Rebase. We cover replacement of the entire denture base, except the teeth, to improve the bite and/or fit.
Rebase. Effective July 1, 2013, the State implemented a new DRG schedule updating the core pieces that affect hospital payments. Goals of the State regarding this change included the following: • Reduce the frequency of outlier payments to be consistent with the intent of prospective payment systems. • More appropriately reimburse for the following types of services/facilities: ─ Rural Facilities. ─ Deliveries. ─ Psychiatric Care. ─ Care for Kids — Impacts Children's Hospitals. In order to estimate the impact of this program change to the ABD <21 population, Xxxxxx relied upon analysis by its subcontractor, Xxxxx and Associates, for an estimate of the impact to the Inpatient COS by rating region. When evaluating the impact of the DRG rebase, the above adjustment should be considered, along with the other inpatient-related prospective program changes described later in this section, and the MCP inpatient pricing targets described in Enclosure 4.
Rebase. Effective July 1, 2013, the State implemented a new DRG schedule updating the core pieces that affect hospital payments. Goals of the State regarding this change included the following: • Reduce the frequency of outlier payments to be consistent with the intent of prospective payment systems. • More appropriately reimburse for the following types of services/facilities: ─ Rural Facilities. ─ Deliveries. ─ Psychiatric Care. ─ Care for Kids — Impacts Children's Hospitals. In order to estimate the impact of this program change to the CFC and ABD 21+ populations, Xxxxxx relied upon analysis by its subcontractor, Xxxxx and Associates, for an estimate of the impact by region. The CFC impact was applied on a rating region and rate group basis to the Inpatient COS. This change was measured by comparing the plan-reported costs per admit in CY 2013 to the expected costs per admit using the All Patient Refined (APR)-DRG fee schedule in effect on July 1, 2013. When evaluating the impact of the DRG rebase, the above adjustment should be considered, along with the inpatient-related prospective program changes in Enclosure 3 and the MCP inpatient pricing targets described in Enclosure 4. ENCLOSURE 3 Projected Cost Development The adjusted base data (described in Enclosure 2) was brought forward to the contract period. The adjustments used to produce the projected costs are described within this section and listed below: • Impact of Medicaid Expansion/Those Eligible But Not Enrolled (EBNE). • Prospective Program Changes. • Trend.
