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HOSPITAL ENGAGEMENT MEETING
Friday, July 13, 2018
9:00 AM – 10:30 AM
Location: The Department of Health Care Policy & Financing, 303 East
17th Avenue, Denver, CO 80203. 7th Floor Rooms B&C.
Conference Line: 1-877-820-7831 Passcode: 294442#
For more information contact: Elizabeth Quaife at
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Overview of Today’s Meetings
• General Hospital Meeting 9:00-10:30
• Break 10:30-11:00
• EAPG Engagement Meeting 11:00-12:30
**Special Note: The webinar room will change for the EAPG meeting.
The link to EAPG Webinar room is shared under ‘Shared Links’ on the
right side of this webinar room. Please log in during the break if you wish
to stay for the EAPG portion of the day.
End of the Meeting
• Recording and Audio will stop at the end of the
meeting.
• The Webinar room will remain open for
participants wishing to attend the EAPG Meeting
can select the shared link
• The Webinar room will close at 10:50am.
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Colorado Department of Health Care Policy and Financing
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HOSPITAL ENGAGEMENT MEETING TOPICS 7/13/2018 9am-10:30am - Specialty Hospital Update
- Items Pending Additional Research/Action
- Hospital Transformation Project Update
- Impacts of Submitting Medicare as Other Insurance
- Observation 24-48 hours prior to Inpatient Stay
- FY 2018-19 Hospital Base Rates Update
- Mass Adjustment Updates (INPATIENT ONLY)
- Inpatient Future Plans/Goals
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GROUND RULES FOR WEBINAR
• WE WILL BE RECORDING THIS WEBINAR
• ALL LINES ARE MUTED. PRESS *6 IF YOU WISH TO UNMUTE.
PARTICIPANTS CAN ALSO UTILIZE THE WEBINAR CHAT
WINDOW
• Please speak clearly when asking a question and give your
name and hospital
• If background noise and/or inappropriate language occurs all
lines will be hard muted.
Thank you for your cooperation
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Welcome & Introductions
• Thank you for participating today!
• We are counting on your participation to
make these meetings successful
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• 1/12/2018
• 3/2/2018
• 5/4/2018
• 7/13/2018
• 9/7/2018
• 11/2/2018
Dates for Future Hospital Engagement Meetings
in 2018
The agenda for upcoming
meetings will be available on our
external website in advance of
each meeting.
https://www.colorado.gov/pacifi
c/hcpf/hospital-engagement-
meetings
EAPG Monthly Meetings
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2018 Meetings, Conference Room 7B, 11:00am-12:30pm
07/13/2018 09/07/2018
11/2/2018
Agenda Items
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If you wish to request a topic for our next meeting. Please submit the
request by the week prior to the meeting to ensure enough time is
allowed to gather correct personnel and information on the topic.
If a topic is submitted the week of the meeting, we cannot guarantee
enough research will be completed to present at the meeting.
However it will be carried over to the following meeting and any
actionable items will be followed up with the Provider as soon as
possible.
Send all requests to Elizabeth Quaife at [email protected]
The Meeting Agenda is posted on Monday the week of the meeting to
our Hospital Engagement Meeting Website.
Specialty Hospital Meetings
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Meetings for the Budget Neutral Per Diems have concluded
and any additional status updates for implementation will be
provided through email .
The Department wishes to pick up meetings by the end of the
year to begin discussing future components of Specialty Per
Diems such as quality measures, rebasing per diems and
adding a severity of illness component.
These meetings will be announced in advanced via Hospital
Engagement Meeting, Provider Bulletin, Hospital Engagement
Meeting Website AND Email.
Specialty Hospital Per Diem
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***Final Draft: Awaiting Department Approval
CLASSIFICATION T1 Days Tier 1 Rate T2 Days Tier 2 Rate T3 Days Tier 3 Rate T4 Days Tier 4 Rate
LTAC 1-21 $2,125.50 22-35 $2,019.22 56 $1,918.26 >56 $1,822.35
REHAB 1-6 $985.71 7-10 $936.42 11-14 $936.42 >14 $845.12
SPINE 1-28 $2,807.61 29-49 $2,667.23 50-77 $2,533.87 >77 $2,407.17
CLASSIFICATION T1 Days Tier 1 Rate T2 Days Tier 2 Rate T3 Days Tier 3 Rate T4 Days Tier 4 Rate
LTAC 1-21 $2,176.81 22-35 $2,067.97 36-56 $1,964.57 >56 $1,866.34
REHAB 1-6 $1,009.50 7-10 $959.03 11-14 $911.08 >14 $865.52
SPINE 1-28 $2,875.38 29-49 $2,731.61 50-77 $2,595.03 >77 $2,465.28
FINAL RATE
Pending Additional Research and/or Actions
The following items have been discussed at
previous meetings and are pending while
additional research and/or processes are being
completed.
• System Request for 12X Crossover and
Medicare Part A Exhaust Pending with DXC
• System Request for IPP-LARC Carveout
Pending with DXC
• Removing Baby from Mom’s Claim
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Colorado Hospital
Transformation Program
Matt Haynes
Special Finance Projects Manager
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Today’s Meeting
• Hospital Transformation Program (HTP) Update
• HTP Timeline
• Community and Health Neighborhood Engagement
• Discussion and Questions
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Hospital Transformation
Program (HTP) Overview• The Hospital Transformation Program (HTP) is a critical step
toward adding value into the system over time.
• Delivery system transformation continues to be a central
goal of HCPF.
• Tied to the existing supplemental payments
• Focus on Community Engagement.
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HTP Goals
• Improve patient outcomes through care redesign and
integration of care across settings;
• Improve the patient experience in the delivery system by
ensuring appropriate care in appropriate settings;
•Lower Health First Colorado (Colorado’s Medicaid Program)
costs through reductions in avoidable hospital utilization and
increased effectiveness and efficiency in care delivery;
•Accelerate hospitals’ organizational, operational, and systems
readiness for value-based payment; and
• Increase collaboration between hospitals and other providers.
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HTP Focus Populations &
PrioritiesThe HTP envisions transforming care across the following
populations and priority areas:
• High Utilizers
• Vulnerable Populations (including pregnant women and
the elderly)
• Behavioral Health and SUD Coordination
• Clinical and Operational Efficiencies
• Community Development Efforts to Address Population
Health and Total Cost of Care
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HTP Hospital Role
Colorado’s hospitals have a critical role to play in the HTP, and
will be asked to:
• Engage with community partners
• Recognize and address the social determinants of health
• Prevent avoidable hospital utilization
• Ensure access to appropriate care and treatment
• Improve patient outcomes
• Ultimately reduce costs and contribute to reductions in total cost
of care
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HTP Framework
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HTP Framework (cont’d)
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HTP Framework (cont’d)
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HTP Framework (cont’d)
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HTP Framework (cont’d)
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HTP TimelineAugust, 2017 – October, 2018 – Planning period
• The Department will host a series of workgroup meetings
with urban and rural providers to finalize the HTP.
• The Department will be engaged with providers and
organizations throughout the spectrum of the delivery
system for input and feedback that will inform program
development
• This period will also include time for hospitals to develop
processes for engaging with their communities.
• We will also be drafting the waiver during this period.
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HTP TimelineOctober, 2018 – October, 2019 – Ramp-up period
• This pre-waiver period will serve as a ramp-up in alignment
with the provider fee year to establish critical relationships
and identify HTP initiatives.
• Hospitals will begin an in-depth community engagement
process to further determine the needs of the community
and the roles hospitals can play to support those needs.
• Hospitals will begin developing project ideas for the program
application
• Waiver negotiations with CMS will occur.
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HTP Timeline
October 1, 2019 – HTP implementation
• As the Enterprise legislation outlines, we will be moving
forward with an 1115 Waiver with an implementation date
beginning October 1, 2019.
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Community and Health
Neighborhood Engagement
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• Hospitals must engage stakeholders in their HTP planning
• Engagement should be:
• Meaningful
• Inclusive
• Not duplicative
• Evidence-based and data-
driven
Community and Health
Neighborhood Engagement:
Stakeholders
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• Stakeholders can assist planning efforts by providing:
• Data and expertise about the community the hospital serves
• Information about and connections to available community
resources
• Ideas and support for HTP initiatives
• Stakeholders include:
• RAEs
• LPHAs
• Health Alliances
• FQHCs
• Health Neighborhood
providers
• Health First advocates
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Sta
te A
cti
vit
ies
Hosp
ital Acti
vit
ies
• Initiate or leverage relationships with organizations that serve and represent the community
• Include organizations that represent a broad cross-section of the community
• Leverage existing forums and collaborations
• Develop a plan for addressing gaps, including recruiting as needed
• Develop and submit a proactive Action Plan outlining the hospital’s engagement strategy and approach to the process
• Include: organizations to be engaged; forums to be utilized; strategies and activities; sources of information to be leveraged; and expected challenges and solutions
• Include Letters of Support from key community organizations
• Leverage or host ongoing discussions to complete and gather input on an environmental scan
• Identify and discuss data and sources of information, including CHNAs
• Work with partners to identify and describe the community and its challenges and needs, including specific to HTP priorities
• Include opportunities for bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow-up communication
• Submit a midpoint report on the C/HN Engagement process, with a focus on engagement to-date, environmental scan findings, and plans going forward
• Submit a final report on the C/HN Engagement process, with a focus on engagement overall, progress in planning HTP participation, and plans for ongoing C/HN Engagement
June – October 2018 August 2018 –October 2018
October 2018 –April 2019
April –September 2019
April - October 2019
• Engage priority stakeholders: RAEs, provider and trade associations, health alliances, and other government agencies
• Leverage stakeholders to communicate expectations to community organizations; identify potential risks to C/HN Engagement process and mitigation strategies
June – October 2018 • Release C/HN Engagement Guidebook • Launch web-based training series on C/HN
Engagement• Provide facilitated Q&A calls and one-on-one
TA calls as needed• Work with hospitals to refine and revise Action
Plans for the C/HN Engagement process• Work with participants on an ongoing basis to
ensure expectations are met and assist with navigating challenges and obstacles
August 2018 - September 2019 • Review midpoint reports of the progress
and findings from the environmental scan and provide recommendations
• Review final report of the stakeholder-informed plans for HTP participation and provide recommendations
April - September 2019
Build partnerships Create an Action Plan
Discuss needs &
opportunities in the
community
Report on activities &
findingsDevelop initiatives & an
application
• Leverage or host ongoing discussions for providing input on needs and opportunities for HTP initiatives
• Work with partners to prioritize community needs, identify target populations and initiatives, and build partnerships for initiatives via an evidence-based and stakeholder-informed decision-making process
• Include opportunities for bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow-up communication
Outreach and Stakeholder Engagement Provide Guidance and Technical Assistance Review Reporting
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Hosp
ital Acti
vit
ies
• Initiate or leverage relationships with organizations that serve and represent the community
• Include organizations that represent a broad cross-section of the community
• Leverage existing forums and collaborations
• Develop a plan for addressing gaps, including recruiting as needed
• Develop and submit a proactive Action Plan outlining the hospital’s engagement strategy and approach to the process
• Include: organizations to be engaged; forums to be utilized; strategies and activities; sources of information to be leveraged; and expected challenges and solutions
• Include Letters of Support from key community organizations
• Leverage or host ongoing discussions to complete and gather input on an environmental scan
• Identify and discuss data and sources of information, including CHNAs
• Work with partners to identify and describe the community and its challenges and needs, including specific to HTP priorities
• Include opportunities for bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow-up communication
• Submit a midpoint report on the C/HN Engagement process, with a focus on engagement to-date, environmental scan findings, and plans going forward
• Submit a final report on the C/HN Engagement process, with a focus on engagement overall, progress in planning HTP participation, and plans for ongoing C/HN Engagement
June – October 2018
August 2018 –October 2018
October 2018 –April 2019
April –September 2019
April - October 2019
• Leverage or host ongoing discussions for providing input on needs and opportunities for HTP initiatives
• Work with partners to prioritize community needs, identify target populations and initiatives, and build partnerships for initiatives via an evidence-based and stakeholder-informed decision-making process
• Include opportunities for bidirectional dialog scheduled at regular intervals, leverage a range of venues and pathways, and provide notice and follow-up communication
Report on
activities and
findings
Develop initiatives
and an application
Discuss
community and
needs
Create an Action
PlanBuild partnerships
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Sta
te A
cti
vit
ies
• Engage priority stakeholders: RAEs, provider and trade associations, health alliances, and other government agencies
• Leverage stakeholders to communicate expectations to community organizations; identify potential risks to C/HN Engagement process and mitigation strategies
June – October 2018
• Release C/HN Engagement Guidebook
• Launch web-based training series on C/HN Engagement
• Provide facilitated Q&A calls and one-on-one TA calls as needed
• Work with hospitals to refine and revise Action Plans for the C/HN Engagement process
• Work with participants on an ongoing basis to ensure expectations are met and assist with navigating challenges and obstacles
August 2018 - September 2019
• Review midpoint reports of the progress and findings from the environmental scan and provide recommendations
• Review final report of the stakeholder-informed plans for HTP participation and provide recommendations
April - September 2019
Outreach and Stakeholder Engagement
Provide Guidance and Technical
AssistanceReview Reporting
Community and Health Neighborhood
Engagement Timeline
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Sta
te
PFMY18: C/HN Engagement Action
Plan Development
2018 2019
Au gJu n Jul
Se p Oc t No v De c Ja n Fe b Ma r
Apr
Ma y Au gJu n Jul
Se p
Q1 Q2 Q3 Q4
PFMY 19 Pre-Waiver Period
Apr
Ma y
Q3 Q4
PFMY*18
PFMY*18Q4
8/1/2018
Kickoff and
Training
PFMY19Q1
October
2018
Action Plans
PFMY19Q3
April 2019
C/HN Engagement
Midpoint Reports
Hosp
itals
PFMY19Q4
September – October
2019
C/HN Engagement Final
Reports
PFMY19: Pre-Waiver C/HN Engagement Process
PFMY19Q3: Review Midpoint Reports
and Work with Hospitals to Finalize
PFMY19Q4: Review C/HN
Engagement Final Reports
PFMY19Q1: Review Action Plans
and Work with Hospitals to
Finalize
*Provider Fee Model Year
Questions and Discussion
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Contact Information
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Matt Haynes
Special Finance Projects Manager
Impacts of Submitting Crossover
Claims as Other Insurance
Topics Covered
• Legacy MMIS
• New interChange
• Provider Impacts
• Department Impacts
• Recovery Vendor Impacts
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Submitting Crossover in MMIS Legacy vs
interChange
MMIS Legacy
• Providers were instructed to submit Crossover
Claims as Non-Crossovers and submit Medicare
Payments, Coinsurance & Deductible as
commercial TPL
interChange
• Following the previously used method of
submission will cause several issues for Providers,
Department Reporting, and for the State’s TPL and
Medicare Recovery Vendor
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Provider Impacts
• If a client has Part A, but Part A was exhausted
before/during the stay – submitting a Non-
Crossover Inpatient Claim (Claim Type I) would
cause an edit to set and the claim would be denied
to bill to Medicare
• COBA Providers would need to void COBA
submitted crossover claims to avoid duplicate
claims audits from posting on the Provider
submitted claim
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Department Impacts
• Reporting of Crossover and Non-Crossover Claims
payments will be inaccurate for both Part B only
and Part A exhausted Clients
• With the launch of interChange, the claim’s engine
can now be configured to be in compliance with
CMS
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Recovery Vendor Impacts
• For Part B Only clients, submitting Claim Type I
with Medicare COB amounts as Commercial COB
amounts will not allow the vendor to identify
claims that should have legitimately been
coordinated with commercial carriers.
• Additionally the Recovery Vendor will not be able
to identify the claim as Medicare and may try to
recover for Medicare on the Non-Crossover claim
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Observation (Services) 24-48
hours prior to Inpatient Stay• EOBs 1730 and 1731
• An SCR has been submitted to DXC to allow From
Date to be up to 2 Days before Admit Date
• Denied claims with payment dates 3/1/2017-
6/30/18 will be reprocessed
• Example: client gets in the emergency room on February 10, 2018, but
he/she doesn’t get admitted as inpatient until February 12, 2018. Discharge date
is February 20, 2018.
➢ From Date: February 10, 2018
➢ Admit Date: February 12, 2018
➢ Reporting Covered (Inpatient) Days: 8 days (February 12, 2018 - February 20, 2018)
➢ Reporting Non-covered Days: 2 days
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1. How much can we spend this year and remain
budget neutral to FY2002-03?
A. FY16-17 discharges are adjusted by the claim Volume Inflator
designated by The Department for FY16-17 (1 + -0.8%) and
FY17-18 (1 + 1.13%) which is .32% this year.
B. Case Mix Index (CMI) is calculated for each hospital’s FY16-17
discharges (Total DRG Weights/Total Discharges).
C. FY2002-03 DRG Base Rates (adjusted by prior Budget Actions) - Note: this does not include the 1.0% increase that is proposed in this year’s
Long Bill.
How Inpatient Rates are Built
Calculation = A*B*C
Budget Year & Type of Action Total
SFY 18-19 (Budget Neutral Amount) $828,205,765
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2. Determine % of Medicare Rate
A. Input 10/1/2017 Medicare Base Rates – DSH + Medicaid Add-Ons for all
PPS Hospitals.
B. Average peer group rates are calculated and attributed to all Critical
Access Hospitals (CAH), low discharge hospitals and new hospitals as
necessary.
C. Non-PPS Hospital Rates are entered with budget increase (1.0%) since
we currently have no instituted methodology to update these rates.
D. Run Goal Seek to find % of Medicare Rate that allows us to remain
Budget Neutral to FY2002-03 Budget which is $828,205,765.
How Inpatient Rates are Built
Percent of Initial Medicare Rate SFY 18-19
At the Budget Neutral Amount 84.49%
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3. Apply Budget Action to PPS Hospitals to arrive at
final percent of initial Medicare Rate
A. Apply Budget Action of 1.0% to Budget Neutral Amount
B. Distribute resulting amount to all PPS Hospitals to arrive at total
budget for FY2018-19 of $836,487,823.
How Inpatient Rates are Built
Budget Year & Type of Action Total
SFY 18-19 Budget Action (1.0% increase) $8,282,058
Percent of Initial Medicare Rate SFY 18-19
With Budget Action/Legislative Increase of 1.0% 85.50%
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Hospital Rates Effective 7/1/2018
The SFY 18-19 Long Bill included a 1.0% rate increase effective this
July 1. This 1.0% increase was added to the budget neutrality
amount for SFY 18-19. The methodology for calculating the
inpatient rates remains the same as previous years.
Inpatient: Percent of Initial Medicare Rate: 85.50%
State Plan Amendment Approval – Sometime in September/October
Percent of Initial Medicare Rate SFY 17-18 SFY 18-19
At the Budget Neutral Amount 83.27% 84.49%
With Budget Action/Legislative Increase of 1.0% NA 85.50%
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• There are about 100 DRG in-state hospitals enrolled with
Medicaid and the Budget Neutrality amount for SFY 2018-19 is
~$828 million.
• The increase in budget is largely due to a significantly higher CMI
(Case Mix Index – so higher rated DRGs) rather than a significant
increase in expected discharges for FY2018-19. Discharges were
expected to grow by 9.5% last year while this year’s expected
growth is only .32%.
• For Medicaid rates effective July 1, 2018, the starting point is
the Medicare rate effective October 1, 2017.
Hospital Rates Effective 7/1/2018
Budget Year & Type of Action Total
SFY 17-18 (w/1.4% Budget Action) $802,699,519
SFY 18-19 (Budget Neutral Amount) $828,205,765
SFY 18-19 Budget Action (1.0% increase) $8,282,058
Total SFY 18-19 w/Budget Action $836,487,823
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• Overall, the average rate change reflects a 1.0% increase in addition to a
change in Medicare base rates between FFY 16 and FFY 17.
Hospital Rates Effective 7/1/2018
• The final rates will not be loaded into the system
until the Department receives approval from
CMS. After which a mass adjustment will be done
to reprocess affected claims.
• In the meantime, the current hospital rates will
be kept in place.
Decreases and increases for PPS
hospitals are mostly due to
fluctuations in the Initial
Medicare base rate from last
year. The few Rural hospitals
that contribute to the peer
group average experienced a
decrease, while urban hospitals
overall experienced a increase.
The peer group average for
specialty hospitals increased
more than 1% because a
hospital in the group closed.
Peer Group Avg 2017-18 Avg 2018-19 % Change
Rural $7,054.07 $6,987.34 -0.95%
Urban $5,129.51 $5,390.68 5.09%
Specialty $7,644.91 $7,870.53 2.95%
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Hospital Rates Effective 7/1/2018
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Hospital Rates Effective 7/1/2018
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Hospital Rates Effective 7/1/2018
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Hospital Rates Effective
7/1/2018
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Hospital Rates Effective 7/1/2018
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• The rates we have shared today are exactly the same as they
were on July 3rd posting. We have added rates for two
hospitals that were inadvertently missed in the first posting.
• Hospitals can request the calculation of their inpatient
rate by contacting Diana Lambe at
[email protected] or 303.866.5526.
• The Department posted updated rates with a restart of the 30
day review period on 7/13/2018.
Hospital Rates Effective 7/1/2018
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• The Department has finished all Legacy Mass Adjustments relating
to ICD-10. Resulting in increased payments of ~$40,000.
Final Legacy Mass Adjustment
Update
Reprocess INPATIENT ICD-10 PAID LEGACY CLAIMS
Claim Type Claim Status Count % of Total
I = Inpatient P 3,462 88.4%
I = Inpatient S 325 8.3%
A = Medicare Crossover P 130 3.3%
A = Medicare Crossover S 14 0.4%
Total 3,917 100.0%
Paid ~92%
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• Plans we have for the new fiscal year are:
• Separate Baby on Mom’s Claim – currently working on
• Possible switch to 3M National Weights afterward?
• Inpatient Base Rate Reform
• Explore using Medicare Federal Base Rate or Other Base Rate as
possible starting point for Medicaid Base Rate
• Possible Peer Group Improvements: Urban/Rural Designation
Overhaul
• Explore what Add-Ons would be necessary for a different base
rate:
• Nursery
• NICU
• GME
• Critical Access Hospitals
• Quality Measures
• Low Volume Payments
• Etc.
Inpatient – Rate Reform
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Federal Base Rate as Possible Starting
Point for Medicaid Base RateHospital Name HOSPITAL 1 HOSPITAL 2 HOSPITAL 3 HOSPITAL 4
MEDICARE FEDERAL BASE RATE
OPERATING
Labor Related Amount 3,805.30 3,760.40 3,389.78 3,349.79
Wage Index 1.0006 1.0006 0.9615 0.9615
Adjusted Labor Amount 3,807.58 3,762.66 3,259.27 3,220.82
Non-Labor Amount 1,662.09 1,642.48 2,077.61 2,053.09
OPERATING TOTAL 5,469.67 5,405.14 5,336.88 5,273.91
CAPITAL
Standard Federal Rate 438.75 438.75 438.75 438.75
GAF 1.0004 1.0004 0.9735 0.9735
CAPITAL TOTAL 438.93 438.93 427.12 427.12
MEDICARE FEDERAL BASE RATE $5,908.60 $5,844.06 $5,764.01 $5,701.04
MEDICAID SPECIFIC ADD-ONS
Nursery $27.00 $6.00 $10.00 $0.00
NICU $0.00 $40.00 $0.00 $0.00
GME $40.00 $8.00 $0.00 $0.00
?? $500.00 $0.00 $0.00 $400.00
?? $0.00 $900.00 $0.00 $0.00
?? $0.00 $0.00 $0.00 $2,000.00
?? $0.00 $0.00 $1,500.00
MEDICAID ADD-ON SUBTOTAL $567.00 $954.00 $1,510.00 $2,400.00
MEDICAID BASE RATE $6,475.60 $6,798.06 $7,274.01 $8,101.04
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Hospital Designations:
Urban/Rural or Something Else?Hospital Peer Groups: A grouping of hospitals for the purpose of cost comparison and
determination of efficiency and economy. The peer groups are defined as follows:
a. Pediatric Specialty Hospitals: all hospitals providing care exclusively to pediatric
populations.
b. Rehabilitation and Specialty-Acute Hospitals: all hospitals providing rehabilitation
or specialty-acute care (hospitals with average lengths of stay greater than 25
days).
c. Rural Hospitals: Colorado Hospitals not located within a federally designated
Metropolitan Statistical Area (MSA).
d. Urban Hospitals: all Colorado hospitals in MSA's including those in the Denver MSA.
Also included would be the Rural Referral Centers in Colorado, as defined by HCFA.
(SSAS, 1886 (d) (5) (c) (I); Reg. 412.90 (c) and 412.96).
Facilities which do not fall into the peer groups described in a. or b. will default to the peer
groups described in c. and d. based on geographic location.
Source: Colorado State Plan Attachment 4.19A
Future Inpatient
➢ Medicaid Base Rate Examples to come in Novembers
meeting.
➢ Please send thoughts/examples ASAP of what kind of
base rate you think would work for inpatient.
➢ Also – any thoughts you have on what should be used to
determine peer groups and urban/rural designations.
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Information Resources
• Inpatient Hospital Rates Webpage Link
• Outpatient Hospital Rates Webpage Link
• Hospital Engagement Meeting Webpage Link
• UB-04: IP and OP Billing Manual Webpage Link
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Questions, Comments, & Solutions
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The final poll is now an external survey to provide anonymity,
please take a few moments to complete it. Thank you
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Thank You!
Elizabeth Quaife
Specialty Hospital Rates Analyst
Ana Lucaci
Hospital Policy Specialist
Raine Henry
Hospital Policy Specialist
Jeremy Oat
Operations Section Manager
Shane Mofford
Payment Reform Section Manager
Kevin Martin
Fee for Service Rates Manager
Diana Lambe
Inpatient Hospital Rates Analyst
Andrew Abalos
Outpatient Hospital Rates Analyst