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HOSPITAL ENGAGEMENT MEETING
Friday, September 7, 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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Welcome & Introductions
• Thank you for participating today!
• We are counting on your participation to
make these meetings successful
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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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• 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
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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 9/7/2018 9am-10:30am - LTAC and Rehabilitation Hospitals Per Diem Rate Update (formerly Specialty Hospital)
- Items Pending Additional Research/Action
- CC/CCEC Rule Update
- 12X Crossover and Medicare Part A Exhaust/Part B Only Quick Update
- IPP-LARC Carveout Update
- FY 2018-19 Hospital Base Rates Update
- Inpatient Future Plans/Goals
- Staff Update
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.
Inpatient Hospital Per Diem Rate Group(formerly Specialty Hospital)
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To better align with existing language, we are removing the ‘Specialty
Hospitals’ term and referring to this group as ‘Inpatient Hospital Per Diem
Rate Group’.
This group includes:
1. Freestanding Long Term Acute Care Hospital
2. Freestanding Rehabilitations Hospital
3. Spine/Brain Injury Treatment Specialty Hospital *NEW*
4. State Owned Psychiatric Hospitals
5. Privately Owned Psychiatric Hospitals
A new webpage to house the rates for the Per Diem Hospitals is currently
underway and will be similar format as the Inpatient Hospital Rates Page
Inpatient Hospital Per Diem Rates Rule Status
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Go Live for the new Per Diem has moved from July 1, 2019 to
January 1, 2019.
• State Plan Amendment (SPA) is pending internal Clearance
and Public/Tribal Notice
• SCR (System Update) has been submitted
• State Rule Changes are being finalized prior to entering internal
Clearance
*SPA and State Rule changes impact Freestanding Long Term
Acute Care Hospitals, Freestanding Rehabilitation Hospitals and
Spine/Brain Injury Treatment Specialty Hospital Only.
**Psychiatric Hospitals currently have a per diem and no
changes to these rates or definitions are being made.
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.
• Observations over 24 hours
• Observation 24-48 hours prior to Inpatient
Stay
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Community Clinic and Community Clinic
and Emergency Center (CC/CCEC) Rule
Update
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The Public Rule Review meeting for the proposed CC/CCEC rule was completed Monday, August 27, 2018. Feedback was documented from the meeting.
The rule will be brought to the Medical Services Board for first reading on September 14, 2018. The target implementation date for this rule is December 1, 2018.
Details on these meetings and the rule making process can be found on the Medical Service Board page located here.
IPP-LARC Carveout Update
A System Change Request (SCR) has been submitted
to DXC. However, due to other priorities related to
system changes the project has been suspended.
IPP-LARCs will continue to be included in the APR-
DRG methodology for the foreseeable future.
If resources become available we will bring updates
to this forum and other communication avenues. If
you have questions/feedback please contact Melanie
Reece.
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12X Crossover, Medicare Part A Exhaust
and Medicare Part B only Quick Update
• System Change Request (SCR) is pending
prioritization
• Several Department representatives will be
attending the next prioritization meeting to get
the SCR into a high priority slot.
• The Department is researching potential
workarounds, however, a workaround will not be
solidified until the SCR is prioritized and DXC and
the Department have agreed on a final solution.
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• The 30-day review period for informal
reconsideration or appeal of FY2018-19 rates
ended 8/12/2018. The finalized rates that are
being sent for CMS approval will be posted next
week.
• When CMS approval is received, we will mass
adjust all claims from 7/1/2018 to reflect the
new rates.
• CMS approval is expected in 4th Quarter 2018.
Hospital Rates Effective 7/1/2018
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• CMS contacted the State for clarification on problems
associated with confirming qualification to receive Low
Volume Payments (LVP) for Rural Community Hospital
Demonstration participants.
• We discussed with CMS the need to receive some indication
from hospital intermediaries (Novitas & WPS) that confirms or
denies LVP qualification for those hospitals as required in
Colorado State Plan.
• CMS is working on getting communication out to fiscal
intermediaries (Novitas & WPS) to ensure they provide that
notification in some form for this year’s Medicare Rates.
Rural Community Hospital Demonstration
Low Volume Payment Update
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Some providers have expressed concerns regarding separating
mother and baby claims. Specifically, the concern is the amount
of time it takes to get a Medicaid ID for the baby.
• Poll: How long does it take to get a Medicaid ID for newborn?
• 1-2 weeks
• 3-4 weeks
• 5-6 weeks
• 7-8 weeks
• 9 weeks or more
• Poll: Do you support separating mother and baby claims?
• Yes, separate them
• No, keep baby on Mother’s birth claim
• Neutral, fine with either option
Separating Baby from Mother’s Claim
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Overview:
Differences in weights between Colo and National:
COLORADO APR-DRG Weight (WT)
TABLE VS. NATIONAL WT TABLE Ver 33
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TrimPoint differences are slightly lower for birth/neonatal DRGs and are about
5-6 days out from current Colorado TrimPoints.
Average length of stay (ALOS) is slightly lower for birth/neonatal DRGs and are
very close to current Colorado ALOS.
COLORADO APR-DRG Weight (WT)
TABLE VS. NATIONAL WT TABLE Ver 33
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Weight Distribution for Birthing Method APR-DRGs
• Background: The goal of this policy was to reduce unnecessary cesarean
section deliveries, which result in higher costs and more complications.
• Current Methodology: APR-DRG 540 (Caesarean Section Delivery) weights were
calculated by setting SOI 1 at the weighted average of Vaginal Delivery (APR-
DRG 560) SOI 2 and SOI 3. APR-DRG 540 SOI 2, 3, and 4 are set with CO-specific
weight. All severities of APR-DRG 560 (Vaginal Delivery) were increased by 10%
to acknowledge the volume and importance of deliveries to the Medicaid
population.
COLORADO SPECIFIC POLICY ADJUSTMENTS
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COLORADO SPECIFIC POLICY ADJUSTMENTS
Weight Increase for Trauma Care APR-DRGs (910, 911, 912, 930)
• Current Methodology: In order to maintain access to high-level trauma
care for Colorado Medicaid patients, all four severity levels had their
calculated weight increase by 40%:
o Craniotomy for Multiple Significant Trauma (APR-DRG 910)
o Extensive Abdominal/Thoracic Procedures for Multiple Significant
Trauma (APR-DRG 911)
o Musculoskeletal & Other Procedure for Multiple Significant Trauma
(APR-DRG 912)
o Multiple Significant Trauma w/o O.R. Procedure (APR-DRG 930)
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COLORADO SPECIFIC POLICY ADJUSTMENTS
Youth Recovery Center Weight Adjustment (772)
• Background: APR-DRG 772 (Alcohol & Drug Dependence w Rehab or
Rehab/Detox Therapy) is a unique case in that only one hospital is
currently approved for payment of claims grouping to this APR-DRG
code.
• Current Methodology: Average Length of Stay (ALOS) and TrimPoint
were changed to national to better reflect standard alcohol and drug
dependence therapy lengths of stay across the nation.
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COLORADO APR-DRG WT TABLE VS.
NATIONAL WT TABLE
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Our intention is to make the change-over to National Weights
budget neutral. However, as we have seen, there will be
weights, ALOS and TrimPoints that will move in both directions
from where they are now. So budget neutrality will have to be
in aggregate.
We will go into more detail during our November 2nd Hospital
Engagement Meeting.
Moving to 3M National Weight Table
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PROS: • Will allow department to keep up with version changes year to
year since we don’t have resources to re-weight to Colorado
weights each year. 3M has mentioned they have been having
more States move to National weights for same reason.
Pros & Cons of Moving to National
Weight Table
CONS: • Will require more direct contact with hospitals to identify where
clinical reality in Colorado differs from national.
FUTURE INPATIENT
➢ Medicaid Base Rate Examples to come in November
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.
▪ National Weights & Separating Baby from Mom’s
Claim
• More detail to be presented in November meeting.
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Staff Updates
Ana Lucaci, Medicaid Policy Specialist,
last day is September 7, 2018 (Yes, that
is TODAY!)
For future questions please direct
inquiries to Raine Henry
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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
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
