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HFMA – Post-Acute Care Track: Post-Acute Reimbursement Update January 17, 2008

HFMA – Post-Acute Care Track: Post-Acute Reimbursement Update January 17, 2008. Presented by : J. William Kutschbach Principal Director, HW Healthcare Advisors kutschbach@hwco.com. Ohio Medicaid System. Recent History HB 66 (7/1/2005 Biannium Budget Bill) Quality Incentives

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HFMA – Post-Acute Care Track: Post-Acute Reimbursement Update January 17, 2008

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  1. HFMA – Post-Acute Care Track:Post-Acute Reimbursement UpdateJanuary 17, 2008 Presented by: J. William Kutschbach Principal Director, HW Healthcare Advisors kutschbach@hwco.com

  2. Ohio Medicaid System Recent History • HB 66 (7/1/2005 Biannium Budget Bill) • Quality Incentives • NF Rate Transition Advisory Council • Depreciation Recapture • Phase-In • HB 530 • Capital Add-On Language Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  3. Ohio Medicaid System Recent Rate History Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  4. Ohio Medicaid System HB 66 – Pricing Model Peer Groups – Support #1 (Cincinnati” Group) Large #1 (Cincinnati” Group) Small #2 (“MSA” Group) Large #2 (“MSA” Group) Small #3 (“Other” Group) Large #3 (“Other” Group) Small Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  5. Ohio Medicaid System July 1, 2007 • No Pricing Formula Changes • 2.75% Stop Gain for FY 2008 • 0% Stop Loss for FY 2008 • 1.00% Inflation Factor for FY 2008 • Certificate of Need Moratorium Continued for 2 More Years Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  6. Ohio Medicaid System July 1, 2008 • No Pricing Formula Changes • 2.75% Stop Gain for FY 2009 • 0% Stop Loss for FY 2009 • 0% Inflation Factor for FY 2009 Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  7. Ohio Medicaid System Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  8. Ohio Medicaid System Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  9. Ohio Medicaid System Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  10. Ohio Medicaid System Capital Component • Peer Group Average (Regardless of Cost) Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  11. Ohio Medicaid System Quality Add-On • State Benchmarks Re-Determined Yearly • Annual Survey (Prior Year) (No Deficiencies) • Annual Survey (Prior Year) (No Deficiencies Above an E) • Nursing Hours (No Purchased Nursing) • Employee Retention Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  12. Ohio Medicaid System Quality Add-On (cont.) • Occupancy Rate Above SWA (Cost Report) • Medicaid Utilization Above SWA (Cost Report) • Case-Mix Score (Total Facility) Above SWA • Resident Satisfaction Above SWA • Family Satisfaction Above SWA Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  13. Ohio Medicaid System Quality Incentive Benchmarks – 7/1/2006 No Health Deficiencies No Health Deficiencies Above Level E Nursing Hours 1.5686 Employee Retention (CSA 1) 72.20% Employee Retention (CSA 2) 74.02% Employee Retention (CSA 3) 77.03% Occupancy Rate 87.55% Medicaid Utilization 66.80% Annual Case-Mix Score 2.0097 Family Satisfaction N/A Resident Satisfaction N/A Price per Point $ 0.88 Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  14. Ohio Medicaid System Quality Incentive Benchmarks – 7/1/2007 No Health Deficiencies No Health Deficiencies Above Level E Nursing Hours 1.5772 Employee Retention (CSA 1) 72.22% Employee Retention (CSA 2) 73.69% Employee Retention (CSA 3) 76.59% Occupancy Rate 88.49% Medicaid Utilization 65.89% Annual Case-Mix Score 2.0361 Family Satisfaction 86.60% Resident Satisfaction N/A Price per Point $ 0.81 Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  15. Medicaid Rate Calculation Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  16. Medicaid Rate Calculation Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  17. Medicare Issues • Roll Back 7/1/2008 (without Legislation) • Low Utilization Cost Reporting • National Government Services (NGS) Website • Fee Schedules • Therapy Caps = $1,810 • P/T & S/T Combined or O/T Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  18. Medicare Issues (cont.) January 1, 2008 • Part A Co-Insurance = $128.00 • Part B Deductible = $135.00 • Part B Premium = $ 96.40 Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  19. Other Issues • Skilled Nursing Coalition • Capital Compensation Pool • New Proposal • Proposed Language • Resident Satisfaction Survey • Deficit Reduction Act (DRA) • $5,000,000 (10/1/06 – 9/30/07) • MAL 522 Guidance Howard, Wershbale & Co. Cleveland + Columbus 877٠FOR٠HWCO HWCO.COM

  20. CONTACT: J. William Kutschbach Principal Director, HW Healthcare Advisors kutschbach@hwco.com

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