FFY 2018-19 CHASE Fees and Payments Nancy Dolson, Special Financing - PowerPoint PPT Presentation

FFY 2018-19 CHASE Fees and Payments Nancy Dolson, Special Financing Division Director 1

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources

Fee from Federal Match Hospitals from CMS Cash Fund (Fee + Federal Match) Administrative/Other Increased Payment to Expanded Coverage to Colorado Citizens Hospitals 3

CHASE Goals Maximize the inpatient and outpatient hospital • reimbursements to up to the upper payment limits Increase hospital reimbursements under the Colorado Indigent • Care Program to up to one hundred percent of the hospital's costs of providing medical care under the program Determine changes that increase number of hospitals • benefitting from the fee or minimize number of hospitals that suffer losses as a result of the fee Meet federal requirements •

FFY 2018-19 CHASE Overview $931.4 million CHASE fees • ➢ $917.9 million to be collected at 5.47% of the estimated net patient revenue (NPR) ▪ Limited by Upper Payment Limit (UPL) ➢ $13.5 million to be used from the cash fund reserve $1.3 billion in hospital supplemental payments including • $90.4 million in quality incentive payments ➢ UPL at 97% ➢ Disproportionate Share Hospital (DSH) Limit $410.2 million in net reimbursement • Net reimbursement reflects direct supplemental payments paid to hospitals minus total CHASE fees and does not include revenue received by hospitals via claims paid for expansion populations 5

2018-19 CHASE Fees and Payments Expenditures Cash Fund Federal Fund Total Fund IP Base Rate Supplemental Payment $236,000,000 $236,000,000 $471,900,000 OP Supplemental Payment $222,400,000 $222,400,000 $444,800,000 Uncompensated Care Supplemental Payment $54,000,000 $54,000,000 $108,000,000 DSH Supplemental Payment $106,400,000 $106,400,000 $212,900,000 HQIP Supplemental Payment $45,200,000 $45,200,000 $90,400,000 Total Supplemental Payment $664,000,000 $664,000,000 $1,328,000,000 MAGI Parents/Caretakers 60-68% FPL $12,500,000 $12,500,000 $25,000,000 MAGI Parents/Caretakers 69-133% FPL $15,400,000 $198,600,000 $214,000,000 MAGI Adults 0-133% FPL $105,000,000 $1,326,700,000 $1,431,800,000 Buy-In for Adults & Children with Disabilities $40,300,000 $40,300,000 $80,700,000 Twelve Month Continuous Eligibility for Children $24,300,000 $24,300,000 $48,600,000 Non-Newly Eligible $11,400,000 $52,900,000 $64,300,000 CHP+ 206-250% FPL $10,700,000 $59,500,000 $70,200,000 Rate Adjustments/BHO Incentive Payments $1,200,000 $2,300,000 $3,500,000 Medicaid Expansion $221,000,000 $1,717,200,000 $1,938,200,000 Administration $30,600,000 $55,900,000 $86,500,000 Transfer to General Fund – 25.5-4-402.4 (5)(b)(VII) $15,700,000 *$0 $15,700,000 Total Other Expenditures $46,300,000 $55,900,000 $102,200,000 Cash Fund Reserve $0 $0 $0 Grand Total $931,400,000 $2,437,100,000 $3,368,500,000 *Federal funds drawn from the transfer to the General Fund are not shown 6

Return on CHASE Fee $931.4 million generates $2.4 billion in federal funds, a • 267% return on investment Administrative expenditures ($86.5 million) are 2.6% of total • CHASE expenditures ($3.4 billion) Administrative expenditures include the following • ➢ Staff costs, legal services, accounting, etc. ➢ Contracted services, including utilization management and external quality review ➢ IT systems (i.e., eligibility and claims) and staffing for the customer contact center for more than 450,000 covered lives 7

Net Reimbursement Net Reimbursement increase due to: • ➢ $27 million in new funds from fee used from the cash fund reserve ➢ Expected caseload decrease offsets increase in expenditure due to a reduction in the expansion federal matching percent from 94% to 93% in January 2019 Item 2017-18 2018-19 Difference Supplemental Payments (Total Funds) $ 1,301,633,071 $ 1,328,099,058 $ 26,465,987 Fee (Cash Funds) $ 894,541,590 $ 917,879,440 $ 23,337,850 Net Reimbursement 1 $ 407,091,481 $ 410,219,618 $ 3,128,137 Net reimbursement reflects direct supplemental payments paid to hospitals minus total CHASE fees and does not include revenue received by hospitals via claims paid for expansion populations 8

Net Reimbursement Increase Row Item Value Calculation Row 1 Increase in CHASE Fee $23,337,850 Row 2 Fee from Cash Fund Reserve $13,500,000 Total Increase in Additional Funds Row 3 $36,837,850 Row 1 + Row 2 Row 4 Expansion Expenditure Increase due to FMAP Reduction $27,360,066 Row 5 Expansion Expenditure Decrease due to Caseload Reduction ($19,530,492) Row 6 Administration Expenditure Increase $3,797,072 Row 7 Decrease in Cash Funds Reserved ($5,594,064) Fee Adjustments for Hospitals Removed from CHASE Row 8 $1,514,613 Row 9 Total Increase in Expenditure $7,547,195 Sum Rows 4 - 8 Row 10 Funds Available for Supplemental Payments (Cash Fund) $29,290,655 Row 3 – Row 9 Row 11 Funds Available for Supplemental Payments (Total Fund) $58,581,310 Row 10 * 2 Row 12 DSH Reduction Elimination (from Cash Fund Reserve) $35,304,550 Payment Adjustments for Hospitals Removed from CHASE Row 13 ($3,189,938) Row 14 Remainder of Available Funding $711 Row 11 – Row 1 – Row 12 – Row 15 Net Reimbursement Increase $3,128,137 Row 13 – Row 14 Net reimbursement reflects direct supplemental payments paid to hospitals minus total CHASE fees and does not include revenue received by hospitals via claims paid for expansion populations 9

CHASE Fee Payers include: Fee exempt: CHASE Fees ✓ General Acute ✓ Rehabilitation ✓ Critical Access ✓ Long Term Care ✓ Pediatric ✓ Psychiatric IP NPR Limit OP NPR Limit IP Fee OP Fee Days Charges 10

CHASE Fee Inpatient fee assessed on managed care & non-managed care • days ➢ Inpatient fee ▪ Per non-managed care day: $416.07 ▪ Per managed care day: $93.07 Outpatient fee assessed on percentage of total Outpatient • charges ➢ Outpatient fee ▪ Percentage of total charges: 1.8119% 1 1

Supplemental Payment Overview 12

Inpatient Base Rate Supplemental Payment Increase rates for inpatient hospital services for Medicaid • members Total Payments: $471.9 million • Inpatient Base Rate Payment = Medicaid rate before add-ons • * inpatient percentage adjustment factor * estimated Medicaid discharges * case mix 13

Outpatient Supplemental Payment Increase rates for outpatient hospital services for Medicaid • members Total Payments: $444.8 million • Outpatient Payment = estimated Medicaid outpatient cost * • outpatient percentage adjustment factor 14

Uncompensated Care Supplemental Payment Reimbursement to hospitals providing services to the • uninsured Total Payments: $108.0 million • ➢ $15.0 million distributed to qualified Essential Access hospitals, based on proportion of beds ➢ $93.0 million distributed to all other qualified Non Essential Access hospitals, based on proportion of uninsured cost 15

DSH Supplemental Payment Reimbursement to hospitals providing services to the • uninsured Total Payments: $212.9 million • Most qualified hospitals capped at 96% of their estimated DSH • limit ➢ A Pediatric Specialty hospital’s DSH Supplemental Payment equals 45% of their estimated DSH limit ➢ A Respiratory hospital’s DSH Supplemental Payment equals 75% of their estimated DSH limit ➢ A new CICP hospital’s or a low Medicaid hospital’s DSH Supplemental Payment equals 10% of their estimated DSH limit 16

HQIP Supplemental Payment Reimbursement to hospitals providing services that improve • health care outcomes Total Payments: $90.4 million • Quality measures and payment methodology approval • concluded by the CHASE Board on February 27, 2018 HQIP Payment = % of normalized eligible points * Medicaid • Adjusted Discharges * dollars per-adjusted discharge point 17

UPL Pools 18

UPL Pools 19

IP UPL Pools IP FFS Base Non-CHASE HQIP UCC IP UPL Gap 3% 3% 3% 17% 17% 37% 6% 13% 4% 5% 9% 1% 5% 1% 3% 68% 57% 47% STATE NON-STATE PRIVATE 20

YOY IP UPL Change IP FFS Base Non-CHASE HQIP UCC IP UPL Gap State Private Non-State 17-18 18-19 17-18 18-19 17-18 18-19 21

State Government IP UPL Pool Row Description FFY 17-18 FFY 18-19 Unit Change Notes Row 1 UPL $ 124,200,000 $ 136,340,000 $ 12,140,000 Row 2 IP FFS Base $ 100,500,000 $ 92,250,000 $ (8,250,000) Row 3 Non-CHASE $ 1,330,000 $ 1,650,000 $ 320,000 $ 20,070,000 Row 1 - Row 2 - Row 4 Remaining Funds $ 22,370,000 $ 42,440,000 Row 3 Row 5 UCC $ 8,670,000 $ 8,450,000 $ (220,000) Row 6 HQIP $ 7,530,000 $ 6,060,000 $ (1,470,000) Row 7 IP $ 1,950,000 $ 23,790,000 $ 21,840,000 $ 12,220,000 Sum Row 2, 3, Row 8 Total $ 119,980,000 $ 132,200,000 5, 6, 7 Row 9 Percent of IP UPL 97.00% 97.00% 0.36% Row 8 / Row 1 22

OP UPL Pools OP FFS Base OP UPL Gap 3% 3% 3% 36% 38% 44% 62% 59% 53% STATE NON-STATE PRIVATE 23

YOY OP UPL Change OP FFS Base OP UPL Gap State Private Non-State 17-18 18-19 17-18 18-19 17-18 18-19 24