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Possible Waiver Revenue Sources, Beyond GF

Draft Only

Activity

Justification

Reaction

Pro

Con

CMS

Stakeholders

17

Create Allowable Provider Tax (such as: revenue tax, license fee, quality fee)

Could be a significant source of revenue.

The challenge is political as some hospitals earn dollars and others lose dollars.  This differential can be minimized.

Such tax is prohibited by the current waiver.  It can be renegotiated.

Hospitals have been concerned about winners and losers.

18

Identify Unmatched County/State Spending

Unmatched spending can be used to match federal money.

Working Committee review of counties found few unmatched dollars.  Unmatched funds may exist in counties absent a public hospital or CI.  

It would be a routine matter to match unmatched spending.

Counties may be concerned re: 1) impact of the Medicaid rules on programs, 2) MOE requirements.

19

Create "Super Pool" (NY model)

Offers flexibility to match and pool dollars--as NY has with its pool that is outside the state budget process.

This may be administratively difficult to create and operate.

CMS would likely be hesitant, but California would point to New York as a precedent.

Hospitals would be concerned about funding impact.

20

Increase Managed Care Rates by Expanding "Good" Managed Care IGTs.

California spends below the maximum possible in managed care rates.

Rates can be increased, with a permissible actuarial justification that would need to be identified.

Rate increases can be routine and done absent a waiver.

This would require coordination with managed care plans and the counties.

21

Increase provider reimbursement by shifting public hospitals from cost based reimbursement to using "good IGTs".

Cost based reimbursement is burdensome, may no longer be required, and Ca. is now limited in what it can federally claim by the CPE process.

This is a major change to the policy in the prior waiver.

CMs may be concerned about abuses and the size of the SNCP with this change.

Likely support to move out of the CPE process.  

Health Management Associates/Harbage ConsultingPage 54

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