CO EMS Supplemental Payment Stakeholder Meeting Presented by: The Department of Health Care Policy and Financing (Department) and Public Consulting Group (PCG). April 4, 2019 1
Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2
Agenda • Introductions • CO EMS S upplemental Payment Overview • Annual Cost Report Overview • CO EMS S upplemental Payment Training Frequently Asked Questions (FAQ) • Feedback and Discussion 3
Introduction: Department The Department will administer the CO EMS S upplemental Payment, communicating with Centers for Medicare and Medicaid S ervices (CMS ) to disburse supplemental payments to EMS providers. • S hannon Huska • S hawn S tanifer 4
Introduction: PCG PCG is the third party assisting public EMS providers with CO EMS S upplemental Payment activities on behalf of the Department. • James Dachos • Garrett Abrahamson • Miles Brown • Damia Mendoza 5
CO EMS Supplemental Payment Overview 6
Situation of EMS Providers • Typically, the rate at which Medicaid transports are reimbursed is 25% or less of the actual cost to the providers. • Payment rates do not recognize the actual costs incurred by providers for the provision of EMS services. • This requires municipalities and counties to use alternative funding sources to supplant the costs, such as the allocation of taxes and fees. 7
Supplemental Payment Overview A voluntary, ongoing reimbursement opportunity for public ambulance providers to recover additional payment revenue for EMS delivered to Health First Colorado beneficiaries. • Created as a means to reduce the gap of low Medicaid reimbursement rates. • Providers will prepare and submit a cost report for the total actual, incurred Medicaid costs/ expenditures annually, for the state fiscal year (July 1 – June 30). 8
Federal Medical Assistance Percentage (FMAP) • S ince Medicaid is a j oint federal and state program, each entity is responsible for its share of costs. The state share is financed by the provider as expenses already incurred by the provider. • For example: If it costs a provider $100 to transport a patient; and the FMAP for the state is 50% , the S tate/ provider is responsible for $50, and the Federal Government is responsible for $50.The state portion ($50) will be financed by the provider as expenses already incurred by the EMS provider through a Certified Public Expenditure (CPE). 9
Key Steps to the Supplemental Payment • Providers complete and certify the Annual Cost Report that captures the total cost of the providers for providing EMS services. • The Annual Cost Report calculates the total Medicaid allowable costs and the federal share of these costs that have not been reimbursed through Health First Colorado billing. • Department draws FMAP and disburses the calculated federal share of the settlement to providers. 10
Supplemental Payment Estimate • The following estimate to be presented is j ust an example of a fire-based EMS provider settlement calculation. It should not be used for budgeting. • Note that several variables will affect the Annual S ettlement (total Health First Colorado transport percentage is one of them). • Providers will receive both, the Health First Colorado Paid Claims and the S upplemental Payment. 11
Sample Calculation Samples Fiscal Year Sample Fire-Based EMS Provider Total Expenditures $ 8,000,000.00 *Includes appropriation, depreciation and indirect costs EMS / Medical Percentage (CAD Allocation) 75% *Not applicable to only EMS providers whose percentage will be 100 Total Health First Colorado Transportation $ 6,000,000.00 S ervices (MTS ) Total Transports 5,000 Cost per Transport $ 1,200.00 Total Health First Colorado Transports (5% ) 250 Total Cost of Providing Health First Colorado $ 300,000.00 Transports Health First Colorado Paid Claims $ 75,000.00 FMAP Application (FY 2018-19) 50% Total Computable $ 112,500.00 S tate Administration of Program (10% ) $ 11,250.00 Projected Annual Settlement $ 101,250.00 12
Important Dates Y ear 1 Y ear 2 Y ear 3 (6 months) (12 months) (12 months) Cost Reporting Period 1/ 1/ 2018 7/ 1/ 2018 7/ 1/ 2019 Begins Cost Reporting Period 6/ 30/ 2018 6/ 30/ 2019 6/ 30/ 2020 Ends Timely Filing Limit 6/ 30/ 2019 6/ 30/ 2020 6/ 30/ 2021 Claims Data Reconciliation and Supplemental 9/ 30/ 2019 9/ 30/ 2020 9/ 30/ 2021 Payment The Department allowed for providers to retroactively capture half of the 2018 cost reporting period. For this reason, Year 1 (6 months) has a quick turnaround. 13
Annual Cost Report Overview 14
Data Collection The S upplemental Payment data collection requirements are designed to utilize reports and materials that most providers prepare for other purposes. # Item Description Expenditures Annual detailed actual expenditures broken 1 (as reported Audited Financial Statements, out by cost center. or in most updated financials ) Asset number, description, date placed in/ out 2 Depreciation of service, useful life, and cost for assets used. Computer Aided-Dispatch System (CAD) CAD data for medical and fire/ other 3 Information (other forms of call reporting responses. are acceptable, too) Cost Allocation Plan or Indirect Cost Rate 4 Indirect Cost Rate Proposal (if applicable) proposal from the provider's county/ city/ town to incorporate additional overhead costs. Gross revenues for all payer types, except 5 Summary Billing Health First Colorado. Total number of trips throughout reporting period. Award documentation and other supporting 6 Federal Funds (if applicable) information regarding federal funds expended. 15
Cost Report Certification • Providers need to electronically certify costs at the bottom of the Final S ettlement tab on the Ambulance S ervice Cost Report (AS CR) portal. • Participating providers are responsible for the accuracy of reported costs and supporting documentation. • Note that due to timing, providers will not see an accurate final settlement amount because their Fee- For-S ervice (FFS ) payments will not be incorporated yet. The FFS data will be entered after providers certify their costs. 16
Desk Reviews • In order to ensure accuracy and completeness of each cost report, desk reviews occur after all cost reports have been certified. • Desk reviews help protect providers from federal audits and potential pay-back situations. During the desk review, all provider responses to triggered warnings and thresholds will be reviewed and clarifying follow up questions may occur. • Once all questions have been resolved, providers will receive an email indicating that their desk review is complete and no further questions are warranted. 17
Certified Public Expenditure (CPE) • Upon completion of the electronic Cost Report certification (due April 30 th ), and the Desk Review process, providers will need to download, sign and upload the CPE form under the Cost Report Certification tab on the AS CR portal. • The CPE form will contain the Annual Cost S ettlement. • Needs to be signed and uploaded on the AS CR portal in August-S eptember to receive a supplemental payment. 18
Year 1 Timeline APR 30, 2019 JUL- AUG 2019 • Providers submit cost S EP 2019 report data • Cost Reports JAN 2019 • S upplemental • Providers certify costs • Program re-released to payments providers. Kickoff dispersed FEB – MAR 2019 MA Y 2019 AUG-S EP 2019 • Cost Reporting • Desk Reviews Occur • Final signed • Providers provide Trainings CPE reports variance collected explanations 19
Supplemental Payment Training FAQs 20
Program Overview Q: What is the funds limit for the CO EMS S upplemental Payment? A: There is no funding limit. The CO EMS S upplemental Payment will reimburse providers on all actual allowable costs incurred providing EMS to Health First Colorado patients. Q: Can I leave the program at any time? A: Yes, the participation in the CO EMS S upplemental Payment is voluntary and providers can drop out of any reporting year at any point before submitting their CPE. 21
Allowable Transport Q: What constitutes as an EMS transport that a provider can report? A: Any call that results in a medical transport for a Health First Colorado beneficiary. 22
Data Collection Q: If my provider operates on a calendar year, how do I align with the S tate Fiscal Year (S FY)? A: The preferred approach is to use your reporting system and pull reports on the given S FY. If this is not possible, you may pro-rate the two respective calendar years accordingly. Q: For hospital-based EMS providers, do we need to report the entire hospital’ s financials? A: No, hospital-based providers only need to use financials for the actual EMS department or division. 23
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