HOSPITAL FRANCHISE FEE, SUPPLEMENTAL PAYMENT PROGRAMS & SIM UPDATE. OHA Medicare & Medicaid Update

Transcription

1 HOSPITAL FRANCHISE FEE, SUPPLEMENTAL PAYMENT PROGRAMS & SIM UPDATE OHA Medicare & Medicaid Update September 14, 2017

2 HOSPITAL FRANCHISE FEE 2018 Franchise Fee - $646M in 2018 (est.) Rate set by rule at 2.66% of non-medicare hospital expenses Unchanged since 2016, but base new cost report data is updated annually (SFY 2016 Medicaid CRs) Supplemental Medicaid Payments Funded by Franchise Fee - $684M in 2018 (est.) One-time 5% IP/OP Rate Increase Mostly eliminated at this point except for children s hospitals Upper Payment Limit (UPL) Payments Continue to decline in response to shrinking fee-for-service system Medicaid Managed Care Inpatient Incentive Payments Long-term threat of federal phase-down of pass-through payments HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

3 HOSPITAL FRANCHISE FEE 2018 One-time 5% IP/OP Rate Increase IP 5% eliminated 1/1/14 for non-children s hospitals OP 5% eliminated 1/1/16 for non-children s hospitals Remaining 5% for children s hospitals yields $39M annually Upper Payment Limit (UPL) Payments Driven by FFS Medicaid utilization, not managed care Uptick in 2016 due to expansion, but downward trend continues Preliminary UPL estimates of $483M in 2018, down from $538M in 17 (10.2%) Medicaid Managed Care Inpatient Incentive Payments $162M annual payment from MCOs OHA Eligible Hospitals based on inpatient utilization HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

4 Millions HOSPITAL FRANCHISE FEE 2018 $1,200 Franchise Fee Funded Payments $1,000 $977,892,976 Separate Expansion UPL Payments $800 $600 5% Base Rate Increase Managed Care Incentive Payments $738,993,886 5% Base Rate Increase Managed Care Incentive Payments $709,983,965 5% Base Rate Increase Managed Care Incentive Payments $683,666,770 5% Base Rate Increase Managed Care Incentive Payments $400 UPL Payments UPL Payments UPL Payments UPL Payments $200 $ Preliminary 2018 w Cut Preliminary 2018 wo Cut HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

5 HOSPITAL FRANCHISE FEE Preliminary 2018 w Cut Preliminary 2018 w/o Cut Systems Net Positive Systems Net Negative Independents Net Positive Independents Net Negative System Gains $221,339,906 $77,985,960 $34,582,377 $23,084,684 System Losses ($411,560) ($20,415,935) ($27,990,357) ($36,826,902) Independent Gains $96,576,112 $80,135,621 $71,629,558 $67,813,833 Independent Losses ($8,736,288) ($20,646,516) ($30,175,095) ($32,342,328) Total Net* $308,768,171 $117,059,130 $48,046,482 $21,729,287 * - Net Gains do not include payments for children s hospital quality incentive program. Source: HMA HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

6 2018 FRANCHISE FEE/UPL/MCP INCENTIVE TIMELINE Tentative/Subject to Change ODM sends Hospital Franchise Fee Assessment Letters by 9/30 This will be hospitals only notice for entire program year Franchise Fee Due UPL Payment Processed MCP Incentive Payment Date October 16 October 30 December 7 December 11 December 26 February 7 February 5 February 20 April 9 April 9 April 23 June 7 HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

7 HOSPITAL FRANCHISE FEE MOVING FORWARD ODM Reviewing 2018 UPL Models When review complete, OHA will push out hospital-specific summaries to members (9/30 est.) OHA Board of Trustees & Finance Committee Developing new principles and goals for programs Working with Health Management Associates to recalibrate payments due to shrinking FFS program Evaluating new models of directed payments through managed care, aligned with state quality goals and allowable under new federal regulations Goal is to have new program recommendations to ODM by Q HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

8 QUESTIONS? HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

9 SIM UPDATE PAPs should have received reports linked to payment (perinatal, asthma, COPD) Reports were to be finalized in August; payment to be implemented in November Reports available through MITS portal. If you don t know your MITS administrator, call HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

10 CFO SURVEY Due September 22 ed to all CFOs last week New questions this year about each Medicaid plan and some additional financial items to better inform OHA s policy and advocacy work Questions: Aly.Deangelo@ohiohospitals.org HFF/UPL/SIM Update Medicare & Medicaid in 2017 September 14,

11 OHA collaborates with member hospitals and health systems to ensure a healthy Ohio Ryan Biles, Sr. Vice President, Health Economics & Policy Ryan.Biles@ohiohospitals.org Ohio Hospital Association 155 E. Broad St., Suite 301 Columbus, OH T ohiohospitals.org