A state health agency wished to develop a hospital assessment for providers located specifically in one major urban county. The goal of the program was to enhance revenues and target providers within the county for specific payments, and achieving these goals required winning local, state, and federal approval for implementation.

The Collaboration

To begin work, Sellers Dorsey worked with the state on modeling the assessment in order to maximize the benefit to providers within the county, and we facilitated discussions with the providers to gain their support for the program. We then helped draft state-enabling legislation, the city ordinance, the public notice, the state plan amendment (SPA), waiver requests, and answers to CMS questions. We also participated in discussions with CMS to gain approval. Alongside these efforts, we assisted the drafting and execution of a memorandum of understanding (MOU) between the state and the county, and we worked with both parties as well as the concerned providers to ensure a smooth initial and ongoing implementation.

The Results

Following the initial implementation, we continued to monitor the assessment model each year, gauging for any necessary changes, and we still do. This program was the first local government provider assessment in the Country to win CMS approval, and it has successfully generated $1.4 billion in new federal Medicaid revenue to date. We continue to support the state and the county through other additional work in connection with this initiative.