HOSPITAL ENGAGEMENT MEETING Friday, September 7, 2018 9:00 AM – 10:30 AM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Rooms B&C. Conference Line: 1-877-820-7831 Passcode: 294442# For more information contact: Elizabeth Quaife at elizabeth.quaife@state.co.us 1
Welcome & Introductions Thank you for participating today! • We are counting on your participation to • make these meetings successful 2
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 3
Dates for Future Hospital Engagement Meetings in 2018 1/12/2018 • 3/2/2018 • The agenda for upcoming meetings will be available on our 5/4/2018 • external website in advance of each meeting. https://www.colorado.gov/pacifi 7/13/2018 • c/hcpf/hospital-engagement- meetings 9/7/2018 • 11/2/2018 • 4
EAPG Monthly Meetings 2018 Meetings, Conference Room 7B, 11:00am-12:30pm 07/13/2018 09/07/2018 11/2/2018 5
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. 6
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. 7
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 8 Colorado Department of Health Care Policy and Financing
Agenda Items 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 our Hospital Engagement Meeting Website. 9
Inpatient Hospital Per Diem Rate Group (formerly Specialty Hospital) 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 10
Inpatient Hospital Per Diem Rates Rule Status 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 . 11
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 12
Community Clinic and Community Clinic and Emergency Center (CC/CCEC) Rule Update 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. 13
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. 14
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. 15
Hospital Rates Effective 7/1/2018 • 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 4 th Quarter 2018. 16
Rural Community Hospital Demonstration Low Volume Payment Update • 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. 17
Separating Baby from Mother’s Claim Some providers have expressed concerns regarding separating mother and baby claims. Specifically, the concern is the amount of 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 18
COLORADO APR-DRG Weight (WT) TABLE VS. NATIONAL WT TABLE Ver 33 Overview: Differences in weights between Colo and National: 19
COLORADO APR-DRG Weight (WT) TABLE VS. NATIONAL WT TABLE Ver 33 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. 20
COLORADO SPECIFIC POLICY ADJUSTMENTS 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. 21
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%: o Craniotomy for Multiple Significant Trauma (APR-DRG 910) o Extensive Abdominal/Thoracic Procedures for Multiple Significant Trauma (APR-DRG 911) o Musculoskeletal & Other Procedure for Multiple Significant Trauma (APR-DRG 912) o Multiple Significant Trauma w/o O.R. Procedure (APR-DRG 930) 22
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