HCA Presentation Ann Foster Division of Finance and Rate Setting Department of Health

Transcription

1 HCA Presentation Ann Foster Division of Finance and Rate Setting Department of Health September 9, 2016

2 September 9, Agenda Global Cap Results Overview of Global Cap Projections Results through June 2016 MLTC Rates Minimum Wage FLSA Survey

3 September 9, Closeout Results Global Cap spending was $3 million below target for closeout. Medicaid Spending (FY 2016) (dollars in millions) Category of Service Estimated Actual Variance Medicaid Managed Care $12,400 $12,466 $66 Mainstream Managed Care $8,760 $8,673 ($87) Long Term Managed Care $3,640 $3,793 $153 Total Fee For Service $9,658 $9,689 $31 Inpatient $2,923 $3,014 $91 Outpatient/Emergency Room $458 $491 $33 Clinic $551 $570 $19 Nursing Homes $3,469 $3,379 ($90) Other Long Term Care $653 $676 $23 Non-Institutional $1,604 $1,559 ($45) Medicaid Administration Costs $498 $504 $6 OHIP Budget / State Operations $257 $271 $14 Medicaid Audits ($358) ($261) $97 All Other $2,502 $2,285 ($217) Local Funding Offset ($7,216) ($7,216) $0 TOTAL $17,741 $17,738 ($3)

4 September 9, Variance Highlights Long Term Managed Care (+$153M) Timing-related (+$102M): additional Federal receipts and cash advances to several plans. Other (+$51M): due to higher than expected enrollment of approximately 5,400 recipients. This is in addition to the 6,375 recipients added in the Mid-Year update. Long-Term Care (-$67M) Primarily due to delayed rate packages..

5 September 9, Global Cap for is $18.5 billion Reflects annual growth of $771 million (primarily for price and utilization). Managed Care trends for Mainstream and Long Term Care set by Mercer. Various FFS rate changes (includes increases for case mix, inpatient, and outpatient/clinic rates). Assumes 93,400 new enrollees from March 2016.

6 September 9, Global Cap Projections DRAFT The Global Spending Cap will increase to $18.5 billion in , reflects underlying growth of $771 million. Price (+$524 million) Trend increases for mainstream managed care and long term managed care; and Increases for various FFS rate packages. Utilization (+$215 million) Annualization of new enrollment (194,000); and New enrollment for (93,400). MRT/One- Timers/Other (+$32 million) State Contribution for the Essential Plan ($500 million); offset by Removal of the 53 rd cycle (-$207 million); Annualization of CFCO enhanced FMAP (-$130 million); and Additional Accounts Receivable collections (-$108 million).

7 September 9, Global Cap Projections DRAFT Medicaid Spending (dollars in millions) Category of Service Online Offline Total Medicaid Managed Care $13,888 ($357) $13,531 Mainstream Managed Care $9,369 ($62) $9,307 Long Term Managed Care $4,519 ($295) $4,224 Fee For Service $7,823 $748 $8,571 Acute Care $2,820 $662 $3,482 Long Term Care $3,627 ($17) $3,610 Non-Institutional $1,376 $103 $1,479 Medicaid Administration Costs $0 $480 $480 OHIP Budget / State Operations $0 $383 $383 Medicaid Audits $0 ($318) ($318) Other State Agency $3,154 ($1,017) $2,137 All Other $0 $884 $884 Local Cap Contribution $0 ($7,157) ($7,157) TOTAL $24,865 ($6,354) $18,511 Online spending includes health care provider claims reimbursement. Offline spending primarily includes grants, DSH/IGT payments and administrative costs. Offline offsets primarily include reimbursements from local governments, other state agencies, pharmacy rebates, cash audits and CFCO.

8 September 9, Long Term MC ($4.2 billion in ) DRAFT Projected increases include: Components ($ in Millions) Price Utilization Base/Trend Update $ Annualization of Enrollment -- $256 New Population Shifts 7,105 individuals -- $98 New Enrollment 12,000 individuals -- $152 Total Increase $168 $506 Other spending primarily reflects the enhanced FMAP for CFCO (-$132 million), recovery of provider cash advances (-$70 million) and removal of the 53 rd cycle (-$20 million).

9 September 9, Fee-For-Service Categories DRAFT Long Term Care Services ($3.6 billion in ) Category of Service ($ in millions) Actual Price Utilization Other Budget Nursing Homes $3,378 $10 ($311) $10 $3,087 Other Long Term Care $675 ($21) ($105) ($26) $523 Total $4,053 ($11) ($416) ($16) $3,610 Projected increases include: Price: Primarily represents case mix increases and cash receipts assessment reconciliations, offset by the annualization of CHHA rebasing. Enrollment/Utilization: Reflects the movement of populations to managed care. Other spending reflects the removal of the 53 rd cycle (-$65 million), enhanced FFP for CFCO (-$14 million) and ACA (-$8 million); offset by the restoration of the 2% ATB (+$70 million).

10 September 9, Results through June 2016 Medicaid expenditures through June 2016 are $8 million above estimates Medicaid Spending (dollars in millions) Category of Service April May June Cumulative Variance Medicaid Managed Care $12 ($7) $13 $18 Mainstream Managed Care $6 ($2) $4 $8 Long Term Managed Care $6 ($5) $9 $10 Total Fee For Service $21 $19 ($3) $37 Inpatient $4 $4 ($5) $3 Outpatient/Emergency Room $3 $4 $0 $7 Clinic $1 ($1) $2 $2 Nursing Homes $6 $1 ($11) ($4) Other Long Term Care $4 $6 $5 $15 Non-Institutional $3 $5 $6 $14 Medicaid Administration Costs ($2) $1 $3 $2 OHIP Budget / State Operations ($9) ($8) ($3) ($20) Medicaid Audits ($1) $0 $0 ($1) All Other ($22) $3 ($9) ($28) Local Funding Offset $0 $0 $0 $0 TOTAL ($1) $8 $1 $8

11 September 9, Accounts Receivable Balance as of August 2016 $200 $150 $100 $50 $9 $32 $18 $74 $28 Inpatient Clinic Home Care Nursing Homes Other o The accounts receivable balance declined by $64 million from March o Global Cap projecting a reduction of $140 million in SFY o Goal is to eliminate AR balance by March $0 $184 million

12 September 9, Cost Report Status Cost Report Status Due Date Expected Received Long Term Home Health Care August Personal Care September CHHA September

13 September MLTC Partial Capitation Rate Methodology Updated cost report base period data from CY12&13 to CY13&14. Continue Wage Parity and FLSA wage adjustments. Administrative cost capped at $215 pmpm. Rates include a 1% surplus. Fraud, Waste and Abuse reduction applied based on legislation for plans and OMIG to work together to obtain savings. 13

14 September MLTC Pools Quality Incentive Pool Projection $140 Million Funded by Surplus Reduction from 3% to 1%. High Cost High Need Risk Pool - $140 million 2% Withhold and redistribution done simultaneously at the end of SFY Nursing Home Price Mitigation Pool - $22 Million Requires accurate encounter data reporting including begin and end service dates. Anticipated Rate Adjustments Minimum Wage Adjustment October New CFCO Services tentatively December

15 September 9, Minimum Wage Stakeholder workgroups began in early July: Provider Associations Plan Associations Joint Meeting of Provider and Plan Associations Draft wage increase of $1.33 to worker cost (NYC). Draft wage increase of $0.99 to MLTC rates (NYC) in October rate package. Next Stakeholder workgroup with DLTC, OMIG and DOL regarding compliance and enforcement. Currently developing fiscal for Upstate Region and subsequent fiscal years.

16 September 9, FLSA Survey DOH and Mercer recently conducted a direct-to-provider survey to assist the Department in obtaining data on the costs incurred by providers for new FLSA requirements including: Overtime Travel New live-in rules 257 surveys were completed. Information from survey expected in October to inform future rate adjustments.

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