Medicaid Fee for Service Acute Rate Exhibit

Transcription

1 Medicaid Fee for Service Acute Rate Exhibit BASE PRICE COMPONENT: 1. Statewide Base Price trended to 2010 [Trend Factor ] $6, Institution-Specific Adjustment Factor [Rate Schedule 4, Line 11] Statewide Base Price Adjusted by ISAF [Line 1 x Line 2] $6, Potentially Preventable Readmissions (PPR) Reduction PPR Percentage Reduction -1.05% (67.25) Average Statewide Base Price Adjusted for ISAF and PPR [Line 3 - Line 4] $6, Average 2008 APR-DRG MA FFS Case Mix [Paid Claims] Average FFS CMI Adjusted Statewide Base Price [Line 5 x Line 6] $6, GRADUATE MEDICAL EDUCATION COMPONENT (GME): Average IME Payment per Discharge [Rate Schedule 3, Line 9] $1, IME Payment Percentage [Rate Schedule 3, Line 6]: 23.38% DME Payment per Discharge [Rate Schedule 3, Line 17] $ Average Total GME Payment per Discharge [Line 8 + Line 9] $2, CAPITAL COMPONENT, PLUS NON-COMPARABLES: Budgeted Allowable Capital [Rate Schedule 6, Pg 2, Ln 1] $11,716, Projected Patient Discharges for Case Payment [Budgeted Capital] 18, Projected Patient Days for Case Payment [Budgeted Capital] 79,634 [Including ALC and Swing Beds] Budgeted Capital per Discharge [Line 11 / Line 12 Discharges] $ Non-Comparable Add-on Components: a Ambulance Payment per Discharge [Rate Schedule 5, Sec A, Ln 12] $ b Teaching Amendment/Physicians Costs Add-on [Rate Schedule 5, Sec B, Ln 8] $0.00 c Transition Adjustment Add-on [Rate Schedule 5, Sec C, Ln 7] $0.00 d School of Nursing Add-on [Rate Schedule 5, Sec D, Line 19] $62.74 Total 2010 Non-Comparable Payments per Discharge [Lines a thru d] $ Total 2010 Capital per Discharge Plus Non-Comparables [Line 13 + Line 14] $ Series #: 0257 Page 1 of 13 Medicaid FFS Acute Rate Exhibit

2 Medicaid Fee for Service Acute Rate Exhibit AVERAGE MEDICAID FFS RATE: Facility Average Medicaid Fee-for-Service Case Payment Rate prior to Surcharge $10, [Line 7 + Line 10 + Line 15] Facility Average Medicaid Fee-for-Service Case Payment Rate including Surcharge $11, [(Line 16 plus Surcharge] ALTERNATIVE LEVEL OF CARE (ALC) RATE CALCULATION: 18. Average 1987 RUGS projected to 2010 [$ x ] $ RATES FOR EMEDNY: Effective 10/1/2010: Billable Rate Codes: Rate Code: Rate Description: Amount: Calculation: 2946 Case Payment Discharge Rate $7, =Line 5 x (1 + Line 8 IME%) 2960 Case Payment Admission Rate $9, =Line 7 + Line Case Payment ALC RHCF $ =Line Case Payment ALC Home Care $ =Line High Cost Charge Convertor Base Non billable Rate Codes: Rate Code: Rate Description: Amount: Calculation: 2990 Case Payment Capital per Discharge $ =Line Case Payment Capital per Day $ =Line 11 / Line 12 Days 2589 Case Payment DME $ =Line 9 HCRA Surcharge: Indigent Care and Health Care Initiative Surcharge 7.04% Series #: 0257 Page 2 of 13 Medicaid FFS Acute Rate Exhibit

3 Medicaid Managed Care Acute Rate Base Price Component BASE PRICE COMPONENT: 1. Statewide Base Price trended to 2010 [Trend Factor ] $6, Institution-Specific Adjustment Factor [Rate Schedule 4, Line 11] Statewide Base Price Adjusted by ISAF (Discharge Rate) [Line 1 x Line 2] $6, Potentially Preventable Readmissions (PPR) Reduction PPR Percentage Reduction -1.05% (67.25) 5. Average Statewide Base Price Adjusted for ISAF and PPR [Line 3 - Line 4] $6, RATES FOR EMEDNY: Effective 10/1/2010: Billable Rate Codes: Rate Code: Rate Description: Amount: Calculation: 3130 Case Payment GME $1, =Line 5 x Acute Exhibit Line 8 IME% 2290 Sterilization During Delivery - Managed Care Enrollees of Fidelis Care $ =Line 5 x [ x APR_DRG Weight of ] Non billable Rate Codes: Rate Code: Rate Description: Amount: Calculation: 2589 Case Payment DME $ =Acute Exhibit Line 9 PAYMENT RATES: Effective 10/1/2010: Rate Description: Amount: Calculation: Default & Contract Discharge Rate (Excl IME) $6, =Line 5 ALC Price per Day $ =FFS Exhibit Line 18 High Cost Charge Convertor Base Capital & Non-Comparables per Discharge $ =FFS Exhibit Line 15 - FFS Exhibit Line 14c Capital per Diem $ =FFS Exhibit 2991 Rate Code HCRA Surcharge: Indigent Care and Health Care Initiative Surcharge 7.04% Series #: 0257 Page 3 of 13 MMC Base Rate Component

4 Workers Compensation / No Fault Acute Rate Exhibit BASE PRICE COMPONENT: 1. Statewide Base Price trended to 2010 [Trend Factor 1.069] $6, Institution-Specific Adjustment Factor [Rate Schedule 4, Line 11] Statewide Base Price Adjusted by ISAF [Line 1 x Line 2] $6, GRADUATE MEDICAL EDUCATION COMPONENT (GME): Average IME Payment per Discharge without CMI Adj Applied [Rate Schedule 3, Line 7] $1, IME Payment Percentage [Rate Schedule 3, Line 6]: 23.38% DME Payment per Discharge [Rate Schedule 3, Line 17] $1, Average Total GME Payment per Discharge [Line 4 + Line 5] $2, CAPITAL COMPONENT, PLUS NON-COMPARABLES: Budgeted Allowable Capital [Rate Schedule 6, Pg 2, Ln 1] $11,716, Projected Patient Discharges for Case Payment [Budgeted Capital] 18, Projected Patient Days for Case Payment [Budgeted Capital] 79,634 [Including ALC and Swing Beds] Budgeted Capital per Discharge [Line 7 / Line 8 Discharges] $ Non-Comparable Add-on Components: a Ambulance Payment per Discharge [Rate Schedule 5, Sec A, Ln 12] $ b Teaching Amendment/Physicians Costs Add-on [Rate Schedule 5, Sec B, Ln 8] $0.00 c Transition Adjustment Add-on [Not Applicable] $0.00 d School of Nursing Add-on [Rate Schedule 5, Sec D, Line 19] $64.49 Total 2010 Non-Comparable Payments per Discharge [Lines a thru d] $ Total 2010 Capital per Discharge Plus Non-Comparables [Line 9 + Line 10] $ Series #: 0257 Page 4 of 13 WCNF Acute Rate Exhibit

5 Workers Compensation / No Fault Acute Rate Exhibit AVERAGE WCNF RATE: Facility Average Case Payment Rate without Surcharge $10, [Line 3 + Line 6 + Line 11] Facility Average Case Payment Rate including Surcharge $11, [(Line 12 plus Surcharge] ALTERNATIVE LEVEL OF CARE (ALC) RATE CALCULATION: 14. Average 1987 RUGS projected to 2010 [$ x ] $ PAYMENT RATES: Effective 10/1/2010: Rate Description: Amount: Calculation: Case Payment Discharge Rate $8, =Line 3 x (1 + Line 4 IME%) Case Payment ALC RHCF $ =Line 14 Case Payment ALC Home Care $ =Line 14 High Cost Charge Convertor Base Case Payment Capital per Discharge $ =Line 11 Case Payment Capital per Day $ =Line 7 / Line 8 Days Case Payment DME $1, =Line 5 WCNF Surcharge: Public Goods Pool Surcharge 9.63% Additional Public Goods Pool Surcharge 28.27% Series #: 0257 Page 5 of 13 WCNF Acute Rate Exhibit

6 TOTAL FACILITY ALLOWABLE OPERATING COSTS: NYS DEPARTMENT OF HEALTH Combined Medicaid Fee for Service and Medicaid Managed Care % for Cost Exclusions 1. Total 2005 Allowable Inpatient Costs $191,104,328 [2005 Base Year Schedule 1, All Inpatient Services] 2. Total 2005 Inpatient Non-Projectable Capital, plus Transfers $21,862,555 [2005 Base Year Schedule 3 and 1A, All Inpatient Services] 3. Total 2005 Inpatient Allowable Operating Costs [Line 1 - Line 2] $169,241,773 MEDICAID FEE-FOR-SERVICE COST CALCULATION: MA FFS Acute Costs generated by 2005 Ratio of Cost to Charges (RCC) $22,452,587 [File: _Acute_RCCcosts.xls (Costs Include Capital)] MA FFS Acute Inlier Costs for High Cost Outlier FFS Cases $1,720,773 [File: _HCO_RCCcosts.xls (Costs Include Capital)] 6. Total 2005 MA FFS Acute RCC generated Costs [Line 4 + Line 5] $24,173, MA FFS Acute % for Cost Exclusion Calculations [Line 6 / Line 1] 12.65% 8. Total 2005 MA FFS Acute Capital for Cost Exclusion [Line 2 x Line 7] $2,765, Total 2005 MA FFS Acute Operating Costs [Line 6 - Line 8] $21,407,747 MEDICAID MANAGED CARE COST CALCULATION (CMI PROXY): 10. Total 2005 MA FFS Acute Operating Costs [Line 9] $21,407, APR-DRG MA FFS CMI APR-DRG MA FFS Paid Claims 2, MA FFS Cost per Case [Line 10 / Line 11 / Line 12] $8, APR-DRG MMC CMI APR-DRG MMC Cases 3, Total 2005 MMC Acute Operating Costs (CMI Proxy) [Line 13 x Line 14 x Line 15] $21,553,619 COMBINED MA FFS AND MMC OPERATING COSTS AND % FOR COST EXCLUSION: 17. Total 2005 MA FFS and MMC Acute Operating Costs [Line 9 + Line 16] $42,961, MA FFS and MMC Acute % for Cost Exclusion Calculations [Line 17 / Line 3] 25.39% Series #: 0257 Page 6 of 13 Rate Schedule 1

7 Acute Operating Costs for Statewide Price MA FFS & MMC WCNF 1. Total 2005 MA Acute Operating Costs [Schedule 1, Ln 17] $42,961, MA Acute Costs Excluded for Statewide Price Calculation: a. Non-Projectable Capital Plus Transfers [Capital Excluded from Line 1] $0 b. Direct Medical Education [Rate Schedule 3, Line 12] $6,169,767 c. Indirect Medical Education [ (Ln 1 - Ln 2a - Ln 2b) x IME Exclusion %] $6,972,008 IME Cost Exclusion % Calculation: 1a Staffed Inpatient Beds [ICR Exhibit 3] 350 1b Total Acute Residents ('05/'06 IME Survey) IME Exclusion % 18.95% [1-1/(1+(1.03*(((1+(Line 1b/Line 1a))^0.405)-1)))] d. Non-Comparable: Ambulance [Rate Schedule 5, Sec A, Line 7] $917,616 e. Non-Comparable: Teaching Election Amendment Hospitals $0 [Rate Schedule 5, Sec B, Line 3] f. Non-Comparable: School of Nursing [Rate Schedule 5, Sec D, Line 14] $387,290 Total Costs Excluded [Sum a thru f] $14,446, MA Acute Operating Costs [Line 1 - Line 2] $28,514, MA Acute Casemix Neutral Operating Costs [Line 3 / Avg 2005 APR CMI] $34,940, MA Average APR CMI Roll Factor MEDICAID WCOMP MA Acute Casemix Neutral Operating Costs for Statewide Price $36,725,628 [Line 4 x Line 5] Series #: 0257 Page 7 of 13 Rate Schedule 2

8 INDIRECT MEDICAL EDUCATION (IME): NYS DEPARTMENT OF HEALTH Graduate Medical Education MA FFS & MMC 1. Statewide Base Price trended to 2010 [Refer to Sch 2 for Trend Factors] $6, $6, Institution-Specific Adjustment Factor (ISAF) [Rate Schedule 4, Line 12] Statewide Base Price Adjusted by ISAF [Line 1 x Line 2] $6, $6, Potentially Preventable Readmissions (PPR) Reduction -1.05% (67.25) Average Statewide Base Price Adjusted for ISAF and PPR [Line 3 - Line 4] 6, $6, IME Payment Percentage: a Staffed Inpatient Beds 350 b Total Acute Residents ('05/'06 IME Survey) IME Payment % [1.03*(((1+(Line 6b/Line 6a))^0.405)-1)] 23.38% 23.38% Average IME Payment per Discharge (FFS, MMC & WCNF) [Line 5 x Line 6] 1, , MEDICAID FFS AVERAGE IME PAYMENT: 8. Average 2008 APR-DRG Medicaid FFS Case Mix [Paid Claims] Average FFS IME Payment per Discharge [Line 7 x Line 8] $1, DIRECT MEDICAL EDUCATION (DME): 10. Reported 2005 Direct Medical Education (DME) Inpatient Costs: a Intern and Resident Expenses (Traceback) $9,639,502 b Supervising Physicians Expenses (Traceback) $8,084,743 c Total Intern and Resident Other Services (Traceback) $0 d Total Supervising Physicians Other (Traceback) $1,293,006 e Inpatient Allocated Overhead $4,734,741 f Inpatient Exhibit 6 DME $0 g Inpatient DME Related to ER Transfers $547,997 h Inpatient DME Related to Clinic Transfers $0 Total Reported 2005 DME Inpatient Costs [Sum of 10a thru 10h] $24,299,989 $24,299, MA Acute Cost % [Rate Schedule 1, Line 21] 25.39% 25.39% 12. Total 2005 MA DME Costs [Line 10 x Line 11] $6,169,767 $6,169, Total Base Year MA DME Costs Trended [Line 12 x Roll Factor] $6,485,042 $6,595, MA Acute and Transfer Cases [Paid Claims and Encounter Data] 6,463 6,463 FFS Inlier/High Cost Claims 2694 Plus Transfer Claims 43 MMC Inlier/High Cost Encounter Data DME Payment per Discharge [Line 13 / Line 14] $1, $1, Potentially Preventable Readmissions (PPR) Reduction -1.05% (10.54) 17. DME Payment per Discharge Adj for PPR Reduction [Line 15 - Line 16] $ $1, Total Average GME per Discharge [Line 7 or 9 + Line 17] $2, $2, WCNF Series #: 0257 Page 8 of 13 Rate Schedule 3

9 Institution Specific Adjustment Factor WAGE EQUALIZATION FACTOR (WEF): Provider Medicare Adjusted Wages [CMS Wage Index] $168,954, Provider Hours Worked [CMS Wage Index] 4,229, Average Hourly Wage [Line 1 / Line 2] $ Statewide Average Hourly Wage [CMS Wage Index] a. Statewide Adjusted Wages $19,447,007,130 b. Statewide Total Hours Worked 511,513,691 Statewide Average Hourly Wage [Line 4a / Line 4b] Medicare Hospital-Specific WEF [Line 3 / Line 4] WAGE ADJUSTMENT FACTOR (WAF): 6. Total Facility Reported 2005 Salary and Fringe Wages [ICR Reported Data] a. ICR Reported 2005 Salaries [Exh 11, 0040/960] $149,621,922 b. ICR Reported Fringe Benefits [Exh 11, 0039/ /003] $37,347,584 Total Salaries and Fringe Benefits [Line a + Line b] $186,969, Total Facility Reported 2005 Operating Costs [ICR Reported Data] a. ICR Reported 2005 Total Costs [Exh 11, 0042/960] $320,409,251 b Non-Projectable Capital $34,654,236 [Exh 40: 0402/ / /005] Total 2005 Operating Costs [Line a - Line b] $285,755, Facility Wage/Operating Cost Ratio [Line 6 / Line 7] Facility Non-Wage/Operating Cost Ratio [ Line 8] Medicare Hospital-Specific WEF [Line 5] Institution-Specific Adjustment Factor [1 / ((Line 8 / Line 10) + Line 9)] Series #: 0257 Page 9 of 13 Rate Schedule 4

10 Non Comparable Costs Section A: AMBULANCE COSTS MA FFS & MMC Stepdown Final Allocated Costs [Stepdown, Cost Center 234] $3,325,931 WCNF Capital Final Allocated Costs [Capital Traceback, Cost Center 234] $247, Ambulance Operating Costs (Line 1 - Line 2) $3,078, Total Acute ICR Discharges 20, Medicaid ICR Acute Discharges 6, MA Acute Cost % [Line 5 / Line 4] 29.81% 7. Total 2005 MA Ambulance Costs [Line 3 x Line 6] $917,616 $917, Total Base Year MA Ambulance Costs Trended [Line 7 x Roll Factor] $964,506 $980, MA Acute Cases [Paid Claims and Encounter Data] 6,420 6, Ambulance Payment per Discharge [Line 8 / Line 9] $ $ Potentially Preventable Readmissions (PPR) Reduction -1.05% (1.58) Ambulance Payment per Discharge Adj for PPR Reduction [Line 10 - Line 11] $ $ Section B: TEACHING ELECTION AMENDMENT (TEA) HOSPITAL COSTS 1. Total All Payer 2005 Physician Cost for Teaching Election Amendment Facilities $ MA Acute Cost % [Rate Schedule 1, Line 21] 25.39% 3. Total 2005 MA Physician Costs for TEA Hospitals [Line 1 x Line 2] $0 $0 4. Total Base Year MA Physician Costs for TEA Hospitals Trended [Line 3 x Roll Factor] $0 $ MA Acute Cases [Paid Claims and Encounter Data] 6,420 6, Physician Costs for TEA Hospitals Payment per Discharge [Line 4 / Line 5] $0.00 $ Potentially Preventable Readmissions (PPR) Reduction -1.05% Physician Costs for TEA Hospitals Payment per Discharge [Line 6 - Line 7] $0.00 $0.00 Section C: TRANSITION ADJUSTMENT (FFS Payment Only) Transition Allocation [4/1/ /31/2010] $0 Total Transition 4/1/2010-3/31/2011 $ MA FFS Acute Cases [Paid Claims] Adjusted for 9 Months 1, Transition Adjustment Add-on [Line 1 / Line 2] $ Transition II Allocation [10/1/ /31/2010] $ MA FFS Acute Cases [Paid Claims] Adjusted for 3 Months Transition II Adjustment Add-on [Line 4 / Line 5] $ Transition Adjustment Add-on [Line 3 + Line 6] $0.00 Not Applicable Series #: 0257 Page 10 of 13 Rate Schedule 5

11 Non Comparable Costs Section D: SCHOOL OF NURSING COSTS MA FFS & MMC Inpatient Direct Costs: 1. Total 2005 School of Nursing Costs Inpatient Direct Costs $225,393 [All Cost Traceback, All Inpatient Cost Centers] WCNF School of Nursing Stepdown Opening Balance $233, Inpatient Cost Percentage [Line 1 / Line 2] 96.73% Inpatient Allocated Overhead: School of Nursing Stepdown Costs $1,817,905 [Stepdown, Allocated Out of Department] School of Nursing Allocated Overhead Including Capital $1,584,887 [Line 4 - Line 2] School of Nursing Capital TBCosts [Adj for Maint of Personnel] $245,489 [Capital Traceback, Allocated Out of Department] School of Nursing Allocated Overhead Excluding Capital $1,339,398 [Line 5 - Line 6] Inpatient School of Nursing Allocated Overhead Excluding Capital $1,295,600 [Line 3 x Line 7] ER and Clinic Transfer Calculation: Inpatient School of Nursing Related to ER Transfers $4, Inpatient School of Nursing Related to Clinic Transfers $0 11. Total 2005 Inpatient School of Nursing Related to Transfers $4,372 Per Discharge Add-on Calculation: 12. Total 2005 Inpatient School of Nursing Costs [Line 1 + Line 8 + Line 11] $1,525, MA Acute Cost % [Rate Schedule 1, Line 21] 25.39% 14. Total Medicaid 2005 Inpatient School of Nursing Costs [Line 12 x Line 13] $387,290 $387, Total Medicaid 2005 Inpt School of Nursing Costs Trended [Line 14 x Roll Factor] $407,081 $414, MA Acute Cases [Paid Claims and Encounter Data] 6,420 6, School of Nursing Payment per Discharge Add-on [Line 15 / Line 16] $63.41 $ Potentially Preventable Readmissions (PPR) Reduction -1.05% (0.67) School of Nursing Payment per Discharge Add-on Adj for PPR [Line 17 - Line 19] $62.74 $64.49 Series #: 0257 Page 11 of 13 Rate Schedule 5

12 2010 Budgeted Capital SECTION A. TOTAL 2010 CAPITAL EXPENSES 1. Depreciation $15,802, Rentals (Leases) $5,695, Interest on Capital Debt $11,260, Property Rentals $1,193, Total 2010 Non-Projectable Capital $33,951,971 (Sum of Lines 1, 2, 3, and 4) 6. Major Moveable Equipment Reduction 44% $5,079,167 SECTION B. ALLOWABLE CAPITAL EXPENSES 1. Total 2010 Non-Projectable Capital (Line 5 - Line 6) $28,872, Conversion S-L TO Accelerated Depre (Adj for 44% Reduction) $ B Depre, Interest on Capital Debt $ B Debt Service $ B Fixed Charges Sinking Funds, Reserves $0 6. Income Offsets $0 7. Maintenance of Personnel $625, Allowable Capital Expense $28,247,101 (Sum of Lines 1, 2, 4, 5 and 6 Less 3 and 7 ) Series #: 0257 Page 12 of 13 Rate Schedule 6

13 2010 Budgeted Capital SECTION C. DISTRIBUTION OF CAPITAL COST 2008 ALLOWABLE RATE SETTING CODE / DESCRIPTION TRACEBACK % CAPITAL Inpatient Acute Care % $11,716, Psychiatric Care % $1,131, Chemical Dependency Detox % $ Chemical Dependency Rehabilitation % $ Other Services % $ Medical Rehabilitation % $372, All Other Combined % $5,157, Rounding Differential $7 TOTALS $18,377, Excess Budget Over Actual % [Using 2006 for Proxy] 65.06% (Effective 1/1 12/31) Series #: 0257 Page 13 of 13 Rate Schedule 6