HomeMy WebLinkAboutSS3 - Medi-Cal Managed Care Rate Transfer Program - Handoutw
June 14, 2016
.n, . Agenda Item No. 883
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Program Overview
Medi-Cal Managed Care Rate Range
Intergovernmental Transfer (IGT)
City Council Study Session
Tuesday, June 14, zoi6
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FIRT
Scott Poster, Fire Chief
Angela Crespi, Administrative Manager
Terms /Definitions
• Medi -Cal - The Medicaid -program administered by the state of
California Department of Healthcare Services (DHCS) to
provide health coverage for low income and disabled
individuals.
Managed Care - A system for delivery of Medi -Cal services
where patients are members of a Health Maintenance
Organization (HMO) of contracted providers.
Rate Range - An actuarially based range of rates that the state
will pay a health plan to ensure adequate reimbursement based
on the cost of health care expenditures and the populations
served. (State pays low/IGT increases to high).
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Intergovernmental Transfer (IGT) -A vehicle for two units of
government to exchange or transfer public funds. This method
is used by 34 states to draw down federal funds and maximize
state dollars.
Headroom- The difference between maximum allowable federal
Medicaid funding level and the actual amount drawn down by
the state.
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• Federal: Center for Medicare and Medicaid Services (CMS)
• State: Department of Healthcare Services (DHCS)
• County Organized Health System (CORS): CalOptima
• Local Funding Entity: City of Newport Beach
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Program Purpose/ Benefits
Enables the states to utilize local dollars as matching funds to
draw down the remaining headroom in a service year.
Allows California's Medi -Cal managed care plans to partner
with local units of government to access additional federal
Medicaid dollars to support uncompensated care and the
provision of health care services.
Provides an opportunity for local service providers to recover
a portion of their previously unreimbursed costs.
Program History
2oo6: California DHCS began offering local governments that
provide health care the opportunity to secure additional Medi -
Cal revenues by participating in a voluntary (IGT) program
with their local Medi -Cal managed care plan.
2010: Orange County's CalOptima began partnering with UC
Irvine Medical Center in the IGT program to draw down over
$6o million in additional Federal funds.
2oi6: CalOptima opens IGT partnerships to other local entities
providing Medi -Cal services to plan beneficiaries.
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Our Eligibility
• Unit of Local Government;
• General Taxing Authority;
• Provide Medi -Cal covered emergency ambulance services
(911 response, care and treatment, transport) to CalOptima
Plan beneficiaries;
• Have documented uncompensated costs for providing
Medi -Cal services; and
• Ability to provide local matching funds.
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Medi -Cal Payment = Payment in Full
In FY2o14-15
• Medi -Cal represented 18% of total emergency ambulance
transport patients
• Of those Medi -Cal patients, 11% were Managed Care a%
were Fee For Service.
• Medi -Cal Managed Care is on the Rise 1
• Average Cost/Transport $1,447
• Average Payment/Transport $1Zg.o8 (g%)
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Medi -Cal Services to CalOptima Patients
FYao14-15
390 Ambulance Transports =Total Service Costs $564,330
Program Steps and Cycle
City of
Newport Beach
(Local Funds)
Transfer of Local Funds &
20% State Administrative Fee
CalOptima Returns Original
Funds + 50% of Leveraged Funds O
State DHCS
State Draws Down Federal Match
Federal
Government
■ Payments Received
Unreimbursed
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CalOptima
CalOptima Receives Increased
Capitation Payment
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City of
Newport Beach State DHCS
(Local Funds)
Administrative Fee to DHCS 20% of IGT Transfer $51,417
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Step 2 State Draws Down Federal Match
State DHCS
Federal
Government
ffaLLUQLQLLgggLf Unds by D HGS X257..087
State DHCS Match 50% of 3.9375% MMCS Tax $10,538
t 1 Sf" t ii Fie" eral r. $257,525
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Step 3 State Draws Down Federal Match
State DHCS
Federal
Government
4.
ds to State DHCS 50% of Unreimbursed Costs $257,Q871
Federal Match $257,087
Step 4
CalOptima Receives Increased
Capitation Payment
DHCS Retains Initial
Administrative Fee Only
20% of IGT Transfer
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$ 51,417
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SteP 5
CalOptima Returns Original
Funds + 50% of Leveraged Funds
City of CalOptima
Newport Beach
(Local Funds)
CalOptima Retains MMCS Tax
'Return of Initial Funds to City
CalOptima Retains 50% of Net
IGT Transaction Revenue
=Net Revenue to City
Total CalOptima to City
3.9375% of Increased Capitation $21,075
IGT Funds + 200/� Adi-nmistrative Fee X303
50% of Net IGT Transaction Revenue $102,835
50% of Net IGT Transaction Reven.ue $1102,835 1
$411,339
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'HGT'T'ransfer to OHCS 50% of lUnreirnbursed Costs $257
CalOptima Pays MMCS Tax
IGT Funds Available After Tax
CalOptima Retains 50% of Net
IGT Transaction Revenue
Payment to City of Newport
,Beach
3.9375% of Increased Capitation ($21,076)
$514,11
$102,835
Original Transfer + 501/b of IG -1 4
Revenue 1, 3j,
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Use of IGT Funds
• IGT funds must be used in the provision of healthcare services.
• The definition of health care services is broad and the services
can be provided to the general population; they do not need to
be Medi -Cal services provided exclusively to Medi -Cal
patients.
• Funds may be comingled with other funds for cash
management, but must be appropriately tracked.
• Funds do not have to be expended in the year received.
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• All counties in California participate in Rate Range IGT
transactions through their Medi -Cal health plan
• Successful Local Government Participants:
County of Marin; City of Fresno; City of Sacramento;
City of San Rafel; City of Rialto; and Novato Fire
Protection District.
• Other Orange County Participants:
Orange County Healthcare .Agency; City of Orange;
Children and Families Commission of Orange County; and
UCI Medical Center.
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• June a6, ao16 - Signed Agreements Due
September2o16 - IGT Funds Transfer Request
(1 Week Notice)
• October Zo16 - CalOptima Receives Increased
Capitation Payment
• November ao16 - City Receives IGT Funds
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Questions?
Medi -Cal Managed Care Rate Range
Intergovernmental Transfer (IGT)
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