X hits on this document

116 views

0 shares

0 downloads

0 comments

51 / 57

6-B. Financing Charts

Financing Options For Budget Neutrality

Draft Only

Activity

Justification

Reaction

Pro

Con

CMS

Stakeholders

1

Setting a High Growth Factor

California has low growth compared to national trends, which limits access.  Access/quality improvements are needed.

California benefits from the low growth rate and could have spent more by choice.

CMS will focus on California's historical trend.

Supportive of the highest level possible.

2

Getting Credit for $360 Million for Mandatory Managed Care

California has operated a responsible program, has generated federal savings, and deserves credit.

California failed to meet the terms for the funding.

Unclear.  Normally, CMS would stand by its deal, but this deal was made by the last administration.

Supportive of including in a waiver.

3

Care Coordination for SPDs

Significant spending occurs on SPDs and there is reason to believe that it is possible to spend less and provide care.

The concern is that "care coordination" will mean limited care.

CMS will be supportive of cost containment efforts, and may demand it.  There is limited evidence support cost-containment reduces five-year costs.

Mandatory managed care remains a high contentious issue.  Other innovative steps could be more acceptable.

4

Assume Managed Care Rates are at Full Actuarial Value

California spends below the maximum possible in managed care rates.  This would give the state credit.

The argument against is that it is a gimmick.

CMS will most likely consider historical rates in the calculation.  

Likely No Opinion

5

Pay public hospital rates at UPL (end  cost-based); Keep SNCP Funding

* Increases hospital payments to pay for growing number of uninsured. * Recognizes that SNCP pool helps with costs beyond DSH.

Does not necessarily give incentive to contain costs. SNCP created from UPL savings.

Unclear, possibly oppose.

Strong support.  This is similar to the request to continue the LAC waiver in the current waiver.

6

Allow Public Hospitals To Be Paid at 150% UPL

* Clinton admin. set level at 150% UPL; Bush admin. reduced to the current 100%. * Gives hospitals the up-front funds for system improvement.

Critics may see it as a giveaway.  Has national implications.

Unclear, possibly oppose.

Strong support.  Some Congressional Staff have indicated that this was always the intent.

Document info
Document views116
Page views116
Page last viewedSat Dec 03 11:01:54 UTC 2016
Pages57
Paragraphs966
Words22378

Comments