FY 2005 Indigent Care Trust Fund

FY 2005 FY 2005 Indigent Care Trust FundIndigent Care Trust Fund

Disproportionate Share Hospital Program

Presented to

House Appropriations

Health Subcommittee

June 23, 2005

June 23, 2005Presented to

House Appropriations Health Subcommittee

OverviewOverview

What is DSH?Administration of DSHHospital Eligibility Hospital Specific DSH LimitsAllocation MethodologyFY 2005



What is DSH?What is DSH?

DSH = Disproportionate HospitalFederal Funds available annually to help

compensate hospitals with a disproportionate share of uncompensated care from Medicaid and uninsured patients

In Georgia, federal funds matched by intergovernmental transfers made by public hospitals – no state appropriations involved



Administration of DSHAdministration of DSH

Information NeededAmount of Federal DSH funds availableList of Hospitals Eligible for DSHHospital-Specific DSH LimitsRural or Urban Designation for HospitalsPublic or private status of hospital



Administration of DSH (cont)Administration of DSH (cont)

Indigent Care Trust Fund Advisory Committee Membership comprised of both rural and urban

hospitals as well as public and private hospitals Makes recommendations to DCH regarding the

administration of the DSH program Meets at least annually or more often as needed Membership appointed by the Commissioner



Hospital Eligibility Hospital Eligibility for DSH Participationfor DSH Participation

Federal Criteria(MUST MEET BOTH) Ability to provide obstetric services to Medicaid

members Medicaid inpatient utilization rate of at least 1

percent




State Criteria(MUST MEET AT LEAST ONE) Medicaid inpatient hospital utilization exceeds

certain level Low-income inpatient utilization rate exceeds 25

percent of revenue Total Medicaid charges exceed 15 percent of

revenue Non-state hospital with the largest number of

Medicaid admissions in its MSA.




State Criteria (continued)(MUST MEET AT LEAST ONE) Children’s hospital Designated regional perinatal center Medicare rural referral center/Medicare DSH

provider Board of Regents teaching hospital Small, rural, public hospital with Medicaid

inpatient utilization of at least 1 percent



Hospital-Specific DSH LimitsHospital-Specific DSH LimitsDSH Limit equal to Medicaid and

Uninsured uncompensated care– DCH uses historical cost data compared to cash

collections to determine what hospital care was not paid for by any other payers

– Data is reported on the annual Hospital Financial Survey

– Data inflated to approximate today’s uncompensated care



Hospital-Specific DSH LimitsHospital-Specific DSH Limits

Hospital Financial Surveys subject to state audit:

DCH contracts with Georgia Department of Audits for audits

All surveys subject to desk reviewsOn-site reviews for

– Hospitals with the largest DSH limits– Hospitals with unusual changes in data



DSH Allocation MethodologyDSH Allocation Methodology

Policies No hospital receives more than their hospital-

specific DSH limit Intergovernmental transfers from public facilities

are used to match federal DSH funds and make DSH payments– For large private or urban private hospitals, the

allocation is capped at 50% of the hospital specific DSH limit



DSH Allocation MethodologyDSH Allocation Methodology

Policies The Department calculates an initial and

secondary DSH allocation based on available funds. – In the initial allocation, small, rural hospitals

receive 100% of their hospital-specific DSH limits.– The secondary allocation distributes the rest of the

available DSH funds to all other, eligible hospitals.



FY 2005FY 2005

Fund Availability and Hospital EligibilityTimeline

– Changes in Data Used for Hospital Specific DSH Limits

– Interim Payments – Expanded On-Site Reviews of Data

Application of Stop Loss and Stop GainNext Steps



FY2005 DSH SummaryFY2005 DSH Summary

FY 2004 FY 2005Available DSH Funding $424,724,498 $419,237,251

Number of Eligible Hospitals*

96 107

Number of Hospitals Newly Eligible in FY 2005

13

Number of Hospitals Ineligible in FY 2005 that participated in FY 2004

2

* Met criteria to participate; does not necessarily guarantee their DSH limit was greater than zero



FY 2005 TimelineFY 2005 TimelineAugust 2004 – Annual Indigent Care Trust Fund

Committee MeetingNovember 2004 - Department releases Individual

DSH Limits and Allocation December 2004 – Hospitals express concerns

about impact of data used in allocation– Data sources– Integrity of self-reporting and the quality of the

review process



Data for Hospital-Specific Data for Hospital-Specific DSH LimitsDSH Limits

As compared to prior years, FY 2005 DSH Limit calculations a little different:

• Based on 2003 data (CMS required) • CY 2003 ICTF Advisory Committee

Recommendations applied



Hospital-Specific DSH LimitsHospital-Specific DSH LimitsMedicaid Loss CalculationMedicaid Loss Calculation

FY 2004 Medicaid Claims-

Based Data Data from Cost

Reports available in 2002

Estimated Accrued Payments

FY 2005 Hospital reported

data Data from 2003

Hospital Financial Survey

Cash Payments



Hospital-Specific DSH LimitsHospital-Specific DSH LimitsUninsured Loss CalculationUninsured Loss Calculation

FY 2004 Hospital reported data Data from 2001


Estimated Accrued Payments

FY 2005 Hospital reported data Data from 2003


Cash Payments



FY 2005 Timeline (cont.)FY 2005 Timeline (cont.)• January 2005 – DCH Agrees to Further

Review Data; Makes Interim Payments to Support Cash Flow for Hospitals • Based on 75% of preliminary FY 2005

allocation• 15% Stop Loss and Stop Gain applied based on

FY 2004 allocations• No more than 90% of FY 2005 allocations were

made for hospitals subject to Stop Loss provision



FY 2005 Timeline (cont.)FY 2005 Timeline (cont.)

February 2005 – ICTF Advisory Committee meets to advise DCH of policy areas that need clarification for on-site reviews

EXAMPLES:– Consideration of pharmacy and physician

services– Advanced Payment Impact on Cash Collections



Expanded On-Site Reviews Expanded On-Site Reviews

February – May 2005 – Additional on-site reviews of data conducted by GDOAA

• Expanded on-site reviews for:• Hospitals with more than 25% change in their FY 2005

DSH allocations when compared to FY 2004• Safety Net Hospitals• Newly Eligible for DSH in FY 2005

• More than 85 hospitals subject to on-site reviews.



Expanded On-Site ReviewsExpanded On-Site Reviews

Data problems identified– Lacked detailed, patient-level data – Data not delineated between services covered by DSH

vs. other programs. Time limitations prevented GDOAA from

accepting some re-created data reports supporting the HFS

DCH used data proxies to validate the reasonableness of self reported data when GDOAA could not validate during on-site reviews



Outcome of Extended Outcome of Extended On-Site ReviewsOn-Site Reviews

Before AfterAggregate DSH Limits

FY 2004 $751,566,897

FY 2005 $866,775,780 $772,074,927

Number of Hospitals with DSH Limits (of 107 eligible)

102 98

Number of Hospitals With Increases in DSH Limits

36

Number of Hospitals With Reductions in DSH Limits

66

Number with No Change 5



June DSH AllocationsJune DSH Allocations-Initial--Initial-

Based on Extended Reviews FY 2005

Number of Hospitals with Increases in Payments vs. FY 2004

58

Number of Hospitals with Decreases in Payments vs. FY 2004

49

Number of Hospitals with DSH Limit Equal to Zero

9

Average Increase 72%

Average Decrease 51%



Why Such Swings in Why Such Swings in Payments?Payments?

• Update to newer data reflects growth in uncompensated care

• Implementation of ICTF Advisory Committee recommendations for data sources

• Smaller pool of funds to distribute• More hospitals participating• Change in hospital business practices



Final AllocationsFinal Allocations• Final Allocation includes a Stop Loss and

Stop Gain and a protection for “negative” balances• 7% Stop Loss applied to FY 2004 hospital-

specific DSH limits• 14% Stop Gain applied to FY 2004 hospital-

specific DSH limits• Eight facilities held harmless where their interim

payments exceeded their final DSH allocation



Impact of Stop Loss/Stop GainImpact of Stop Loss/Stop GainFY 2005 No SLSG With SLSG

Aggregate DSH Limits $772,074,927 $796,066,992

Number of Hospitals Subject to Stop Gain 38

Number of Hospitals Subject to Stop Loss 46

Number of Hospitals With No Impact 10

Number of Hospitals Where No SLSG Could Be Applied Due to New Eligibility

13



Final DSH AllocationsFinal DSH AllocationsFY 2005 No SLSG With SLSG

Number of Hospitals with Increases in Payments vs. FY 2004

58 58

Number of Hospitals with Decreases in Payments vs. FY 2004

49 49

Average Increase 72% 9%

Average Decrease 51% 10%



Next StepsNext Steps

Hospitals Provide Notice of Intent to Transfer Intergovernmental Funds by Friday, June 24

If all transfers received on June 27, payments made by June 28

If all transfers not received, remaining FY 2005 funding rolled forward to distribute in FY 2006 – NO PAYMENTS MADE IN JUNE

For FY 2006, seek hospital consensus, through an expanded ICTF Advisory Committee, on data collection and DSH fund allocation methodologies

Date post:	06-Feb-2016
Category:	Documents
Upload:	aitana
View:	34 times
Download:	0 times

FY 2005 Indigent Care Trust Fund

Documents