The governor's special adviser on Medicaid Program, Esther Muna, disclosed to the Commonwealth Healthcare Corp. board that the public hospital will soon receive a significant increase in its Medicaid reimbursement starting this fiscal year once formal approval is received from the Center for Medicare Medicaid Services.
CMMS Region IX is currently reviewing the CNMI's proposal to use certain “certified expenditure authority” (CPE) as its local matching fund for its Medicaid program in order to receive higher reimbursement from the federal government. The Medicaid program is a federal/state program established for low-income residents and was assigned 45-55 percent matching requirements.
Muna, in her presentation to the board Friday, disclosed that the government has identified $15 million “CPE” that can all be used as local matching for the Medicaid program.
These are the $5 million seed money for the corporation, the $3 million initial loan from Marianas Public Land Trust, and the yet-to-be released $7 million additional line of credit from MPLT. All these monies are considered CPEs because they went through legislative process and were approved for the corporation by virtue of statute.
According to Muna, of these three identified “CPEs” only the $5 million seed money has so far been approved and will be factored in the new calculation of Medicaid reimbursement for the CHC, which will be used as basis in calculating the “actual cost” incurred by the public hospital in providing services to Medicaid patients.
Saipan Tribune learned that there are several steps that the CNMI Medicaid Program has gone through in order to get approval of CPE. First, a memorandum of understanding was secured early this year between CMMS and CNMI.
“When we realized there's no money for CHC, we presented to the governor ways on how we can help CHC.and the answer is CPE. So the first thing we did, we secured an MOU as soon as possible and we got this approved in March this year,” said Muna.
The second step was the identification of additional matching funds and which has been achieved as it identified the $15 million to be used as the 45-percent matching requirement of the CNMI.
Muna revealed that after identifying the $15 million, they had submitted an amendment to the Medicaid state plan for 2012 which specifically indicated two changes: definition and identification of emergency services at the hospital, and the inclusion of Federated States of Micronesia pregnant women as among those eligible for Medicaid benefits. This amendment plan was approved in January.
The next step is the new calculation for reimbursement using the CPE. Muna said an agreement was reached that new calculation for reimbursement will use as basis the formula used in calculating the Medicare cost. This, she said, has also been approved and accepted last month by both parties.
The final step, according to Muna, is to wait for the formal approval of the CMMS on the CPE proposal. She said once approval is received, new calculation will take effect since start of FY 2012 in October.
“The funding [reimbursement] we are giving you is based on actual data or actual cost. We don't want to give you pieces-by-pieces [reimbursement].but the bulk of the amount so we can see improvement of the services,” Muna told the board.
Muna said what the corporation is receiving from Medicaid this year is classified as “interim or advanced payment” for the new calculation of reimbursement.
She disclosed that under the new calculation of reimbursement, $4 million has yet been released from the federal side pending the formal approval from CMMS.