Tag: Toyon University

• Medicare discharges and Case Mix Indices (CMI) – For projecting future reimbursement, CMS provides discharges and CMI from 2021 (i.e., MEDPAR data) impacted by COVID-19. In FFY 2022, CMS provided Medicare discharges and CMI using pre-COVID-19 data (2019). In the dashboard reports, Toyon holds discharges and CMI constant using the values provided in the FFY 2023 Proposed Rule.   
• Alternative Rates for FFY 2023 – CMS provides two separate sets of base rates and variables for FFY 2023 rate setting. CMS is proposing rates are updated by factors projecting fewer COVID-19 hospitalizations in FFY 2023 than in FFY 2021. In CMS’s alternative rates, CMS does not make an adjustment projecting a decline in COVID-19 hospitalizations from FFY 2021 to FFY 2023.   
• Uncompensated Care (UC) DSH – CMS is proposing UC DSH payments of $6.6 billion, a reduction of $563M as compared to FFY 2022 ($1.8 billion reduction compared to FFY 2021). Decreasing UC DSH funding is an important area of focus for FFY 2023, and Toyon will be sending comments to providers and CMS, aimed at increasing this funding.    
• Wage Index – CMS is proposing to cap wage indices so providers can experience a decrease of no more than 5% as compared to prior year (i.e., FFY 2022).   
• Low Volume Adjustment and Medicare Dependent Hospital Status – Unless otherwise extended by law, these provisions are set to expire for FFY 2023. Therefore, CMS does not propose rate adjustments for these provisions in the FFY 2023 Proposed Rule. 
• Value Based Purchasing (VBP) Adjustment – CMS is also proposing to not calculate a Total Performance Score (TPS) for any hospital and to instead award all hospitals a VBP amount for each discharge that is equal to the amount withheld, which is 2% of the base operating rate. Toyon’s estimated VBP amount for FFY 2023 is estimated at 2% of base rate payments.   

Providers that do not attest to the T&C and retain the funds past 45 days will retain payments and be included in HHS’s public release of providers and payments. In HHS’s updated FAQs, the agency states:

“Generally, HHS does not intend to recoup funds as long as a provider’s lost revenue and increased expenses exceed the amount of Provider Relief funding a provider has received.”

Providers must also submit revenue detail by June 3 to receive additional funding from the PHSSEF Distribution.
Please visit Toyon University’s COVID-19 Funding and Documentation Presentation for a discussion on submitting expenses and revenue loss. In HHS’s updated FAQs, HHS indicates this information may be used for other funds, such as the High Impact Fund. HHS states:

“Providers should update their capacity and COVID-19 census data to ensure that HHS can make timely payments in the event that the provider becomes a high-impact provider. Providers can continue to update their information through the same method they used previously.”

Also, providers are required to accept HHS’s T&C and submit revenue information to be considered for additional relief payments.

Toyon’s estimation of unallocated funds (to eligible hospitals) from the CARES Act PHSSEF is below. It is noted some of this funding will be used as part of provider relief funding for skilled nursing facilities (SNF) and HRSA’s Uninsured Program.

$50,000 Payments to RHCs for COVID-19 testing | expenses
Also included in HHS’s provider relief funding update is a distribution of $225 million to RHCs for COVID-19 testing. Payments are based on the number of certified clinic sites. HHS also released RHC T&Cs here. 

Provider relief for Skilled Nursing Facilities
As part of the CARES provider relief funding, HHS is distributing $50,000 to each SNF plus a variable distribution between $2000 per bed for smaller SNFs (5 and 25
beds) and $1,8000 per bed for larger SNFs (more than 200 beds). HHS also released SNF T&Cs here.

Thank you

Toyon is committed to apprising providers with important reimbursement updates and will keep you updated with the latest on UC DSH and COVID-19 funding and documentation.  Please feel free to visit Toyon’s COVID-19 Resources for updates on hospital funding estimates, recommendations on documenting cost and revenue losses associated with this public health emergency. Toyon’s website provides information on how to contact Toyon’s team members.