC/CCEC entities that may then participate in the Medicaid program. • The Department will gather data post-change in order to create a payment methodology that differs from the current hospital methodology. • The proposed provider type will be paid using the Enhanced Ambulatory Patient Grouper payment methodology similar to the way outpatient hospital services are paid (UB-04 claim type) • Independent professionals that provide professional services will be paid separately (CMS 1500 claim type) 8
Regulatory Steps • The Department must submit a State Plan Amendment to the Centers for Medicare and Medicaid Services (CMS) ➢ CMS has 90 days to either approve, deny, or request additional information • Once the SPA is approved, new Department rules that define the provider type and scope of services will be submitted to the Medical Services Board (MSB) for approval ➢ The MSB meets on the second Friday of each month. ➢ Usually, a rule is approved upon second reading and becomes effective the last day of the month following the approval date. 9
Provider Payment • For the time being, you are going to be reimbursed at the same rates as hospitals. ➢ In the future, we will be looking at a different reimbursement methodology that reflects actual services provided at these facilities and the costs incurred in providing this care. ➢ This will be a data-driven process, during which we will need your participation and input. 10
Ask • Please provide us with the names, locations and affiliations of all those CC/CCEC entities you represent, and whether those entities are Medicare certified to be recognized as part of a hospital. ➢ If you are able to collaborate to create a single list prior to sending, we welcome that approach. ➢ Please email Ana Lucaci, ana.lucaci@state.co.us with this information. • Please provide any additional non-claims-based data sets you believe reflect actual services provided at these facilities and the costs incurred in providing this care, for Department consideration when developing a reimbursement methodology. 11
Questions and Discussion 12
Thank You! Kevin Martin Ana Lucaci Fee for Service Rates Manager Hospital Policy Specialist Kevin.Martin@state.co.us Ana.Lucaci@state.co.us Kimberley Smith Richard Delaney Compliance & Stakeholder Relations Unit Manager Physician Services Policy Specialist Kimberley.Smith@state.co.us Richard.Delaney@state.co.us 13
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