REQUEST FOR PROVIDERS AND STAKEHOLDERS INPUT ON THE PROPOSED GUAM MEDICAID STATE PLAN AMENDMENT TO REVISE THE GUAM HOSPITAL INPATIENT AND OUTPATIENT PAYMENT METHODOLOGY

For Immediate Release

June 2, 2017; 3:45pm

DPHSS Release No. 2017-052

Request for Providers and Stakeholders Input on the Proposed Guam Medicaid State Plan Amendment to Revise the Guam Hospital Inpatient and Outpatient Payment Methodology

The Department of Public Health and Social Services (DPHSS) Bureau of Health Care Financing Administration (BHCFA) is requesting input from providers, beneficiaries, and other interested stakeholders concerning the Guam Medicaid State Plan Amendment 17-001 revising the Guam Hospital Inpatient and Outpatient payment methodology.   

Guam Medicaid SPA 17-001 will revise the payment methodology for Guam Hospital Services as follows:

Inpatient Hospital Services:

(a)Medicaid will pay all Guam inpatient hospital services that are covered by the Medicaid Program the lowest of the following:

i)hospital’s current Medicare Interim Rate;

ii)80% of hospital’s current Medicare Interim Rate if the hospital’s Medicare Interim Rate exceeds the lowest prevailing on-island hospital Medicare Interim Rate;

iii)negotiated rate of hospital’s current Medicare Interim Rate.

Outpatient Hospital Services:

Medicaid will pay Guam hospital emergency, hospital-based clinic, and ancillary services including operating room, laboratory, x-ray, physical, occupational and inhalation therapy; renal dialysis; etc., the lowest of the following:

i)hospital’s current Medicare Interim Rate;

ii)90% of hospital’s current Medicare Interim Rate if the hospital’s Medicare Interim Rate exceeds the lowest prevailing on-island hospital Medicare Interim Rate;

iii)negotiated rate of hospital’s current Medicare Interim Rate.

The Guam Medicaid hospital payment methodology changes will be effective June 3, 2017. This will decrease the annual aggregate expenditures by approximately $5,966,023.68 to ensure program remains within the budget and establish impartial services of the Guam hospitals in the interest of our recipients’ access to care.    

A copy of the proposed SPA will be posted on the Guam DPHSS website or can be requested via email teresita.gumataotao@dphss.guam.gov / janet.cruz@dphss.guam.gov, via telephone  (671) 735-7293 / (671) 735-7471, and can also be picked up at DPHSS BHCFA office-Room 238, 123 Chalan Kareta, Mangilao / DPHSS BHCFA Program Management Office-next door to Subway, Castle Mall building, Mangilao between the hours of 8:00 a.m. to 5:00 p.m., Monday through Friday excluding holidays.

Please submit comments and questions via email to teresita.gumataotao@dphss.guam.gov / janet.cruz@dphss.guam.gov and reference SPA 17-001 no later than 4:00 p.m. June 30, 2017 (ChST), and will be posted on the Guam DPHSS website for public view.

For more information or inquiries, please call Teresita C. Gumataotao, BHCFA Acting Administrator, at 735-7293 or email at teresita.gumataotao@dphss.guam.gov / Janet B. Cruz, BHCFA Management Analyst, at 735-7471 or email at janet.cruz@dphss.guam.gov .