RHP DISTRICT 10 Finance Committee

1. RHP DISTRICT 10Finance Committee May 10, 2012

2. Goals for Today • Committee charter • Understand waiver funds flow • IGT fundamentals • UC pool payments • DSRIP pool payments • Timeframes • Begin work on RHP budget

3. Waiver Funds Flow State/Local Funds (42%) Federal Match (58%)

4. IGT Fundamentals • Intergovernmental Transfers • Federal Government matches state/local funds spent on the Medicaid program • Approximately 42% state/local • Approximately 58% federal • Expect that FMAP rate changes over the life of the waiver • IGT providers • Hospital districts • Counties • MHMRs • Medical schools • Other government?

5. IGT Fundamentals • State/local share must be public funds • Taxes • Commercial insurance receipts • Investment income • Qualified donations • Other non-Federal • Other? • Cannot be receipts from delegation of a governmental duty • Spreadsheet available for use by potential IGT entities

6. UC Pool • Eligibility for pool payments • RHP membership • UC application filed • Eligible entities • Hospitals • Physician practices • Government ambulance providers • Governmental dental providers • Other providers in rural RHPs with no public hospital • IGT must be provided by governmental entity

7. UC Pool • Qualified amounts – based on data from 2 years prior to payment year • Costs related to providing care to persons with no third party coverage • Medicaid shortfall • For services covered by Medicaid • Inpatient/outpatient (DSH cap calculation) • Physician and mid-level services • Outpatient drugs • Physician practices

8. UC Pool • Necessary data elements • Medicaid and uninsured charges by Medicare cost center • Medicaid and uninsured days by Medicare cost center • Medicaid cost to charge ratios • Medicaid payments • DSH • FFS and managed care • Patient payments • Any other payment made on behalf of the patient

9. UC Pool • UC payments classified as Medicaid payments • Total payments received for uninsured and Medicaid cannot exceed costs for providing services • Process description document at end of this document • Spreadsheets we used are available

10. DSRIP Pool • Payment is incentive based – unrelated to cost • Eligibility for pool payments • RHP membership • Participation in transformation projects • Eligible entities – any health care entity participating in DSRIP projects

11. DSRIP Pool • IGT must be provided by governmental entity • Performance metrics must be met in order to receive payment • Not considered a Medicaid payment

12. Issues at HHSC - Update • UC Tool completion • Contracted services issue • Tobacco funds • Adjustments to cost report numbers • Pool allocations • IGT – conversion of private funds to public funds • Provider donation limitations • DSRIP project pricing

13. Timeframes • June 15: • Finalize UC and IGT numbers • June 30: • Finalize DSRIP pricing strategy • Plan for 2012 DSRIP • August 31: RHP plan due to HHSC • October 31: RHP plan to CMS

14. Next Steps • Begin work on budget • Identification of available IGT • Put together actual UC numbers • Assist in developing pricing model for DSRIP projects • Continue to monitor and impact waiver issues with HHSC and CMS

15. Questions/Concerns?www.jpshealthnet.org/RHP.aspx