SPECIALTY HOSPITAL ENGAGEMENT MEETING Friday, May 4, 2018 3:00 PM – 4:00 PM Location: The Department of Health Care Policy & Financing, 303 East 17 th Avenue, Denver, CO 80203. 7 th Floor Room A. 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 • We are a small group so we highly encourage logging onto the Conference Line for discussion. Conference Line: 1-877-820-7831 Passcode: 294442# 2
GROUND RULES FOR WEBINAR • WE WILL BE RECORDING THIS WEBINAR • Please speak clearly when asking a question/comment and give your name and hospital • 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 • Be cautious of side conversations and language (we can hear you and it is being recording) 3
Specialty Hospital Meetings Future Meetings: Will be announced via Provider Bulletin, Hospital Engagement Meetings, Hospital Engagement Website and Email Notification. Next Meeting: June 1, 2018 **NEW TIME: 3:00pm-4:00pm** For more information, please visit our Hospital Engagement Meeting Page https://www.colorado.gov/pacific/hcpf/hospital-engagement-meetings 4
Type of Bill Type of bill (TOB) will still be 11X will still be used for billing Reimbursement Profile will be assigned upon new will dictate payment rate not the Type of Bill Interim will still utilize TOB: 112, 113, 114 5
Interim Billing Options ** Feedback received showed preference to 30 days as it currently reflects Provider billing cycles. Do others agree? 6
Provider Type Providers will be required to enroll in a new Provider Type: • The new type will be announced as we get closer to 07/01/2019 • Profile will link Provider to correct classification and correct Per Diem for reimbursement • Working with Policy to request Provider Enrollment Fee waiver 7
Timeline & Deadlines Budget Neutral Per Diem will start July 1, 2019 Timeline: May 4, 2018 – Additional discussion and feedback from Meeting May 18, 2018 – Per diem to move forward for implementation, start State Plan Amendment (SPA) June 15, 2018 – Submit system changes • Allows for testing • Adequate implementation time • Prevent mass adjustments November 1, 2018* – Have SPA submitted May 1, 2019* – Rule and SPA approved. Announce new Provider type for Providers to enroll for July 1, 2019 *Completed at the latest, hoping to have completed prior to date provided 8
Medicare Crossover Application of ‘Lesser of’ Logic Two Different Calculations: • Coinsurance and Deductible • Per Diem Reimbursement amount – Medicare Reimbursement Whichever is less. Majority of claims will utilize Coinsurance and Deductible. The later option is to ensure the reimbursed amount does not exceed what Health First Colorado would reimburse as primary payer. 9
Additional Details to be Defined • Construct language to define each Classification for future enrollment. Possible options include: o Utilize Colorado Department of Public Health and Environment License o Medicare Licensure • A decision on the Interim Bill requirements: 30, 45 or 60 days • Obtain approval and feedback from other groups within Health First Colorado • Write State Plan Amendment (SPA), State Rule and System documentation for implementation 10
Onsite Visits Site Visits were and continue to be a helpful inspiration on decisions made for current Budget Neutral Per Diem and would like to keep the hospitals involved as we begin to look into long term reimbursement options. Goal: Would like to meet with most of the LTACs and Rehabilitations To volunteer for an Onsite Visit please contact Elizabeth Quaife at Elizabeth.quaife@state.co.us Update: Thank you to two hospitals that reached out and scheduled a visit. We appreciate your time. 11
Budget Neutral Formula Budget Neutral Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝐶1 + (1 − 𝑦)𝐶2 + (1 − 𝑦) 2 𝐶3 + (1 − 𝑦) 3 𝐶4 Total Dollars = Total dollars reimbursed to specific Classification • LTAC Total Reimbursed Dollars • Rehab Total Reimbursed Dollars • Brain/Spine Total Reimbursed Dollars B = Stepdown Bracket x = Percentage of stepdown (decimal form ex. 5% is 0.05) **Note: Budget Neutral to Health First Colorado Reimbursed dollars for FY 2017 (7/1/2016-06/30/2017) not Provider billed amount. 12
Difference from Previous Per Diems Received questions on cause of difference of Per Diem amounts from previous • Change in equation utilized for calculation • Equation was inaccurate and used a multiplier to manipulate results to come close to Budget Neutral • Additional claims changed total amounts reimbursed and days Old equation: 𝑈𝑝𝑢𝑏𝑚 $ 𝑆𝑓𝑗𝑛𝑐𝑣𝑠𝑡𝑓𝑒 𝑐𝑧 𝐼𝑓𝑏𝑚𝑢ℎ 𝐺𝑗𝑠𝑡𝑢 𝐷𝑝𝑚𝑝𝑠𝑏𝑒𝑝 multiplied by a variable 𝑈𝑝𝑢𝑏𝑚 # 𝑝𝑔 𝑑𝑝𝑤𝑓𝑠𝑓𝑒 𝑒𝑏𝑧𝑡 13
Old Calculation Per Diem vs. New Per Diem Old Per Diem New Per Diem CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $2,188.44 35 $2,079.02 56 $1,975.07 >56 $1,876.31 REHAB 7 $962.63 14 $914.50 21 $868.77 >21 $825.33 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13 CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 $2,172.96 35 $2,064.31 56 $1,961.09 >56 $1,863.04 REHAB 14 $944.23 21 $897.02 28 $852.17 >28 $809.56 SPINE 28 $2,807.56 49 $2,667.18 77 $2,533.82 >77 $2,407.13 14
Why Custom Brackets instead of General? 1. More even day distribution between group classification 2. Impact is more consistent for each class of per diem 3. Better reflects the long term goals the Department is working towards General: Custom : 15
Comparison of General vs. Custom Bracket General Bracket Per Diems: Custom Bracket Per Diems: CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $ 2,188.44 35 $ 2,079.02 56 $ 1,975.07 >56 $ 1,876.31 REHAB 7 $ 962.63 14 $ 914.50 21 $ 868.77 >21 $ 825.33 SPINE 28 $ 2,807.56 49 $ 2,667.18 77 $ 2,533.82 >77 $ 2,407.13 CLASS BRACKET 1 DAYS % OF TOTAL DAYS BRACKET 2 DAYS % OF TOTAL DAYS BRACKET 3 DAYS % OF TOTAL DAYS BRACKET 4 DAYS % OF TOTAL DAYS TOTAL DAYS LTAC 1500 33.79% 1542 34.74% 687 15.48% 710 15.99% 4,439 REHAB 6,319 59.76% 3,015 28.51% 758 7.17% 482 4.56% 10,574 SPINE 1244 50.80% 582 23.76% 432 17.64% 191 7.80% 2,449 16
Adjusting the First Bracket by a Week Department Per Diem Choice: CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 14 $ 2,188.44 35 $ 2,079.02 56 $ 1,975.07 >56 $ 1,876.31 REHAB 7 $ 962.63 14 $ 914.50 21 $ 868.77 >21 $ 825.33 SPINE 28 $ 2,807.56 49 $ 2,667.18 77 $ 2,533.82 >77 $ 2,407.13 Percentage Breakdown CLASS BRACKET 1 DAYS % OF TOTAL DAYS BRACKET 2 DAYS % OF TOTAL DAYS BRACKET 3 DAYS % OF TOTAL DAYS BRACKET 4 DAYS % OF TOTAL DAYS TOTAL DAYS LTAC 1500 33.79% 1542 34.74% 687 15.48% 710 15.99% 4,439 REHAB 6,319 59.76% 3,015 28.51% 758 7.17% 482 4.56% 10,574 SPINE 1244 50.80% 582 23.76% 432 17.64% 191 7.80% 2,449 Added a week for LTAC and Rehab CLASSIFICATION B1 B1 Rate B2 B2 Rate B3 B3 Rate B4 B4 Rate LTAC 21 $ 2,172.96 35 $ 2,064.31 56 $ 1,961.09 >56 $ 1,863.04 REHAB 14 $ 944.23 21 $ 897.02 28 $ 852.17 >28 $ 809.56 SPINE 28 $ 2,807.56 49 $ 2,667.18 77 $ 2,533.82 >77 $ 2,407.13 Percentage Breakdown CLASS BRACKET 1 DAYS % OF TOTAL DAYS BRACKET 2 DAYS % OF TOTAL DAYS BRACKET 3 DAYS % OF TOTAL DAYS BRACKET 4 DAYS % OF TOTAL DAYS TOTAL DAYS LTAC 2113 47.60% 929 20.93% 687 15.48% 710 15.99% 4,439 REHAB 9,334 88.27% 758 7.17% 274 2.59% 208 1.97% 10,574 SPINE 1244 50.80% 582 23.76% 432 17.64% 191 7.80% 2,449 17
Budget Neutral Formula Budget Neutral Formula: 𝑈𝑝𝑢𝑏𝑚 𝑒𝑝𝑚𝑚𝑏𝑠𝑡 𝐶1 + (1 − 𝑦)𝐶2 + (1 − 𝑦) 2 𝐶3 + (1 − 𝑦) 3 𝐶4 Total Dollars = Total dollars reimbursed to specific Classification • LTAC Total Reimbursed Dollars • Rehab Total Reimbursed Dollars • Brain/Spine Total Reimbursed Dollars B = Stepdown Bracket Day quantity x = Percentage of stepdown (decimal form ex. 5% is 0.05) Multiplier: B2=0.95 B3=0.9025 B3=0.857375 **Note: Budget Neutral to Health First Colorado Reimbursed dollars for FY 2017 (7/1/2016-06/30/2017) not Provider billed amount. 18
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