JATF--June 2009 Meeting by wuzhengqin

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									 JOINT ASSOCIATION TASK
FORCE ON NURSING HOME
    REIMBURSEMENT
   POLICY/TECHNICAL
ADVISORY GROUP MEETING
      Monday, June 15, 2009
      10:30 a.m. – 2:30 p.m.
         HANYS Offices
       One Empire Drive
         Rensselaer, NY
                           AGENDA
I.     Welcome & Introduction                         Robert Murphy (NYSHFA)


II.    Proposed Charge to the JATF                    Robert Murphy (NYSHFA)
III.   Review of Regional Pricing                     Daniel Heim, NYAHSA
       Legislation                                    Full Group
       •    Basic Features
       •    JATF Proposals Included
       •    Timeframes and Process
       •    Associations’ Regional Pricing Critique
IV.    Funding Constraints                            Raymond Sweeney, HANYS
       •    Capped Price $210M                        Full Group
       •    Transition Funding
       •    Recognizing Actual Costs
        AGENDA (Continued)
V.    DOH Work Group         Robert Murphy (NYSFHA)
      • Membership           Full Group
      • Charge
      • Timeframes

VI.   Discussion on Reform   Raymond Sweeney (HANYS)
      Principles             Full Group
      • DOH
      • JATF
        AGENDA (Continued)
VII.    Financial Modeling of         Raymond Sweeney (HANYS)
        Regional Pricing and          Full Group
        Other Options
        • DOH Estimates
        • JATF Independent Analysis
        • Timetables

VIII.   Discussion of Quality         Daniel Heim (NYAHSA)
        Incentive Pool

IX.     Other Agenda Items            Full Group

X.      Future Meetings               Full Group

XI.     Adjournment                   Full Group
      CHARGE TO JATF
“PROVIDE POLICY ADVICE AND
  DIRECTION TO THE PARTICIPATING
  ASSOCIATIONS AND
  REPRESENTATIVES SERVING ON
  DOH WORK GROUP ON THE
  IMPORTANT COMPONENTS THAT
  SHOULD BE INCLUDED IN A
  REBASED AND REFORMED NURSING
  HOME REIMBURSEMENT SYSTEM.”
 JATF RECOMMENDED FEATURES IN
  REGIONAL PRICING LEGISLATION
Updated cost base (2007 vs. 2002)
Periodic rebasing (at least every six years)
RUG-III case-mix adjusted
Rate add-ons for hard-to-serve patients
Transition funding
Residual capital reimbursement
   ASSOCIATIONS’ REGIONAL
      PRICING CRITIQUE
Reimbursement was already reformed
Process issues
Substance issues:
  Pay every facility less than average cost
  No limit on DOH disallowances
  Huge revenue swings for facilities/regions
  Ignore legitimate cost differentials
  Poorly adjusts for labor costs
  Disproportionately impacts losing facilities
  Create chaos in system
  Discourage rightsizing and resident-centered care
   WORKGROUP ISSUES TO BE
         STUDIED
Allowable operating costs in developing
 regional prices
Cost differentials based on size, affiliation,
 location, public vs. private, facility layout and
 labor costs (i.e. direct care staffing differentials)
Quality care incentive pool
Specialized populations
Relationship between facility-spending vs.
 quality of care
  WORKGROUP ISSUES TO BE
    STUDIED (Continued)
Appropriate regions to be utilized
Proportion of Medicaid to non-Medicaid
 patients
Medicare issues
Rightsizing of acute care system impact
Medicaid-only case mix
Other issues determined by Commissioner
    RHCF REIMBURSEMENT REFORM
               PRINCIPLES
       (as proposed by DOH in 2009)
• Medicaid rates should:
  1. be transparent and administratively efficient
  2. pay for Medicaid patients
  3. encourage cost-effective care and promote efficiencies
  4. encourage and reward quality care
  5. encourage care in the right setting
  6. be updated periodically
  7. comply with federal Medicaid rules
  8. reinforce health systems planning and advance state
      health care programs
  9. be consistent with budget constraints
   RHCF REIMBURSEMENT REFORM
  PRINCIPLES (as proposed by the JATF in
                 2004)
1. Medicaid payments should be reasonably related to costs
   and sufficient to ensure the provision of quality care that
   adheres to all regulatory requirements, as well as
   reasonable access to appropriate services for frail elderly
   individuals and other persons with special needs.
2. The allowable costs used to determine rates should be
   updated periodically to ensure they reflect current
   requirements and operational realities. In the interim,
   payment rates should be updated annually for inflation
   using price indicators relevant to health care and adjusted
   to reflect anticipated costs to comply with any new
   mandates.
  RHCF REIMBURSEMENT REFORM
 PRINCIPLES (as proposed by the JATF in
          2004) - continued
3. The methodology should incorporate a case-mix
  classification system to ensure that
  reimbursements are linked to the resources
  required to provide care, based on residents’
  clinical condition, functional status and need for
  specialized treatments. Such a system should be
  based on an appropriate resident assessment, and
  include “outlier” provisions for high cost residents
  and high cost items and services needed to
  maintain or improve residents’ conditions.
   RHCF REIMBURSEMENT REFORM
 PRINCIPLES (as proposed by the JATF in
                     2004)
4. Consistency, predictability, administrative
  simplicity and timelines or payments are
  critically important. State oversight and
  administration of the methodology –
  including determinations on allowable costs
  and rate revisions based on case-mix
  changes, provider rate appeals and other
  updates – should reflect these goals.
  RHCF REIMBURSEMENT REFORM
 PRINCIPLES (as proposed by the JATF in
                2004)


5. To the extent possible, the payment
  methodology should include tangible
  incentives to optimize high quality care, to
  reward efficiency, to foster innovation and
  application of technology and to promote
  residents’ functional independence.
   RHCF REIMBURSEMENT REFORM
  PRINCIPLES (as proposed by the JATF in
                 2004)
6. The methodology should properly account
  for inter- and intra-regional variations in the
  price of labor for relevant occupations based
  on properly drawn regions, current labor
  market dynamics and inter-facility variations
  in labor costs. To this end, labor
  adjustments should be updated periodically
  to ensure they reflect prevailing market
  conditions.
  RHCF REIMBURSEMENT REFORM
 PRINCIPLES (as proposed by the JATF in
                2004)
7. Capital cost reimbursement should be reasonably
  related to actual facility expenditures, and promote
  investments to maintain and upgrade facility
  physical plants, new and innovative facility
  compliance with pertinent codes and regulatory
  requirements.
8. Significant methodological changes should be
  accompanied by a transition strategy that
  minimizes short-term disruptions and provides
  facilities with reasonable opportunities to adapt to
  such changes.
   RHCF REIMBURSEMENT REFORM
  PRINCIPLES (as proposed by the JATF in
                 2004)
9. The methodology should be based on
  carefully articulated goals, expectations and
  payment standards and published on a
  periodic basis. Proposed methodology
  changes should be properly justified, and
  undertaken in a way the ensures a
  meaningful process for obtaining and acting
  on public input as well as the current
  relevancy of the system.
 ASSOCIATIONS’ CRITIQUE OF
  QUALITY INCENTIVE POOL
Staffing
  quality of data
  exclusive use of ratio of RN time as proxy
   failure to account for CMI
Survey results
  inconsistency
  which surveys to include
Quality measures
  lack of proper risk adjustment
   QUALITY INCENTIVE POOL
       ALTERNATIVES
Staffing
   expanded data
   broader range of staff
   case-mix sensitive
   not increase reporting requirements
   incentive to reduce turnover
   not penalize facilities in shortage areas
Survey results
   health survey focused
   which surveys to include
Quality Measures
   use measures that are properly risk adjusted

								
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