H E A L T H W E A L T H C A R E E R

February 25, 2016

Janet Flynn, Mercer

James Matthisen, Mercer

Sarah Yahna, Mercer

Amy Perry, Myers and Stauffer

Scott Simerly, Myers and Stauffer

S T A T E O F C O N N E C T I C U T

H O S P I T A L P A Y M E N T M O D E R N I Z A T I O N

T R A N S I T I O N T O O U T P A T I E N T H O S P I T A L

A M B U L A T O R Y P A Y M E N T C L A S S I F I C A T I O N

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A G E N D A

• Welcome and Introduction.

• Project Overview.

• Data Modeling.

• Conversion Factor and Fiscal Impact.

• Next Steps.

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INTRODUCTION

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PROJECT OVERVIEW

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P R O J E C T O V E R V I E W

C O N T E X T R E V I E W

• Hospital Payment Modernization.

• Phase II Focus — Outpatient.

• Guiding Principle — Follow Medicare with Limited Exceptions.

• Method Redesign — Not Budget Exercise.

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P R O J E C T O V E R V I E W

P R O J E C T P L A N O V E R V I E W

Task Completion

Claims Data Acquisition Q2 2015

Payment Design and Policies

Identify Policy Exclusions Q4 2015

Identify Exceptions to Medicare Policies Q4 2015

Document Payment Approaches Q4 2015

Data Modeling

Claims Analysis Q3 2015

Modeling and Fiscal Impact Q1 2016

Peer Review Q1 2016

Target Development Q1 2016

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P R O J E C T O V E R V I E W

P R O J E C T P L A N O V E R V I E W ( C O N T ’ D )

Task Completion

Regulations and State Plan Amendment Q2+ 2016

Communication Plan

Hospital Meeting #1 (web conference) 4/9/2015

Hospital Meeting #2 (onsite at DSS) 7/9/2015

Hospital Meeting #3 (web conference) 11/19/2015

Hospital Meeting #4 (web conference) 2/25/2016

Additional Hospital Meetings TBD

Systems and Operations

Document APC Business Requirements Q2+ 2016

Support Medicaid Management Information System (MMIS)

Implementation

Q2+ 2016

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P R O J E C T O V E R V I E W

T I M E L I N E R E V I E W

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P R O J E C T O V E R V I E W

L A S T M E E T I N G “ N E X T S T E P S ”

• Finalize Fiscal Impact Modeling.

• Obtain Stakeholder Feedback.

• Determine Initial Conversion Factor.

• Systems/Training/Implementation.

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DATA MODELING

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D A T A M O D E L I N G

D A T A O V E R V I E W

• Outpatient Claims.

• Dates of Services from May 1, 2014 through December 31, 2014.

• Paid through April 10, 2015.

• After February 2015 Mass Adjustments Applied.

Outpatient Claims Data

Claim Details 5.56 million

Payments $440 million

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D A T A M O D E L I N G

A N A L Y T I C A L D A T A S E T

• Universe of future outpatient claims.

• Percentage of payments by category.

• Adjusted for policy changes.

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CONVERSION FACTOR

AND FISCAL IMPACT

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S T A T E W I D E C O N V E R S I O N F A C T O R

• Conversion Factor*

– $73.60

• Previous Estimate*

– $71.75

• Differences

– Minor data enhancements.

– Based on “original” wage indices.

– State of Connecticut and Connecticut Children’s not included in calculation.

* Conversion factors shown before wage index adjustment applied.

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F I S C A L I M P A C T

• Today’s Materials:

– Hospital-Specific Fiscal Impact Model.

– APC Claim Payment Workflow.

– Hospital-Specific APC Claims Data.

– Data Dictionary.

• Other Available Materials/Issue Papers:

– http://www.ct.gov/dss/cwp/view.asp?a=4598&q=571050

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I S S U E P A P E R S

• APC Policy Changes

• APC System Updates

• APC Policy Exclusions

• Basis for Fiscal Modeling

• Connecticut Addendum B

• Edits and Billing Issues

• Outpatient Outliers

• Person-Centered Medical Home

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NEXT STEPS

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N E X T S T E P S

• Additional stakeholder feedback.

• Complete systems development and implementation.

• Conduct provider training.

• Finalize project documentation.

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QUESTIONS? P l e a s e a d d r e s s a n y q u e s t i o n s i n w r i t i n g t o :

K a t e M c E v o y

D S S M e d i c a i d D i r e c t o r

5 5 F a r m i n g t o n A v e n u e

H a r t f o r d , C T 0 6 1 0 5

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R E S O U R C E S

Connecticut Department of Social Services Reimbursement Modernization:

http://www.ct.gov/dss/cwp/view.asp?a=4598&q=538256

Connecticut Medical Assistance Program:

www.ctdssmap.com

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