CHARLIE CRIST GOVERNOR IGT TAP Members 1. Tom Wilfong 2. Michael Good 3. David Verinder 4. Scott Davis 5. Margaret Brennan 6. Mary Lou Tighe 7. Chris Paterson Agency Staff Present 1. Michele Morgan 2. Phil Williams 3. Edwin Stephens 4. Shannon Bagenholm Better Health Care for all Floridians IGT TAP November 30, 2010 10:00 a.m. - 12:00 p.m. Meeting Minutes ELIZABETH DUDEK INTERIM SECRETARY Non-Members Participating by Telephone 1. Eric Prutsman 2. Mary Pat Moore 3. Elaine Peters 4. Albert Arca 5. Paul Belcher 6. Kelly Register 7. Deborah Breen 8. Lori Hundley 9. Marty Lucia 10. Janet Carter 11. Roger Hahn 272 7 Mah an Dri ve Mail S top # Tallahassee, FL 3 23 08 Visit AHCA online at AHCA.MyFlori da.com
I. Welcome/Opening Comments Michele Morgan, Bureau Chief for Medicaid Program Analysis, opened the conference call at 10:00a.m. II. Discussion Michele Morgan informed the IGT TAP members that the LIP Council is keeping updates on IGT Workgroup. The Council wants to see the next draft of the report as it is updated. Tom Wilfong asked what the LIP Council was considering doing to budget for any short falls. Phil Williams responded that the LIP Council was making various models to measure the impact and determine if there are things the LIP Council can do. Scott Davis asked if the LIP Council models that have been presented as part of addressing that funding deficit, take some reduction to the exemptions and buybacks of the numbers that were in the 10-11 LIP model. Phil Williams explained that the LIP Council is working on a variety of models that are under consideration with a tiered approach so that a hospital that would qualify for an exemption rather than getting the full exemption would get 80% or 60% of an exemption payment depending on certain qualifying criteria. Tom Wilfong asked if, assuming there is a cost shift from the current LIP pool to local governments, then the exemption would be restored based on the cost report. Michele Morgan explained that the exemption ceiling will still remain the same, but the issue is whether or not that IGT will receive any credit and is treated as part of the LIP. Michele Morgan noted the possibility of people not being able to receive exemptions is similar to the buybacks; if they are receiving less credit then they are not likely to get another county or taxing authority to put up the money on their behalf. Unless they are able to put up the money they are likely to receive a low payment if exempt criteria or process changes. Scott Davis noted that to the extent that the models take a tiered approach or any reductions to exemption through LIP, LIP is not the answer to funding requirements to managed care. Tom Wilfong identified two compound problems: 1) Keep hospitals whole for where they are now and replace any federal dollars because of the loss of federal dollars and the increase in expenditures to the hospitals; and 2) Any dollars that would have to be replaced for movement to Managed Care. The report should reflect that. Scott Davis discussed his format for a table, to consider for the report, and how it takes that benefit that was calculated for exemptions and buybacks by hospital, sorts it by county and calculates for the value of exemptions and buybacks, the amount of IGTs that
would be required again by county and lays out next to that the amount of IGTs currently being put up by area to show a deficit or surplus by area. Scott Davis believes that would give providers and the county governments in each part of the state some information on just how big of a hole we are digging if we try to fund this without going through LIP in some fashion. Margaret Brennan asked if the model takes into consideration the donating counties or does it level the playing field requiring counties to fund themselves if they want to make their community whole? Scott Davis noted the table is graphically representing the facts; allows counties to see who is contributing and who is not and what they are benefiting from. Tom Wilfong asked to add the utilization issue, which Melanie has given us, to the model when it is sent out. Cost county utilization tab. It has the amount of inpatient, outpatient and physician claims. Tom Wilfong explained that we know there is an incremental cost per day and per line for both the exempt payment and buyback and we know what that is for each institution. We don not know the number of counts. If we had a percentage of what was spent on inpatients then we could get a total dollars spent in the county for inpatient care. We could then look at what percentage is IGT and buyback and then we could deduce to find out how much is exempt and buyback. We could then attribute that to that county. Scott Davis asked what is the message we want included in the report on this based on this. Tom Wilfong added that we have three views: 1) Who contributes? 2) Who collects? 3) What portion of your population is benefiting from that contribution and collection? Scott David agreed that you would ultimately see who would be impacted by a change in policy. Tom Wilfong noted that the report will show that the problem is much bigger than the Managed Care change. We have a foundational problem not a remodeling problem. Michele Morgan noted that in writing the report she knows we want to list out that there are alternatives and the Managed Care plans have provided information downtown but we should truly focus the report to be fact finding. For example the foundation problem, addressing the funding, explaining that there is distribution but there are so many other contributing factors that need to be addressed prior to developing a distribution model. Tom Wilfong noted that we need to size it; we know what it is worth based on the assumptions the Agency has given us in terms of capture rate. Scott Davis explained that we have some visible dollar impact on the individual counties. We could anticipate the county impact of all the sixty seven counties and what the impact would be.
Tom Wilfong asked to have all the tables ready to discuss at the next call on December 7, 2010. Dr. Michael Good noted that he has a draft out to the medical schools on the Physician UPL issue and hopes to have that out to committee members and to AHCA by the end of the week. He asked to carve out time on December 7, 2010 conference call to discuss the medical school physician payment issue. Tom Wilfong suggested that in the report, with consideration to how much detail to include in it, we put in a summary of what the models are, a flow chart, a sample and pros and cons for each one. Scott Davis added that we should include a distribution methodology encompassing a chart that shows the values of exemptions and buybacks by area. Tom Wilfong noted that the message is that this is a complicated funding issue. The challenge on the state is figuring out a way to solve some of the structural funding issues. Movement to Managed Care does not change that one way or another; it is an issue of magnitude. Fee for service does not go away in any form or fashion, we just narrow the number of lives in fee for service we do not eliminate them. We end up structurally trying to figure out how to fund Medicaid fee for service as well as how to fund managed care fee for service. Margaret Brennan expressed that counties are faced with economic challenges and are impacted by current state mandates. There is limited funding available for additional mandated or non mandated requests. Margaret will compile a list of requirements that are affecting their communities to include in the report. Follow up Task List: Send out Minutes from November 16 th meeting to members once they are approved. Rate sheet that gives providers information on how big of a whole. South Carolina IGT model. Revised draft of the report. Revised county cross tab in Excel format. Percentages by county (inpatient/outpatient hospitals). III. Follow-up Conference Call Schedule December 7, 2010 10:00AM 12:00PM December 9, 2010 10:00AM 12:00PM December 14, 2010 10:00AM 12:00PM December 16, 2010 10:00AM 12:00PM
IV. Adjournment Meeting adjourned at 11:15am