$ 1,693,010
$ 744,598
$ 948,412
$ 538.54
[A]
Provider
Revenue
= [B]
Provider
Transports
X
[C]
Medi-Cal
Payment
(Estimated)
[A]
Provider Revenue = [B]
Provider
Transports
X
[C]
Medi-Cal
Payment
(Estimated)
$ 1,406,833 1,321 $ 1,065.12 $ 286,177.83 440 $ 650.00
[D]
Requested IGT = [B]
Provider
Transports
/
[E]
Total Transports
(Participating Providers)
X
[F]
Total NonFederal Share
$ 744,598 1,761 258,743 $ 109,397,828
[G]
Net Benefit
= [A]
Provider
Revenue
- [D]
Requested IGT
$ 948,412 $ 1,693,010 $ 744,598
Definitions
Notes:
○ The projected transports are calculated at an aggregate level (i.e. across all providers). In order to inform provider-specific trips, hisorical encounter data from July 2020 through December 2021 was used to determine the portion of projected trips attibutable to participating providers. ○ All projections/estimates are for informational purposes and remain subject to change. ○ Split of Total Non-Federal Share between Non-Dual and Dual calculations assumes a 80/20 ratio. This assumption does not impact the 'Requested IGT ' nor the 'Net Benefit ' components of the calculation. ○ Split of trips between Non-Dual and Dual calculations assumes a 75/25 ratio. This is an aggregate assumption and may vary between regions and providers.
Purpose Statement: The primary function of this exhibit is to leverage annualized trip counts from Jul 2020 – Dec 2021 and the CY 2023 DRAFT non-federal share cost to show what the revenue, requested IGT, and net benefit will be in 2023 within managed care. The trip counts and breakout of Dual & Non-Dual are high-level assumptions for illustration purposes. In addition, the actual net benefit in 2023 will vary based on actual 2023 trip counts (payments) and Final CY 2023 rates/non-federal share.
• The base rate + add-on for A0225 is $61.72 higher than the other four (4) HCPCS Codes. However, for simplicitification, the other four (4) codes are leveraged in this calculation. Code A0225 makes up less than 1% of total trips.
• The dual amount represents the assumed Medi-Cal payment liability of the add-on in managed care above 80% of Medicare fee schedule. The amount receieved may be higher or lower than this amount and is dependent on code/region.
[D]: Requested IGT - Draft amount estimated to be collected - the projected transports divided by total transports of participating providers creates a percent share for provider. This percent is applied to the total non-federal share in managed care to determine IGT amount (excludes admin collection). [E] Total Transports (Participating Providers) - Total CY 2023 projected transports for participating providers. The trips include both beneficiaries with and without Medicare Part B. [F]: Total Non-Federal Share - Estimated CY 2023 Non-Federal Share of payments to managed care plans, as built into the managed care plans' rates. [G]: Net Benefit - Total estimated gain of estimated provider revenue net of the requested IGT amount. ○ This calculation applies to managed care ONLY and is draft/subject to change.
Non-Dual Net Benefit Calculation Dual Net Benefit Calculation Combined Non-Dual and Dual Calculation
[A]: Provider Revenue - Estimated total AB 1705 provider revenue based on projected CY 2023 trips multiplied by assumed Base Rate plus Add-on. [B]: Provider Transports - Total CY 2023 (provider-specific) projected transports. The trips are broken out into beneficiaries without Medicare Part B (Cell E12 ) and those with Medicare Part B (Cell K12 ). This projection leverages annualized provider trips seen in July 2020 through December 2021 data. An aggregate trend is applied to these trips to inform the counts shown above. [C]: Medi-Cal Payment (Estimated) - Reflects the current CY 2023 fee schedule rate plus Add-on.
Managed Care Estimated CY 2023 Net Benefit Calculation
CY 2023 Net Benefit Summary
Total Projected Provider Revenue:
Total Requested IGT:
Total Projected Net Benefit:
Projected Net Benefit per Trip: