cc/ccec stakeholder meeting - colorado clinic or a... · 1 cc/ccec stakeholder meeting friday,...
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CC/CCEC STAKEHOLDER MEETING
Friday, September 1, 20171:00 PM – 2:00 PM
Location: The Department of Health Care Policy & Financing, 303 East 17th Avenue, Denver, CO 80203. 11th Floor Rooms A&B.
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Overview of Meeting
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GROUND RULES FOR WEBINAR
• WE WILL BE RECORDING THIS WEBINAR
• We are going to try to avoid muting the phone lines to encourage conversation, so please don’t:
• Put us on hold• Drive in your car w/window open while listening• Sit in a noisy location
• Please speak clearly when asking a question and give your name and hospital
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Welcome & Introductions
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Purpose of Meeting
The purpose of this meeting is to share information regarding upcoming changes
to how the Department will classify medical providers that are licensed by CDPHE
as a Community Clinic or a Community Clinic with Emergency Centers
(CC/CCEC).
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Purpose of Meeting
• Make you aware of planned creation of a new provider type
• Share our expectations of providers once the new provider type takes effect
• Provide you with time and opportunity to suggest, for example, additional
non-claims-based data sets the Department should consider evaluating
post-change
• Solicit from you data sets that may assist us in creating an appropriate provider payment methodology post-change
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Background
• Currently CC/CCEC entities are allowed to bill for services as a
hospital under the ID of the hospital with which they are
associated.
• CDPHE licenses these entities separately from a hospital.
• Those entities that are not associated with a hospital may bill as
Clinics.
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New Provider Type
• The Department plans to create a provider type specifically for Hospital
Affiliated/CMS Certified CC/CCEC entities that may then participate in
the Medicaid program.
• The Department will gather data post-change in order to create a
payment methodology that differs from the current hospital
methodology.
• The proposed provider type will be paid using the Enhanced
Ambulatory Patient Grouper payment methodology similar to the way
outpatient hospital services are paid (UB-04 claim type)
• Independent professionals that provide professional services will be
paid separately (CMS 1500 claim type)
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Regulatory Steps
• The Department must submit a State Plan Amendment to the Centers
for Medicare and Medicaid Services (CMS)
➢ CMS has 90 days to either approve, deny, or request additional
information
• Once the SPA is approved, new Department rules that define the
provider type and scope of services will be submitted to the Medical
Services Board (MSB) for approval
➢ The MSB meets on the second Friday of each month.
➢ Usually, a rule is approved upon second reading and becomes
effective the last day of the month following the approval date.
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Provider Payment
• For the time being, you are going to be reimbursed at the same rates as
hospitals.
➢ In the future, we will be looking at a different reimbursement
methodology that reflects actual services provided at these facilities and
the costs incurred in providing this care.
➢ This will be a data-driven process, during which we will need your
participation and input.
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Ask
• Please provide us with the names, locations and affiliations of all those
CC/CCEC entities you represent, and whether those entities are Medicare
certified to be recognized as part of a hospital.
➢ If you are able to collaborate to create a single list prior to sending, we
welcome that approach.
➢ Please email Ana Lucaci, [email protected] with this information.
• Please provide any additional non-claims-based data sets you believe reflect
actual services provided at these facilities and the costs incurred in providing
this care, for Department consideration when developing a reimbursement
methodology.
Questions and Discussion
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Thank You!Ana LucaciHospital Policy [email protected]
Richard DelaneyPhysician Services Policy [email protected]
Kevin MartinFee for Service Rates [email protected]
Kimberley SmithCompliance & Stakeholder Relations Unit [email protected]