care. Together these strategies are projected to save the State $30.9 million as outlined in Table 20. Table 20: Summary of Task Force Recommendations Rank Predicted Savings Proposed Change : Strategy Low = 1 & High = 5 Federal Prior Implement concurrent review for inpatient psychiatric services 4.7 $90K $34K Authorization for individuals 21 Elective surgeries 5.0 $0.8M $0.3M High cost imaging & Radiology 4.7 $2.5M $0.9M Expand list to include all of listed for the State of MD and Payment adjustments made annually based on HACs 3.9 $1.75M $0.7M Conditions (HACs) Readmissions Increase time span for which readmissions are not reimbursed 4.7 $15M $5.6M Leave Days Eliminate reimbursement for hospital leave & therapeutic Nursing leave days Facility 3.5 $1.7M $0.6M IMD ICFMR Total savings from Short-term strategies $21.8M $8.1M Rank Predicted Savings Proposed Change : Mid-term Strategy Low = 1 State & High = 5 State Federal Pharmacy Competitive bid for specialty pharmacy 4.7 $2.1M $0.8M Expand Medication Management Initiative Addtl. 5.0 research research needed needed Monitor use of Anti-Psychotics in Children and Adults and Seniors 4.8 $0.3M $0.7M PA required Restore smoking cessation services Addtl. Addtl. 3.7 research research needed needed Program Develop operational policy and procedure to handle day to day Integrity Medicaid discretionary functions and Internal review of data collected 4.4 $6.5M $2.4M Utilize CMS’s best practice annual summary report Develop policy/procedure and mechanisms for reporting to the Medicaid and CHIP Payment and Access Commission No cash for controlled substances Addtl. Addtl. 4.8 research research needed needed Total savings for Mid-term strategies $9.3M $3.5M
care. Together these strategies are projected to save the State $30.9 million as outlined in Table 20. Table 20: Summary of Task Force Recommendations Proposed Change : Strategy Rank Low = 1 High = 5 Predicted Savings & Federal Prior Authorization Implement concurrent review for inpatient psychiatric services for individuals 21 4.7 $90K $34K Elective surgeries 5.0 $0.8M $0.3M High cost imaging & Radiology 4.7 $2.5M $0.9M Conditions (HACs) Expand list to include all of listed for the State of MD and Payment adjustments made annually based on HACs 3.9 $1.75M $0.7M Readmissions Increase time span for which readmissions are not reimbursed 4.7 $15M $5.6M Leave Days Nursing Facility IMD ICFMR Eliminate reimbursement for hospital leave & therapeutic leave days 3.5 $1.7M $0.6M Total savings from Short-term strategies $21.8M $8.1M Proposed Change : Mid-term Strategy Rank Low = 1 High = 5 Predicted Savings State & Federal State Pharmacy Competitive bid for specialty pharmacy 4.7 $2.1M $0.8M Expand Medication Management Initiative 5.0 Addtl. research needed research needed Monitor use of Anti-Psychotics in Children and Adults and Seniors PA required 4.8 $0.7M $0.3M Restore smoking cessation services 3.7 Addtl. research needed Addtl. research needed Program Integrity Develop operational policy and procedure to handle day to day Medicaid discretionary functions and Internal review of data collected Utilize CMS’s best practice annual summary report Develop policy/procedure and mechanisms for reporting to the Medicaid and CHIP Payment and Access Commission 4.4 $6.5M $2.4M No cash for controlled substances 4.8 Addtl. research needed Addtl. research needed Total savings for Mid-term strategies $9.3M $3.5M
recommendation-report12-15-2012.docx