Mercer Short Duration Fixed Income Fund Class Y-3 · NASDAQ:MSDYX
Mercer Short Duration Fixed Income Fund Class Y-3 — Mercer Government — Investor Presentation (August 2023)
33 slides from Mercer Short Duration Fixed Income Fund Class Y-3's investor presentation, Aug 10, 2023
Slide 1: Medicaid Hot Topics
Medicaid Hot Topics —_ Za August 10, 2023
Slide 2: Speakers
Speakers Dianne Heffron Carmen Laudenschlager Judy Hatfield, CPA Principal Senior Consultant Member Mercer Government Milliman Myers & Stauffer David McMahon Principal Mercer Government
Slide 3: Agenda
Agenda Access Provisions of the May 3, 2023, Proposed Rule on Managed Care State Directed Payment Provisions of the May 3, 2023, Proposed Rule on Managed Care Quality Assessment and Performance Improvement Program, State Quality Strategies and External Quality Review Provisions of the May 3, 2
Slide 4: Proposed Rules Part I: Medicaid & CHIP Managed Care
welcome to brighter Proposed Rules Part I: Medicaid & CHIP Managed Care Proposals and Considerations August 10, 2023 A business of Marsh McLennan
Slide 5: Medicaid Managed Care Proposed Rule Overview
Medicaid Managed Care Proposed Rule Overview Access and Rate Directed Payments, In Quality Ratings for Transparency Lieu Of Services, and Plans Medical Loss Ratio External Quality Implementation Review and Timeline Quality Strategies 5
Slide 6: Managed Care NPRM: Access and Rate Transparency Proposals
Managed Care NPRM Access and Rate Transparency Proposals (§§438.66 and 438.68) Maximum Appointment Wait Annual Enrollee Times + Network Secret Shopper Surveys Network Exceptions Experience Surveys Adequacy Standards • 90% compliance with maximum • Mandatory surveys • Provider directory oversight, •
Slide 7: Access and Rate Transparency: Annual Network Certification
Managed Care NPRM Access and Rate Transparency Proposals: Annual Network Certification (§438.207) Annual Payment HCBS Annual Annual Network Remedy Analysis Payment Analysis Certification Plans • Benchmarks primary care, • Benchmarks homemaker, • Adds secret shopper and • Plans due to CMS within 90 O
Slide 8: State Directed Payments: The Good, the Bad, the Ugly
State Directed Payments: The Good, the Bad, the Ugly The Good (§§438.3 and 438.6) Streamlining VBP Out-of-Network Providers • No preprint if 100% of Medicare • Removes rules that prohibit states • Will be allowed, but not required (Comment: CMS should offer a from setting the amount or • Addresses a
Slide 9: State Directed Payments: The Bad
State Directed Payments: The Good, the Bad, the Ugly The Bad (§§ 438.6 and 438.7) Certification Reports More Rigorous Evaluation VBP Administration • Calculate SDP cost percentages • Written evaluation plan for CMS • No payment unless improvement • Two-year retro report prior approval, updated with
Slide 10: State Directed Payments: The Ugly
State Directed Payments: The Good, the Bad, the Ugly The Ugly (§ 438.6(c)) Average Commercial Rate SDP Limit? Financing & Redistribution • Total Payment Rate for facility IP, • CMS floated a proposal to develop a • Concern is with taxes and IGTs that facility OP, NF, or practitioner “State directed
Slide 11: Medical Loss Ratio Changes and Considerations
Medical Loss Ratio Changes and Considerations Carmen Laudenschlager, ASA, MAAA Consulting Actuary AUGUST 10, 2023
Slide 12: Proposed changes to medical loss ratio calculations
Proposed changes to medical loss ratio calculations Provider Incentive Arrangements Reporting of Overpayments Some arrangements would be Clarifies definition of “prompt” prohibited from inclusion in the reporting to State numerator Requires inclusion of “identified” State will need to modify
Slide 13: Provider incentive arrangements
Provider incentive arrangements MCO provider incentives must be established with a documented arrangement prior to the effective date of the measurement period and that arrangement must require the provider to meet clearly-defined, measurable, and well-documented improvement standards to receive the
Slide 14: Reporting of overpayments
Reporting of overpayments CMS intends to clarify “prompt” reporting of overpayments by the MCOs. The proposed rule seeks comment on whether “within 10 business days” is a reasonable definition. Expecting significant push back from all stakeholders regarding this proposal. MCOs to report “identified
Slide 15: State directed payments (SDP)
State directed payments (SDP) MLR calculation must include lines in the numerator and denominator for the SDP in the reports submitted to CMS. States may need to consider whether SDPs should be included in MLR remittance calculations. Including SDPs artificially inflates the loss ratio of the plans.
Slide 16: Other minor changes
Other minor changes Overhead and indirect costs that do not directly improve health care quality will be unallowable in healthcare quality improvement expenses in the numerator. Expense allocation methodologies must be described in detail related to how it was allocated to Medicaid, how expenses met
Slide 17: Medicaid "Hot Topics" (continued)
MEDICAID “HOT TOPICS” (continued) JUDY HATFIELD, CPA
Slide 18: May 3, 2023 Medicaid Managed Care Quality Rule (Proposed)
May 3, 2023 Medicaid Program; Medicaid and • Quality Assessment and CHIP Managed Care Performance Improvement Access, Finance and Program, State Quality Quality Rule (Proposed) Strategies and External Quality Review (42 CFR §§ 438.330, 438.340, 438.350, 438.354, 438.358, 438.360, 438.364, 457.1201,
Slide 19: Managed Care State Quality Strategies
Managed Care State Quality Strategies • Increase opportunity interested • Quality strategy must be submitted parties have to provide input. to CMS, prior to finalizing a revised • Require states make their quality or renewed strategy, at a minimum strategy available for public every 3 years, followi
Slide 20: External Quality Review
External Quality Review 1) Removal of primary care case 4) Removal of requirement that private, management (PCCM) entities from national accreditation organizations mandatory external quality review. (PAOs) must apply for authority from CMS in order for States to rely on PAO 2) Defined 12-month EQR
Slide 21: Medicaid & CHIP Managed Care Quality Rating System
Medicaid & CHIP Managed Care Quality Rating System • Envisioned as a one-stop shop where beneficiaries can access information regarding: 1) Medicaid and CHIP eligibility and managed care. 2) Compare health plans based on quality, performance, and other key factors to beneficiary decision making. • C
Slide 22: Quality Rating System Timeline
Medicaid & CHIP Managed Care Quality Rating System • Timeline 1) CMS proposes implementation requirement no later than the end of the fourth year following the effective date of the final rule. 2) Annual updates would be required after the initial implementation. 3) States would be given at least tw
Slide 23: Quality Rating System
Quality Rating System • Measures & • Knowledge of State Website Display • Annual State Agency Priorities and Data Collection Reporting Challenges • 18 proposed mandatory • Information must be • Supporting documentation measures. Many of clear and for quality measures. which are already being underst
Slide 24: February 24, 2023 Medicaid DSH Third Party Payer Rule (Proposed)
February 24, 2023 Medicaid • Purpose of the Proposed Program; Disproportionate Rule: Share Hospital Third Party 1) Update the regulatory Payer Rule (Proposed) requirements of the disproportionate share hospital (DSH) program in response to the Consolidated Appropriations Act (CAA), 2021 2) Further i
Slide 25: Hospital-Specific Disproportionate Share Payment Limit
Hospital-Specific Disproportionate Share Payment Limit (42 CFR § 447.295) • Effective October 1, 2021 CAA revised methodology for calculating the Medicaid shortfall component of the DSH payment limit 1) Only Medicaid costs and payments for services provided to beneficiaries for whom Medicaid is the
Slide 26: 97th Percentile Exception
97th Percentile Exception • Qualifying • Knowledge of State Data Sources • Notification Agency Priorities and Hospitals Challenges • Applies to hospitals • Healthcare Cost • CMS to publish a at or above 97th Report Information list annually prior percentile of all System (HCRIS), to October 1 each h
Slide 27: Reporting Requirements (42 CFR § 447.299)
Reporting Requirements (42 CFR § 447.299) • Calculating Medicaid Shortfall 1) Revise reporting in DSH audit to incorporate CAA requirements allowing inclusion of only Medicaid primary inpatient and outpatient hospital services. 2) Applicable to SPRY beginning on or after October 1, 2021. • Reporting
Slide 28: Questions Regarding New Data Element
Questions Regarding New Data Element • Is it CMS’ intention to incorporate the estimated impacts into DSH overpayment calculations? • If so, how will caveats where a range is reported for the impact be included? • Many of the auditors’ disclosures require legal interpretation or further guidance to
Slide 29: Discovery of DSH Overpayment and Its Significance
Discovery of DSH Overpayment and Its Significance (42 CFR § 433.136) • Proposed rule specifies overpayments identified through the DSH independent audit will be considered discovered the earliest of: 1) The date the State submits the DSH certified audit report to CMS, or any of the following: 2) The
Slide 30: Reporting DSH Overpayments
Reporting DSH Overpayments (CFR 42 § 447.299) • Codifies existing policy on overpayments identified through the annual independent DSH audit. 1) Federal share must be returned to the Federal Government, or 2) Redistributed by the State to other qualifying hospitals if redistribution is allowed under
Slide 31: Limitations on Aggregate Payments for DSHs
Limitations on Aggregate Payments for DSHs Beginning October 1, 1992 (CFR § 447.297) • Proposed rule eliminates requirement to publish annual DSH allotments in the Federal Register. • Alternatively the Secretary will post preliminary and final national expenditure targets and state DSH allotments in
Slide 32: DSH Health Reform Reduction Methodology
DSH Health Reform Reduction Methodology(42 CFR § 447.294) • Proposed rule eliminates provision that DSH allotments included in budget neutrality calculations for coverage expansion under section 1115 as of July 31, 2009 be excluded in the DSH allotment reduction calculation. 1) All section 1115 waiv
Slide 33: Questions
David McMahon Dianne Heffron david. mcmahon@mercer.gov dianne.heffron@mercer.com Carmen Laudenschlager Judy Hatfield carmen.laudenschlager@milliman.com hatfield'
Mercer Government — Investor Presentation (August 2023) on 6ix