Acute services - State of Illinois
Acute services - State of Illinois Acute services - State of Illinois
Shadow Pricing ModelsShadow Pricing Assumptions – Full SFY 2011 Claims Data» To evaluate the new system using the most fully mature and completestate fiscal year of claims data available, HFS has re-priced SFY 2011FFS claims under the Revised Model payment rates and methodology» SMART Act reductions had not yet occurred in SFY 2011› As such, for comparison purposes, 3.5% SMART Act reductions were not appliedto simulated new system payments› Simulated new system payments were compared to reported claim payments netof DSH, MPA/MHVA and LTAC add-onsPage 14
Shadow Pricing ModelsShadow Pricing Assumptions – SFY 2011 Claims (Continued)» Revised Model rates applied to SFY 2011 FFS claims data resulted in simulatednew system payments that are lower than current system payments:Category ofServiceDRG/PerDiemPaymentsSFY 2011 Claims DataReported PaymentsOutlierPaymentsTotal ClaimPayments(Net ofDSH/MPA)Revised Model Rates Appliedto SFY 2011 Claims DataDRG/PerDiemPaymentsOutlierPaymentsTotal ClaimPayments(Net ofDSH/MPA)EstimatedPaymentChangeAcute COS 20 Services $1,261.2 $610.4 $1,871.6 $1,543.2 $249.1 $1,792.2 -$79.4Psychiatric COS 21 Services $160.9 $0.0 $160.9 $153.4 $0.0 $153.4 -$7.5Rehabilitation COS 22 Services $31.2 $0.1 $31.3 $30.7 $0.0 $30.7 -$0.6LTAC COS 20 Services $46.1 $6.5 $52.5 $37.3 $0.0 $37.3 -$15.2Inpatient Total $1,499.3 $617.0 $2,116.3 $1,764.5 $249.1 $2,013.6 -$102.7Page 15
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- Page 3 and 4: Revised Inpatient Model withPolicy
- Page 5 and 6: Revised Inpatient Model With Policy
- Page 7 and 8: Revised Inpatient Model With Policy
- Page 9 and 10: Revised Inpatient Model With Policy
- Page 11 and 12: Revised Inpatient Model With Policy
- Page 13: Shadow Pricing ModelsShadow Pricing
- Page 17 and 18: Requested TAG AnalysesRequested ana
- Page 19 and 20: Requested TAG AnalysesTransplant Se
- Page 21 and 22: Requested TAG AnalysesCapital Cost
- Page 23 and 24: Alternative Inpatient Model Update
- Page 25 and 26: Transitional CorridorPage 25Example
Shadow Pricing ModelsShadow Pricing Assumptions – Full SFY 2011 Claims Data» To evaluate the new system using the most fully mature and completestate fiscal year <strong>of</strong> claims data available, HFS has re-priced SFY 2011FFS claims under the Revised Model payment rates and methodology» SMART Act reductions had not yet occurred in SFY 2011› As such, for comparison purposes, 3.5% SMART Act reductions were not appliedto simulated new system payments› Simulated new system payments were compared to reported claim payments net<strong>of</strong> DSH, MPA/MHVA and LTAC add-onsPage 14
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