1 / 32

Medicaid DSH

Medicaid DSH. John Berta Senior Director, Policy Analysis Texas Hospital Association June 19, 2014. THA – Who We Are.

kordell
Download Presentation

Medicaid DSH

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medicaid DSH John Berta Senior Director, Policy Analysis Texas Hospital Association June 19, 2014

  2. THA – Who We Are • The Texas Hospital Association is a nonprofit trade association representing Texas hospitals and health systems. In addition to providing a unified voice for health care, THA serves its 500+ members with timely information, data analysis, education on essential operational requirements, networking and leadership opportunities.

  3. Serving Texas Hospitals/Health Systems

  4. Medicaid DSH - Outline • FY2011 • FY2012-13 – Waiver DY1 & DY2 • FY2014-15 – DY3 & DY4 • FY2016 and Beyond

  5. FY2011 DSH (and Before) • DSH & UPL – Pre-Waiver • Programs Related to each other • Public Hospitals have incentive to Fund DSH • Fully Funded for Every Year

  6. DSH Funding Incentive • UPL at Maximum – No Other Funds Available • IGT ~$0.40 • Paid $1.00 • DSH • IGT ~$0.40 • Paid ~$0.55

  7. Medicaid DSH - Outline • FY2011 • FY2012-13 – Waiver DY1 & DY2 • FY2014-15 – DY3 & DY4 • FY2016 and Beyond

  8. FY2012 Financing Transformation • Transformation Waiver • Shifting Landscape • DSH & UC - Closer Connection • Additional PCP Costs Allowed for UC • Result = Alternate Funding Opportunities for Public Hospitals • DSH Audit • Dollars Recouped beginning in Program Year 2011

  9. FY2012 - Shifting Landscape • FY2011 UPL $2.8B • FY2012 UC & DSRIP $4.2B • DSH & UC Closely Aligned • Medicaid Shortfall Growing Larger

  10. Medicaid Disproportionate Share FY2012 • Public Hospitals Agree to Fund $502M of $569 Potential • DSH Dollars Unspent • THA Forms Task Force on DSH

  11. THA Task Force Concepts 2012-2013 • Medicaid Disproportionate Share Hospital Task Force – 6/1/2012 • the money follows the work • shared responsibility for funding the Medicaid DSH program • protection for the most vulnerable classes of hospitals

  12. UC and DSRIP Funding= $29B UC/UPL Transition- $466M

  13. Medicaid DSH FY2013 - Issues • FY 2013 Payments – 100% Amounts - $138M GR $323M IGT • New DSH Rule • Lubbock and Odessa drop out of 8 hospital coalition leaving big 6 • DSH is Regionalized • Pass 3 Rural Funding Mechanism Developed • GR and IGT are separated • Texas Children’s Lawsuit • Max TPL payment = Cost • DSH paid @ 90% (10% Expected)

  14. Medicaid DSH - Outline • FY2011 • FY2012-13 – Waiver DY1 & DY2 • FY2014-15 – DY3 & DY4 • FY2016 and Beyond

  15. Medicaid Disproportionate Share FY2014 • New Rider 86 covers DSH & UC • $300M GR authorized for FY2014 & FY2015 • 2014 = $160M • 2015 = $140M • No General Revenue Funds appropriated after FY2015 • Other Budget Riders not written in this manner

  16. Medicaid DSH Rider 86 • Proportional allocation of supplemental hospital payments among large public, small public, and non-public providers • Mechanisms though which Medicaid payments are made through managed care organizations • Recommended statutory changes and any other legislative direction needed to fully implement the plan

  17. Medicaid DSH Rider 86 (cont’d) • Assess the extent to which supplemental payments are needed to cover Medicaid and uninsured/uncompensated care costs • Transition plan from supplemental payments to rates that recognize improvements in quality of patient care, the most appropriate use of care, and patient outcomes • No General Revenue Funds appropriated after FY2015

  18. Medicaid DSH Rider 86 (cont’d) • FY 2014 request must show a measurable progress in developing the plan • FY 2015 request should include the final plan • No GR funds may be expended for FY 15 until plan is finalized

  19. Medicaid DSH FY2014 2011-Before Transformation Waiver • Non-State Hospital DSH Pool = $1.2B • UPL Payments = $2.8B • Total = $4.0B 2014-After Transformation Waiver • FY2014 UC & DSRIP = $6.2B • FY2014 DSH Non State = $1.3B • Total = $7.5B

  20. 2014 DSH – Attributes - 1 • State-owned hospitals – No change • 2013 – Regional Approach (RHP) • 2014 – Hospitals in statewide pools • 2013 – Funds for Low Income and Medicaid • 2014 – Days added together

  21. 2014 DSH – Attributes - 2 • 2013 - GR funded non RHP areas • 2014 – Hospitals share in GR and related FF • 2014 – 3 Pools = all GR and FF in Pools 1&2 shared by all (e.g. net DSH proceeds) • 2014 - Pool 3 = IGT back to IGT hospitals • 2013 – Pass 3 Methodology in place • 2014 – No change • 2013 – 6 Large public hospitals transfer for their region • 2014 – Fed Funds on IGT by 6 shared by all

  22. 2014 DSH – Attributes - 3 • 2013 – no provision • 2014 – Most other public hospitals IGT ½ of their DSH (Lubbock & Ector IGT for themselves) • 2014 – Non-8 public hospitals have their days weighted such that net DSH is equal • 2014 – Big 6 = $377 total = $396

  23. 2014 UC Attributes - 1 • UC funds are divided into seven pools • state-owned hospitals • COTH members (6 large public) • other public hospitals • private hospitals • physician group practices • governmental ambulance • publicly owned dental providers

  24. 2014 UC Attributes - 2 • Pool amounts are Allocated pro-rata • Allocation basis: • Hospitals - Post DSH Payment unpaid HSL • Other groups – UC Cost

  25. 2014 UC Attributes - 3 • 6 Large transferring hospitals receive “bump” on allocation basis (pre-allocation basis) • UC pre-allocation “bump” equals amount of DSH IGT made for other hospitals

  26. $284M added to 6 UC Pool • Net DSH proceeds = $1.344B - $395M IGT = $949M • Big 6 = 23% of $949M net proceeds • Total IGT = $395M * 23% = $93M • $377M – $93M = $284M • $284M = UC bump for big 6

  27. 2014 UC Attributes - 4 • Special Provision for smaller (Rider 38) hospitals: • The reduction in future years is limited to decreases in UC Pool • E.g. $3.9 billion to 3.1 billion • Reduction is still significant but no greater than this amount • Applies to county < 60k, RRC,SCH,CAH

  28. 2014-17 Key Dates • Fall 2014 - FY 2014 DSH paid (1/2 paid) • Jan 2015 – 84th TX Leg in session • Spring 2015 – last half of 2014 DSH Paid • June 2015 TX Leg leaves • FY2015 DSH – needs final plan • FY2016 – last year of 5 year waiver • 2017 DSH cuts begin

  29. Medicaid DSH - Outline • FY2011 • FY2012-13 – Waiver DY1 & DY2 • FY2014-15 – DY3 & DY4 • FY2016 and Beyond

  30. Medicaid DSH – Future Years • Composition of 84th Legislature • Federal DSH Allotment • DSH Audit Outcomes • Waiver Extension/Renewal/Replacement • Available UC Funds • CMS Negotiation / Federal Outlook • Medicaid Shortfall ~$3B

  31. Medicaid Federal DSH Reductions

  32. Questions? John Berta Texas Hospital Association 512/465-1556 jberta@tha.org

More Related