Hospital Outpatient Services EAPG Implementation Rate Year 2017 Colorado Department of Health Care Policy & Financing March 4, 2016 1 Purpose of Meeting The Departments overall objective of this meeting is to
continue providing the Colorado hospital community a transparent EAPG implementation process o The Department will provide updates to general policy decisions This public meeting also provides an opportunity for the Colorado hospital community to ask questions or provide feedback pertaining to the implementation of EAPGs 2
Agenda 1. Welcome and Introduction 2. Milestones Update 3. General Policy Updates 4. Lab & PT/OT Procedures 5. Public Comment 6. Adjournment 3
Welcome and Introduction The Department of Health Care Policy & Financing (The Department) is working with Public Consulting Group (PCG) and 3M through the implementation of EAPGs The Department welcomes questions and feedback from attendees during the presentation 4 Milestones Update
March 4, 2016: 3rd Stakeholder meeting o Review updates to policy decisions May 2016: Fiscal impact letters sent out May 13, 2016: EAPG weights table will be posted on HCPF website August 2016: Provider training meeting November 2016: EAPG go-live for all claims with dates of service on or after November 1, 2016
5 General Policy Updates- 340B Discount UD modifiers will be required on all instances of a 340B qualifying drug The discount applied for 340B drugs is based on the average rebate percentage in Colorado At the time of implementation this will be 50%
6 General Policy Updates- Anatomic Modifiers Anatomical modifiers will be set to the off position in the grouper This means consolidation will not be overridden if anatomical modifiers are present Stay consistent with other policy decisions regarding discounting and consolidation
7 General Policy Updates- Transportation EAPG doesnt accommodate transportation services Hospitals will need to enroll as a transportation provider to receive payment for these services Any costs reported on claims data will be excluded in EAPG weight development 8
General Policy Updates- Drug Discounting Ancillary drug discounting will not be utilized Due to the nature of various provider-administered drugs being grouped together in one EAPG Also due to the use of units on provider-administered drugs 9
General Policy Updates- Telehealth Modifier Telehealth modifier GT is recognized by the EAPG grouper as a valid code The GT modifier is not currently utilized by the grouper to influence payment in any way 10 Lab & PT/OT Procedures Lab and PT/OT procedures will be processed through the
EAPG grouper Therefore all costs associated to these two types of services will be included in the EAPG weights Due to CMS regulations on labs, an alternate, weight capped method will be used in weight development for lab codes A similar weight capping method will also be used for PT/OT codes using the fee schedule
11 Lab & PT/OT Procedures Continued Weight capping method Regular method of weight development uses costs calculated from claims data
Lab and PT/OT code cost calculations will not be allowed to exceed the current fee schedule value for the specific procedure code on the claim Handout 1: Weight Capping Method 12 Request for Public Comment 13
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