Reimbursement

HAH continues to advocate at the state and federal levels for equitable reimbursement so that its members across the continuum of care can maintain a sustainable future. HAH also works with regulatory agencies to ensure HAH members maximize the monies available from pay-for-performance and pay-for-value programs.

As the COVID-19 pandemic raged on through the year, many hospitals, nursing facilities, assisted living facilities, type II adult residential care homes, home health agencies and hospices continued to experience financial hardship. To address the fiscal burden, Congress authorized $8.5 billion in additional funds for providers who service rural Medicaid patients, and an additional $17 billion in Provider Relief Funds (PRF) through the CARES and American Rescue Plan Acts for healthcare providers. The aid covers additional expenses and losses incurred due to the COVID-19 Public Health Emergency (PHE), which continues to affect us all today.

HAH has continued to assist its members in monitoring federal reporting and other requirements for appropriate use of the relief funds, while also advocating for better and clearer reporting and auditing requirements and standards.

Throughout FY22, HAH additionally:

• Tracked PRF tranches and targeted distributions to ensure that HAH members received maximum aid available.

• Identified and communicated emerging and evolving reporting and auditing requirements for the PRF and other government-sponsored funding opportunities.

• Developed & received Med-QUEST & the Centers for Medicare and Medicaid Services (CMS) approval for a new Medicaid Disproportionate Share Hospital (DSH) calculation, maximizing the equity between facilities in the final distribution of funds.

• Partnered with Med-QUEST & Milliman to remodel and communicate Provider Tax Program changes such as:

1) the Med-QUEST proposed transition to Inpatient DRG Reimbursements.

2) the Med-QUEST proposed, and CMS required, transition from supplemental access payments to prospective, utilization-based payments.

3) ongoing application of the Public Health Emergency (PHE) Federal Medical Assistance Percentage (FMAP) enhancements.

• Renegotiated Med-QUEST Hospital Pay-for-Performance (P4P) terms for CY21 & CY22 to minimize impact to the program in light of the increased state Medicaid population and decreased state budget.