Southern California Chapter Healthcare Financial Management Association

1
Southern California ChapterHealthcare Financial
Management Association

• Chapter Education Program
• March 18, 2008
• Long Term Care Track

2
State and Federal Budget Issues

• Darryl Nixon, Director
• Reimbursement and Data Systems - CAHF

3
Contact Information

• Darryl Nixon, Director
• Reimbursement and Data Systems
• California Association of Health Facilities
• [phone], ext. 112
• dnixon_at_cahf.org

4
State Budget Issues

• Deficit Current Year 2007/08 and Budget Year
  2008/09.
• Budget Balancing Reductions Approved
• LAO Concerns and Recommendations
• Future of AB 1629
• Facility License Fees
• Other - NPI

5
Deficit Budget

• Current Year 2006/07 coupled with Budget Year
  2008/09 14.5 billion deficit.
• LAO Estimates deficit at 16 billion.
• Special Session concluded February 15, Governor
  signed legislation February 16.
• Early adoption of 2008/09 budget encouraged.

6
Budget Balancing Reductions

• Approved Budget Balancing Reductions
• 10 Payment Cut Medi-Cal Providers (Most LTC
  Providers Exempt)
• Payment Delays June and August
• Not Approved
• Elimination of optional benefits

7
LAO Concerns

• Deficit 1.5 billion higher.
• Reserve will be smaller than projected.
• Structural shortfalls to return in 2008/09.
• Budget fails to set priorities (Disagreement with
  across-the-board cut approach).
• Revenue solutions minimal.
• LAO proposed alternative budget.

8
LAO Recommendations

• Implement rate CAP for NFs Effectively reduces
  5.5 budget CAP by 1 for 2008/09 to 4.5.
• Implement cash and counseling methodology for
  HCBS Diversion.
• Shift aged, blind and disabled to managed care.
• Implement P4P.

9
AB 1629 Future Issues

• Continuation
• Funding
• Federal Changes
• Community Diversion
• Pay for Performance
• Staffing Increases

10
2008/09 License Fees

• Fees Rightsizing requires that fees charged are
  based on workload and cost of licensing and
  regulating specific categories of facilities.
• 72 of LC Time/activities related to SNF.
• SNF increase from 250.77 per bed to 292.20.
• Increase primarily related to SB 1312 State
  Licensing Reviews.

11
NPI Implementation

• Medi-Cal Legacy Drop Dead Date (Ends) May 23,
  2008.
• Use of NPI Automatically Ends Medi-Cal Legacy.
  (Cant use both to bill).
• Old proprietary forms Drop Dead Date (End) April
  15, 2008.
• Conduct NPI test before dual use period ends.

12
Federal Budget Issues

• Medicare Cuts
• MedPac Recommendations
• Medicare RACs
• Selective Contracting
• Medicaid Funding Constraints

13
Medicare Cuts

• California Impact for FY 2009, 142.60 million or
  22.47 per resident day.
• No SNF Market Basket Update.
• RUGs cost neutrality adjustment (RUGs creep).
• SNF Bad debt.
• Revisit Fees.
• Part B Therapy CAPs.

14
MedPac Recommendations

• No market basket update for FY 2009
• Establish quality incentive payment policy for
  SNFs.
• Rates of community discharge.
• Avoidable re-hospitalizations.
• Improve quality measurement.
• Revise measures for pain, pressure ulcers and
  delirium.
• Require patient assessments at admission and
  discharge

15
Medicare RACs

• Current program concludes March 27.
• RACs become permanent program with national
  expansion in 2010.
• Contingency fee reimbursement and process have
  been problematic.
• AHCA and CAHF advocacy have been to fix the
  process before embarking anew.

16
Medicare Selective Contracting

• DMEPOS Pilot 10 geographic areas and 10 product
  categories - Inland Empire - Riverside/San
  Bernardino.
• Bids in September 25, 2007.
• Currently evaluating bids release imminent.
• Starts July 2008.
• Lab Services San Diego
• DMEPOS Expansion 70 areas, 8 products. 1
  billion savings annually.

17
Medicaid Funding Constraints

• Legislative
• Target case management
• Administrative cost allocation clawback for TANF.
• Administrative match streamlining.
• Family planning match.
• Regulation
• Public hospital IGTs.
• Rehab

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Questions?

• And
• Answers