Health Care Reform

1
Health Care Reform

• A broad health care reform that includes a
  Medicaid expansion will require
• Increased staffing resources at both local health
  departments and local department of social
  services to handle increased applications,
  outreach and ombudsman efforts
• Increased need for provider networks (increase
  usage of public health providers)
• Increased coordination between other public
  health programs (e.g., ADAA) to identify coverage
  gap
• Increased tracking mechanisms to capture hospital
  uncompensated care savings

2
Long-Term Care Reform

• A Medicaid proposal shifting care from
  institutional providers to community providers,
  requires
• Additional resources in OHCQ to monitor and
  license providers
• A critical evaluation of the nursing home needs
  CON process
• Need to coordinate efforts with other
  administrations / state agencies (e.g., DDA,
  Mental Hygiene Administration)

3
Dental Services for Children

• Medicaid is committed to improving access to
  dental services for children
• We are working with Public Health to staff a
  dental action committee to consider
• Outreach and education to recipients
• Public health infrastructure
• Models of care under Medicaid/ Payment Rates
• Dental provider participation/ Scope of practice
• Recommendations due to the Secretary in Sept.

4
Hospital Expenditures

• It is difficult for the Department to budget for
  hospital expenditures
• Department finalizes budget in Fall for upcoming
  fiscal year
• Department determines the calendar year MCO
  capitation rates by end of Summer
• HSCRC sets hospital rates in Spring, which may
  include catch-up from prior fiscal years
• In addition, the Commission may take rate actions
  any time during calendar, resulting in higher
  unbudgeted Medicaid costs, e.g., recent 1
  increase

5
ER Diversion

• Reducing Medicaid ER usage rates will
• Put increased pressure on developing more
  community provider networks should coordinate
  efforts with the Maryland Community Health
  Resource Commission
• Need to coordinate with Mental Hygiene
  Administration (and ADAA) to ensure alternative
  care is available
• Need to coordinate with HSCRC to reduce hospital
  rate incentives to increase ER usage

6
Federal Vulnerabilities

• Recent announcement by CMS that they were
  releasing new regulations on the rehab option,
  including placing time limits on receipt of rehab
  services this would affect Mental Hygiene, DHR,
  DJS, and Medicaid therapeutic behavioral aid
  services
• New scrutiny over payment methodologies for
  public providers LHD payment rates, MSDE school
  health-related service providers, public clinics

7
School health-related service audit

• Maryland has two large audits pending on school
  health-related special education services (up to
  80- million in federal funds)
• One relates to documentation of services
• One relates to payment rates
• We have appealed the first audit and are
  disputing the findings in the second
• Nevertheless, we need to be more vigilant in
  monitoring programs and be prepared for many more
  audits given CMS new focus on deficit reduction

8
Citizenship and Identity Verification

• Decrease in Enrollment of 6,500 since August 2006
• LHDs negatively impacted due to increased time
  required to confirm CI for what had become an
  expedited process.
• Vital Records matching of 4,000 new applicants a
  week. More direct access to VR could expedite
  eligibility for Maryland-born applicants. No
  Interstate matching available.
• Public Health impact. Where did the 6,500 go?
  Who did not bother to apply and where are they
  receiving care?
• Is Presumptive Eligibility a workable solution to
  the delay in receiving services?

9
MCHP Reauthorization

• Issues
• Federal renewal being debated
• Level of funding unknown
• Potential increased need for general funds to
  fill gap from federal funding shortfall
• Public Health Impact
• Potential reduction of funding for parents

10
DLS Audit Findings and Updates

• Issues
• Unsatisfactory rating
• Systems limitations
• Dependency on other agencies
• CMS requirement to approve changes are more
  stringent (CAP, SPA, etc.)
• Public Health Impact
• Responsibility for audit findings which cross
  multiple administrations

11
NPI Impact To DHMH Administrations Including
Local Health Departments

• LHDs will need to determine if they require a NPI
  when billing for Medicaid services.
• Administrations who are considered covered
  entities will need to align their Medicaid
  Provider numbers to new NPIs to ensure proper
  billing and payment processing.
• Some of the DHMH Administrations, ex. DDA, have
  been identified as atypical providers- Medicaid
  will prefix your existing provider number with a
  5 to create a pseudo NPI.
• LHDs, MHA, FHA, and other administrative units
  will need to comply with the CMS1500 UB04.
  Medicaid will require NPIs on paper claims.
• MHAs contractor MAPS-MD must use Medicaids
  provider crosswalk when transmitting claims.

12
Workforce Development

• Issues
• 10 vacancy rate
• Loss of experienced staff to CMS and other
  agencies
• Lack of succession planning
• Salary structure not market based
• Recruitment process burdensome
• Public Health Impact
• Lack of adequate trained staff create challenges
  for addressing systems issues that cross multiple
  administration