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Congressional Black Caucus's 39th Annual Legislative Conference

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Congressional Black Caucus's 39th Annual Legislative Conference Powered By Docstoc
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Current Health Care Coverage by Payor

     Health Coverage of USVI Residents


                      Other Private
                         27,670             Uninsured
                          24.1%               32,970
                                              28.7%
     State Employees, Retirees, and
             Dependants
                31,000                             Medicare
                27.0%                               14,604
                                      Medicaid      12.7%
                                       8,500
                                       7.4%
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                  MAP Federal Funding
#     Fund               Expenditure Type                    Fed. Match Rate       Capped?
                Most health care services except for
1a   MEDICAID                                              50%                       Yes
                “family planning” services

1b   MEDICAID   “Family planning” services                 90%                       Yes

                Most administrative functions except for
1c   MEDICAID                                              50%                       Yes
                “quality management/review”
                “Quality management/review” functions
1d   MEDICAID                                              75%                       Yes
                (EQRO, PRO)
                Pharmacy expenditures for MAP “dual
2    MEDICAID                                              50%                       Yes
                eligible” members (MAP and Medicare)

                                                           90% (planning/design/
                Medicaid Management Information
                                                           acquisition/
3    SYSTEMS    System (MMIS) and associated Fiscal                                  No
                                                           implementation)
                Agent (FA) functions
                                                           75% (ops./support)
                Children; access funds per agreement
4    CHIP                                                  65%                       Yes
                with CMS
     MAP Increase in Federal Funds

                          MAP f ederal f unds made available in FY
$24,000,000
                                                                               $22,529,167
$22,000,000
                                                                      $22,229,948
$20,000,000

$18,000,000

$16,000,000
                                                     $15,217,753
                                  $14,659,787
$14,000,000

$12,000,000
                 $11,520,434
$10,000,000
              2006             2007             2008                 2009           2010
                 MAP LOCAL FUNDING
$7,100,000                                                                  $24,000,000
                          6,993,236    Local Funding
$7,000,000
                                       Federal Funding                      $22,000,000
$6,900,000
                                                                            $20,000,000
             $6,779,721
$6,800,000
                                      6,704,946
$6,700,000                                                                  $18,000,000

$6,600,000                                                                  $16,000,000
                                               `         6,531,065
$6,500,000
                                                                            $14,000,000
$6,400,000
                                                                            $12,000,000
$6,300,000

$6,200,000                                                                  $10,000,000
               2006         2007        2008               2009      2010
               MAP CHALLENGES
   Low levels of MAP enrollment – based at least partly on
    the long-standing belief that MAP funding is so limited
    that program enrollment must be “contained”
   Chronically low payment levels, particularly to public
    providers
       Hospital reimbursement rates have not been updated in 18
        years
   High uncompensated care costs – covered by the
    Territory
   Increase in RX Consumption at a cost of $2.3 million in FY
    2007
   Increase in the use of private local and off-island
    providers for specialized, high-cost care
   Lack of timeliness in MAP payments
   Lack of an MMIS
                      MAP TRANSFORMATION
   Submitted six State Plan Amendments (SPAs) to the Centers for Medicare & Medicaid Services (CMS). The MAP State Plan had not been revised
    since 1994. The following SPAs were approved by CMS and they will:
       Add services that will improve the health of our children, such as covering in-patient psychiatric services for MAP recipients under age 21;
       Expand the scope of covered transportation services by, for example, providing for escorts both on and off-island;
       Clarify what services are available outside of the public providers with prior authorization; and
       Restructure our hospital reimbursement methodology to ensure the long-term viability of these institutions and their ability to provide more
           services in the Territory (for example, oncology and cardiology services).

   Submitted two Advance Planning Documents (APD) to CMS to develop an IT strategic plan towards the purchase of a Medicaid Management
    Information Systems (MMIS) and the Implementation of the MMIS and an Electronic Health Record. This APD was approved by CMS in the amount
    of $815,760.

   Realized $1.3 Million in Re-tro claiming which was approved by CMS and will provide additional match once the funds are reimbursed for FY 2010.

   Adopted a Fee Schedule on October 1st which uses the Medicare rates for all providers except hospitals and off island providers.

   Conducted a site visit with the West Virginia State Health Department to preview their MAP Medicaid Management Information Systems. The
    current capacity of their MMIS includes claims payment, provider enrollment, pharmacy management, member services and data analysis/reporting.
    A letter of interest in partnering was forwarded to the Commissioner of the West Virginia State Health Department.

   MAP Staff attended the MMIS Conference in Chicago to pre-view other MMIS vendors.

   Received a Health Information Technology grant for $1 Million to develop and implement the exchange of information across health providers.

   Received $295,171 for a Electronic Health Incentive Program provides 90% federal match for the DOH to provide incentives to providers for the
    acquisition and operation of an Electronic Health Record (EHR)

   Health Information Technology Extension Program (Regional Centers) provides support and technical assistance to providers in the acquisition of
    an EHR. The Virgin Islands Medical Institute has partnered with the University of Puerto Rico, Ponce School of Puerto Rico to facilitate the
    Territories participation in this $19.2 Million project

   We are exploring the acquisition of the Caribes System to facilitate the eligibility of all MAP clients. This software is currently used by the
    Department of Human Services.

   Facilitated tentative agreements with Cigna to provide Pharmacy Benefit Management services which should take effect by November 2010.
   Governor de Jongh approved our request to partner with the State of West Virginia on the acquisition of an MMIS for MAP
              MAP REFORM
Use the opportunity of health care reform to
 expand coverage to the uninsured population of
 the Virgin Islands
Expand coverage pool of MAP based on the
 following uninsured groups:
 Children
 Pregnant Women
 Disabled Adults
 Elderly, Non-Disabled
 Non-Disabled, Non-Pregnant Adults with Dependants
     MAP REFORM CONTINUED
The Medicaid FMAP will be raised from 50% to
 55% as of July 1, 2011
CHIP FMAP raised 23 percentage points from
 65% to 88% as of January 1, 2015
Total pool of additional Medicaid funding for the
 territories of 7 billion dollars, of which 273.8
 million dollars go to the Virgin Islands over the
 reform period
Approximately 30 million dollars will be available
 to the Virgin Islands in 2014 to establish an
 insurance exchange
 Increase members covered to 20,000
                   MAP SUMMARY
   Retroactive federal claiming (second round)
   Pharmacy benefit manager (PBM)
   MMIS/Fiscal Agent acquisition
   Partnership with DHS Caribes System for Eligibility
   Training and development of staff
   Provider agreement streamlining
   Standardization/simplification of provider reimbursement terms
   Agreements with “preferred providers” for key services
   Clearing account for consolidated payment irrespective of fund sources
    used
   “Remittance advice” or similar – leveraging current systems
   ACH/EFT for expediting claim payment
   Discrete accounts
   Electronic Health Record
   Program management support (Fiscal Agent/Third Party Administrator/
    Administrative Services Organization/Disease Management Organization)
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