Transcript Legislative Update 2012 - Orange County Comptroller

Legislative Update 2012
• Medicaid
• DOH Reorganization
George A. Ralls M.D.
Health Services Department
February 7, 2012
Medicaid
F.S. 409.915: County contributions to Medicaid
35% of inpatient
hospitalization costs
 60 Days to pay
Days 11 to 45
 State can withhold revenue sharing
funds if not paid
$55 per month, per Medicaid
recipient in a nursing home
Medicaid
Orange County
Medicaid Billed/Paid FY07-11
Medicaid:
Proposed Changes
Collection of • Recovery of last 4 years of
previously denied bills
Unpaid Bills
Attributing
Costs to
Counties
Payment
Method
• Changes the way Medicaid costs
are assigned to each County
• Eliminates our ability to
scrutinize bills and deny
payment
Medicaid:
Proposed Changes
Collection of Unpaid Bills for last 4 Years
• Balance between what we’ve paid and
75% of total billed
– Approximately $20 Million Dollars
• 36 monthly installments directly out of
revenue sharing dollars
– $556,000 per month
Medicaid:
Proposed Changes
Attributing Costs to Counties
• County’s eligible recipients will be
determined solely on the address listed in
the DCF system
• If no address, eligibility is based on the
county where services were rendered
– Tertiary referral centers
– High risk obstetrics
– Neonatal intensive care centers
Medicaid:
Proposed Changes
Payment Method
• Beginning Dec. 2012:
– Future unpaid billings will be taken from
revenue sharing after 6 months
– Counties will be paying the entire bill
– No reconciliation process or “re-billing”
Medicaid:
Proposed Changes
Summary of local impact:
• $20 Million in past denied bills
• Loss of our ability to determine County
residence
• Services rendered at any of our tertiary
referral centers may contribute to costs
• Mandate to pay entire bill submitted to us
– 2011 billed amount was $29.5 M, versus
$17.4 M paid
DOH Reorganization
• HB 1263
• Rep. Matt Hudson
DOH Reorganization
HB 1263 - Department of Health (DOH)
DOH Reorganization
• All CHDs have responsibilities in three
functional areas:
– Infectious disease prevention & control
• Surveillance, diagnosis, treatment, risk
reduction
– Basic family health care services
• Primary care, pre-natal care, school based
health care
– Environmental health services
• Sanitary nuisances, on-site sewage disposal
systems, water well monitoring
DOH Reorganization
• Orange County Health Department:
– Neighborhood Centers for Families
– HUG-Me Program
– Office of Community Health
•
•
•
•
Health Disparities
Chronic Disease and Tobacco Prevention
Risk Communication
Prevention Research, Informatics, and
Health Education Center (PRIHEC)
• “All In”
– PCAN Partner
DOH Reorganization
Orange County Health Dept
Revenues
Expenditures
$45 M
$45.6 M
OCHD FY10 Annual Report
DOH Reorganization
OCHD Revenue Sources
Local
Revenue
•$21.7 Million
State
Revenue
•$12.5 million
Federal
Revenue
•$10.8 Million
FY10
DOH Reorganization
OCHD Expenditures
Salaries
• $31.2 million
Misc.
Expenses
• $6.2 million
Contractural
Services
• $3.5 Million
FY10
DOH Reorganization
• Summary of HB 1263:
– Counties to take over local health depts
• Health dept employees become county
employees
– DOH contracts with counties to maintain
primary health department functions
• Environmental Health
• Communicable Disease
• Primary Care
– State block grants will offset county costs
DOH Reorganization
Concerns:
• A significant shift of responsibilities.
• A significant increase in the County
workforce.
• Will services be compromised?
• Will State block grants offset the added
County costs?
• Amount based on population
• No mention of funding formula yet
Legislative Update 2012
• Medicaid
• DOH Reorganization
George A. Ralls M.D.
Health Services Department
February 7, 2012