Surviving ACA Open Enrollment - Round One

Transcription

1 Surviving ACA Open Enrollment - Round One Glen Boles, CFO CHRISTUS St. Michael Health System Shauna Wardrop CRCE-I, Dir. Client Relations, Cardon Outreach

2 Initial warnings Affordable Care Act Passed Mandate for everyone to have minimal essential health coverage or pay a tax Individual state choices on Expansion Federal or State Marketplace offerings Employer shared responsibility/employer mandates (postponed)

3 Federal Recommendations Activities to include public education, outreach and in-person assistance. Three consumer assistance models: Navigators Administered and grant funded under Federally-Facilitated Exchange (FFE) - Responsible for outreach, education, and enrollment. In Person Assistors (IPAs) Administered and grant funded under state/partner exchanges - Responsible for outreach, education, and enrollment. Certified Application Counselors (CACs) Unfunded but with certification licensure requirements as 1 & 2. Ex. Hospital financial counselors, designated patient advocates, etc.

4 Provider Anticipations Reduction in Self Pay Reduction in Bad Debt Additional Revenue Previous Uninsured Previous Charity patients Disproportionate Share Hospital Payment replacement Medicaid Expansion would occur in all states

5 Preparations made Contract with new Qualified Health Plans (QHP) Set up billing system with new payers Understand and educate staff on new payer requirements Understand new opportunities for self pay patients Contracted with partner to offer patient in hospital education and assistance with enrollment Decisions whether to provide Outreach programs or not Knowing where a patient can get help Navigators, IPA, CAC Offered Community Education and CAC enrollment to identified populations, with minimal participation

6 Obstacles in Preparation Stage Understanding state decision Expansion or Not Expansion states need to understand changes to program criteria Understanding Health Insurance Exchange options Understanding Tax Credits For patient education Getting patients involved prior to services QHP s not retroactive like Medicaid Understanding border state programs Also non-border states Resources for additional patient education

7 Tax Credits..simple enough

8 October 1, 2013 National website technical difficulties

9 October 1, 2013 Marketplaces open? Some payer contracts not in place Navigators/Brokers still ramping up State decisions still in question Public education behind schedule

10 Open Enrollment Efforts Screen current self pay patients for new programs Patient education and enrollment assistance Town Hall meetings/community outreach Open door assistance Mailing and call campaign to previous self pay frequent flyers

11 Obstacles of Pre-Enrollment Some states decision on expansion still in question Continuation of the state expansion can also be in jeopardy, which was the case in Arkansas this year CMS/DWS/HHS offices overwhelmed Patient and provider calls/questions Paper applications bogging down system Determinations delayed Late in processing and issuing ID Cards Contracts/testing with all QHP s not complete Patients reluctance = Low enrollment Do not believe it was real Are not threatened by tax penalty Refusal to be educated or enroll

12 Current Risk to the Providers Presumptive Eligibility Temporary enrollment - pending completed application. Paid at regular Medicaid rate, even if the applicant is later found to be ineligible. Liability for claims during premium grace period Patient non-compliance with premium payment and inability to re-enroll Patient trend buying lower plans Sticker shock for premiums, even with assistance Higher out of pocket Increased resource needs for collection efforts Possible increase in charity and/or bad debt Most appropriate coverage rules: MAGI vs Non MAGI excepted 501R Compliance (Not for Profit Providers) Will political motivations cause states to continue to change Expansion on again, off again

13 CHRISTUS St. Michael Discoveries Arkansas (expansion solution) vs Texas (no expansion) 45/55 self pay population at facility Patients can only have one plan- patients with both Medicaid IDs and AR Blue Cross IDs because this is considered as wrapped benefits Caused confusion in the beginning. Medicaid states that a PCP is not required, BUT the Medicaid biller is unable to submitted Medicaid claims. The claims are rejecting for PCPs. Issue existed in the beginning, but is not resolved. In the 2 nd year of the plan, the PCP is required. Genesis Primecare is an FQHC partner with CHRISTUS St. Michael. Genesis also helps sign up Medicaid expansion or Federal expansion beneficiaries. Local DHS and Medicaid Managed Care Services have been training resources for Admission and AR Medicaid biller.

14 CHRISTUS St. Michaels Discoveries continued Getting paid about 10% more on expansion patients than traditional Medicaid The charity care policy will need to redefine financially indigent to include fully insured patients whose income is at or below 400% of the federal poverty levels. This will allow insured patients with higher deductibles and more out of pocket to qualify for assistance. These patients will qualify for tier 2 and tier 3 discounts.

15 Impacts to Revenue Cycle (reality) Have we seen a decrease in Self pay? Have we seen a drop in bad debt? Patients with out of pocket expense that did not have it before or were charity Have we seen in drop in charity? Could see a slight reduction in the Charity care due to more people have coverage Possible changes in the Charity Policies Possible changes to the Admissions process Knowing patients have higher deductibles or more out of pocket

16 Client Discoveries continued

17 Where are we today?

18 Where are we today? continued Today [April 1, 2014], the White House announced that more than 7 million Americans signed up for affordable health care through the Health Insurance Marketplace during the Affordable Care Act's open enrollment period, which ended on March 31. Questions still being asked: Have they all paid the premiums? Will they continue to pay the premiums? Are they all new (previously uninsured)? How many were just a change in insurance? Is it combined Medicaid and Qualified Health Plan enrollees? How many are Medicaid re-enrollments?

19 Decisions still being made Changes to Charity policies to encourage patient participation in HIX opportunities States changing minds on expansions and how to implement Arkansas announcement 3/6/2014 to expand States still pending PE guidelines Premium assistance Having trouble view ing or need a printer-friendly version? Click here to view in your brow ser. HFM A S P O NS O R S HI P O P P O RT U NI T I E S NO V EM BE R 1, F E AT U R E D S T O R I E S S P O N S O R HHS: Hospitals Not Prohibited from Paying Insurance Costs An obstacle to hospitals covering the insurance costs of their disadvantaged patients was cleared this week by the U.S. Department of Health and Human Services (HHS). HHS Secretary Kathleen Sebelius stated in a letter to Rep. Jim McDermott (D- Wash.) that the federal anti-kickback statute barring assistance to patients covered by federal health programs does not apply to those with coverage from private plans sold under the new federal marketplaces, also known as exchanges. Hospital advocates said the opinion eliminated an obstacle to hospitals helping their patients afford health insurance coverage through those marketplaces a potentially significant issue for hospitals with large uncompensated care populations who are unable to afford the coverage. HFMA Analysis: For hospitals, the impact of this opinion is potentially huge, said Chad Mulvany, director of healthcare finance policy, strategy, and development for HFMA, who along with other hospital advocates had also sought clarification from HHS on the issue. There s an opportunity to do an analysis of all of the charity care and bad debt cases to find individuals who would benefit from having assistance purchasing insurance coverage. Read more here. HFMA Announces Patient Financial Communications Best Practices To address the industrywide need for better communication between patients and healthcare organizations, a blue-ribbon panel of healthcare stakeholders has released best practices for clear, timely communications between Achievable, sustainable revenue cycle improvements. Transform revenue cycle efficiency, maximize cash collections and the overall cost of running your business o with Dell Services Revenue Cycle Solution FEA TURE D CA REER OPPO RTUNITIES Chief Financial Officer Managed Services Orlando, FL Controller Yuma Regional Medical Center Yuma, AZ Director, Corporate Compliance Appalachian Regional Healthcare System Boone, NC Finance Data Analyst, Decision Support, Finan Cape Fear Valley Health System Fayetteville, NC Healthcare Senior Sales Officer Bank of America Various Manager, Medical Claims Audit Connolly, Inc. Conshohocken, PA Frisco, TX

20 Ongoing enrollments Qualifying Life Events: Birth/Adoption Death Marriage Divorce/ Legal Separation Spouse gains coverage elsewhere Spouse loses coverage elsewhere Loss of coverage (employee) Child loses dependent status Change in employment status (PT to FT, FT to PT) Eligibility for Medicare/Medicaid/state sponsored Return from military service program

21 Preparing for 2 nd round Legislative changes to the law? Employer mandates 2015? Feds to shore up technology States changing exchange options Fed to State or State to Fed Identification of eligible patient population Are there enough young, healthy people enrolled to stabilize premiums? Education programs for patients/community Resources for assistance Charity policy changes change culture

22

23 Questions? Glen Boles, CFO CHRISTUS St. Michaels Health System Shauna Wardrop, CPAM Director Client Relations, Cardon Outreach