Mar. 22, 2010 MA HDC Meeting 1

MA Health Disparities Council

Working Group on Interpreter Services

Update on ISWG Recommendations forReimbursement for Medical Interpreters

March 22, 2010

Content for this update is from ISWG Presentation by Terri Yannetti, Director Primary Provider NetworkOffice of Acute and Ambulatory Care

Georgia Simpson May, Director, MDPH-Office of Health Equity (OHE)James Destine, Coordinator of Interpreter Services, MDPH-OHEIyah Romm, Intern, MDPH-OHE

Mar. 22, 2010 MA HDC Meeting 2

The 2007 Massachusetts LegislativeCommission to End Racial and Ethnic Health Disparities Recommendations “to expand access to quality health care”

Recommendation #3:

Reimbursement procedures for interpreter services by all payers, public and private.

Mar. 22, 2010 MA HDC Meeting 3

MassHealth Reimbursement Principles

• Encourage efficiency and economy• Use sound reimbursement methods

to reasonably compensate all hospitals

• Maintain access and quality of care• Comply with all applicable state and

federal payment requirements

Mar. 22, 2010 MA HDC Meeting 4

MassHealth Federal Limitations

• Upper Payment Limit (UPL) on Medicaid Rates – not to exceed amounts payable using Medicare payment principles

• Safety Net Care (SNC)– Replaces federal Disproportionate Share Hospital (DSH) Payments and Limits

• Budget Neutrality – Waiver costs cannot exceed costs absent a waiver

Mar. 22, 2010 MA HDC Meeting 5

Acute Inpatient Methodology: (Standard Payment Amount per Discharge) SPAD covers a 20 day stay

• The Hospital–Specific SPAD is based on hospital reported costs (submitted on the DHCFP 403 cost report) and consists of:– Statewide average payment amount per

discharge adjusted by an efficiency standard and then for wage area differences, hospital-specific casemix and an operating cost inflation factor

– A per discharge payment for hospital-specific expenses for malpractice insurance and organ acquisition

– A per discharge payment amount for capital cost, adjusted by hospital-specific casemix and by a capital inflation factor

Mar. 22, 2010 MA HDC Meeting 6

Acute Hospital Outpatient Methodology

Mar. 22, 2010 MA HDC Meeting 7

PAPE (Payment Amount Per Episode)• Hospital Specific Episodic Payment

Methodology– Per Patient/Per Day– Based on 3M Ambulatory Patient Group

(APG) bundling – Utilizes cost-based weights that capture

resource intensity and applies a forcasted trend to the monthly average

• PAPE Covers most outpatient services– Outpatient departments (OPDs)– Hospital Licensed Health Centers (HLHCs)– Hospital Satellite Clinics

• PAPE doesn’t cover– Laboratory services, professional services

and other specified services paid though DHCFP fee schedules

Mar. 22, 2010 MA HDC Meeting 8

PAPE• The Statewide Standard is

derived from the Total APG payment– For Base Year – Inflated to Hospital Rate Year

• Based on Ambulatory Patient Group (APG) Payment and Episodes– Exclude Lab Services– Utilize Cost-to-Charge Ratios (CCR) to

Price Outliers– 1-day Episodes

• PAPE = Forecasted Average APG Weight x Statewide Standard

Mar. 22, 2010 MA HDC Meeting 9

Interpreter Services• Interpreter Services costs are

captured in the payment methodologies, in the same manner as nurses, x-ray technologists, pharmacists, dieticians, and the costs of other hospital personnel, in support of providing patient care services

• These costs are reported on the hospital cost reports, are in the cost-based weights and are therefore included in the hospital specific payment rates.

Mar. 22, 2010 MA HDC Meeting 10

Coverage Consistent with other Payers

• Representatives of the payers in the workgroup also noted that their hospital contracted rates cover the provision of Interpreter services

Mar. 22, 2010 MA HDC Meeting 11

Future Decision Points for HDC (to-date)

• Sustainability of effort, ongoing monitoring.

• Potential for instituting registration process for medical interpreters. Registration would allow us to have, within the state’s domain, a repository of all certified medical interpreters who are practicing in MA, similar to the registry within the Commission for the Deaf and Hard of Hearing.  G.L. c.6 s.196. (interpreter referral service).

Mar. 22, 2010 MA HDC Meeting 12

ISWG Meetings and Tentative AgendasSeptember 23, 2009 √ October 28th, 2009 √November 18th, 2009 (changed from Nov. 25th) √December 16th, 2009 (changed from Dec. 23rd) √January 27th, 2010 √

February 24th, 2010 √

March 24th, 2010

Location: 250 Washington Street, BostonCommissioner’s Conference Room, 2nd Floor

Time: 3:15 – 4:45

Mar. 22, 2010 MA HDC Meeting 13

March – April 2010 AgendaMarch 24, 2010 – Mtg #7 (Reimbursement-

Part II)• Finalize reimbursement recommendation(s)

April 28, 2010 – Mtg #8• Review, modify finalize full set of

recommendations