Control Points Options to ConsiderSlide 2
Creating an Effective PowerPoint Presentation Generally close to 6 words a line Generally close to 6 lines a slide Avoid long sentencesSlide 3
Creating an Exciting Power Point Add sounds and impacts to connect with the group of onlookersSlide 4
Creating Pathetically Boring Power Point Lots of Slides Too Much Information Real Sleeper Makes crowd dribble, watch clock and dream of the last genuine summer get-away A genuine state of mind adjusting experience!!!!Slide 5
Welcome to my reality! Pour some espresso Take a minute to agile up And feel free toward the end to not make inquiriesSlide 6
Oklahoma Health Care Authority Presenter: Stephen Weiss Sr. Arrangement Advisor January 26, 2007Slide 7
Disproportionate Share Hospital Program DSH Not DISHSlide 8
Revised DSH Presentation has been modified to join 2007 State Plan Amendment Also incorporates new content to locations remarks got after starting introductions were made amid the fall of 2006. The introductions were held as takes after: November 7, Oklahoma City November 27 th , Tulsa December 5 th , LawtonSlide 9
In Summary DSH built up in 1981. To begin with Concern: Address the requirements of healing centers which serve a high number of Medicaid patients and low-salary, regularly uninsured, patients. The second concern was that there was the potential for a developing hole in 1981 between what Medicaid paid doctor\'s facilities and what the cost of care was at the doctor\'s facilities.Slide 10
Background OBRA \'81 (Pub. L. No. 97-35) gave states adaptability to create Medicaid repayment frameworks that contrasted from Medicare. With this adaptability came a worry that states would cut Medicaid installments, in this way making troubles for doctor\'s facilities serving vast quantities of Medicaid and uninsured patients. To limit the potential negative effect on these healing facilities, OBRA \'81 incorporated a prerequisite that states make "extra" Medicaid installments to doctor\'s facilities that serve an unbalanced number of low-salary patients with extraordinary needs.Slide 11
Background At first the states overlooked the law since it was wide and unclear. In 1985, the HCFA (now CMS) decided that states could utilize healing center expenses and gifts as state share for the DSH program. The state share is the FMAP. West Virginia was the principal state to institute such an arrangement in 1985. OBRA1986 Congress illuminated that HCFA had no expert to confine in any capacity the measure of installment alterations made to DSH healing centers (PL 99-509).Slide 12
Background OBRA 1987 set up a government definition for DSH doctor\'s facilities and obliged states to make installments to these offices. Definition included healing facilities with Medicaid use rate of one standard deviation or more over the mean Medicaid usage rate in the state or low-wage use rate of 25 percent or more. OBRA 1987 additionally gave states adaptability to assign DSH doctor\'s facilities and set installment levels.Slide 13
Why DSH? Pain free income! Initially no restrictions on the measure of DSH a state could get. Nobody was considered responsible for their consumptions. In the event that a state could demonstrate through a recipe how greatly uncompensated care a doctor\'s facility given in a specific era then the healing center could get a DSH installment.Slide 14
The Results…Slide 15
Oklahoma Tried to DSH before Reforms restricted the program… In 1992 the Oklahoma voters dismisses a state address on a supplier assess. 1993 An Oklahoma Medicaid Reform Task Force suggested appropriation of four subsidizing pools in view of an equation focusing on philanthropy mind and consolidating the government laws identified with low salary use. 1993 SB 576 (Section 19) required a DSH recipe weighted against the University of Oklahoma\'s Medical Center. Since Oklahoma got under $25 million for DSH, needed to measure the subsidizing toward the University of Oklahoma by law and the accessibility of coordinating assets were constrained, the University Medical Center got more than 80% of the accessible DSH supports every year.Slide 16
Congress Reins in DSH OBRA 1987 gave that healing centers could get DSH just in the event that they met the accompanying criteria: Have no less than 2 obstetricians who have staff benefits at the clinic and who have consented to give obstetric administrations to people who are qualified for medicinal help for such administrations; or doctor\'s facilities which serve people under 18 years old; For doctor\'s facilities which did not offer nonemergency obstetric administrations to the overall public and were good to go as of December 22, 1987. On account of a healing facility situated in a rustic zone the expression "obstetrician" incorporates any doctor with staff benefits at the clinic who performs nonemergency obstetric systems.Slide 17
Reining in DSH by Law 1991 - The Medicaid Voluntary Contribution and Provider-Specific Tax Amendments (P.L. 101-234), set up strict rules for supplier duties and gifts. DSH installments were topped at generally their 1992 levels and the law constrained national DSH installments to 12 percent of aggregate Medicaid costs. Congress presented the idea of High and Low DSH states utilizing the 12 percent criteria for each state.Slide 18
Reining in DSH by Law 1993 - OBRA (P.L. 103-66) topped aggregate DSH installments to a solitary healing facility; got to be distinctly known as the "clinic particular top" or DSH Upper Payment Limit (UPL). Likewise restricted assignment of a healing facility as a DSH doctor\'s facility unless doctor\'s facility had a Medicaid inpatient use rate of no less than 1%. 1997 - BBA (P.L. 105-33) built up state particular DSH portions for every year through 2002. Constrained the amount DSH cash IMD can get in view of a government recipe utilizing the 1995 as base year.Slide 19
Reining in DSH by Law 2000 - BIPA (P.L. 106-554) put off the state particular DSH cuts for 2001 and 2002. BIPA included another Special Rule for Extremely Low DSH States. States with 1999 DSH uses that were in the vicinity of 0% and 1% of the states\' 1999 aggregate medicinal help uses were thought to be ``low-DSH States.\'\' Oklahoma assigned a low DSH state. 2003 MMA (P.L. 108-173) switched the BIPA decays. For 2004, roofs for high DSH states were expanded by 16% for one year .Slide 20
Reining in DSH by Law MMA changed the meaning of Low-DSH State by extending the scope of DSH uses to medicinal help uses to 0% to 3% in light of 2000 consumption reports. Low DSH states got 16% increments in their roofs every year from 2004 through 2008, and after that a CPI figuring for every year from there on. At long last, the MMA built up exceptionally strict and extended DSH announcing and examining prerequisites which states should follow once the government guidelines are issued.Slide 21
"The race for quality has no complete line-so in fact, it\'s more similar to a demise walk."Slide 22
Unintended Consequences… The unintended outcome of every one of these changes was to: bolt states into certain subsidizing circumstances that are in a few regards out of line, and Penalize states that did not misuse the DSH program before the establishment of the laws which were planned to stop the apparent misuse of the program.Slide 24
Oklahoma After the MMASlide 25
Oklahoma Response… Initial reaction in 2004 and 2005 from the increments in the MMA was to give added assets to OU Medical Center. In 2006 the organization chose that the recipes should have been changed to add more healing centers to the blend. An underlying allotment was made in 2006 however an adjust was left to disseminate under another equation on the off chance that one could be made.Slide 27
Changes to the Plan another segment of the state plan was included 2006 to designate the $13.9 million. To begin with, there was a pledge that since we had more cash there would be no failures from any progressions made. In 2005 OU Medical Center got $25.5 million so the principal segment of the State Plan Amendment (SPA) allotted $7.2 million to OU Medical Center. Second, $840,486 was allotted to the J.D. McCarty Center for Handicapped Children situated in Norman. At last, $5.9 million was dispensed to the greatest number of healing centers as we could qualify under government law for DSH.Slide 28
Final Oklahoma DSH Allocation for 2006Slide 29
Changes to the Plan For 2007: OU Medical Center will get an indistinguishable sum from it did in 2006 in addition to a swelling alteration in light of the main portion of the schedule year. The rest of the healing centers will then partake in a critical position of assets left after the OU distribution and the IMD designation are subtractedSlide 30
Proposed DSH Allocation for 2007Slide 31
Changes to the Plan for 2006 and 2007 for Private and Community Hospitals The recipe and approach received by Oklahoma endeavors to catch the embodiment of the fundamental concerns communicated by Congress when the DSH program was made: -target doctor\'s facilities that serve a lopsided number of Medicaid and low pay, regularly uninsured, patients. Congress gave states wide tact in characterizing and recognizing these healing facilities - which are frequently alluded to as "wellbeing net" doctor\'s facilities. A 2002 RAND announced noticed that "A critical qualification of security net clinics is that they give care to powerless populaces. Shockingly, there is no broad concurrence on which gatherings ought to be viewed as defenseless."Slide 32
Changes to the Plan The 2002 RAND report: inspected the dispersion of both Medicare and Medicaid DSH subsidizes crosswise over doctor\'s facilities, surveyed elective criteria that could be utilized to distinguish wellbeing net clinics, created measures of healing center money related powerlessness to recognize those security doctor\'s facilities that are under most budgetary weight, and investigated the degree to which elective assignment arrangements to the present Medicare and Medicaid DSH installment systems would enhance the circulation of assets to those wellbeing net doctor\'s facilities that are generally helpless. the report found that a recipe including Medicaid inpatient
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