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Agenda Item Number: <br /> <br />ORANGE COUNTY BOARD OF HEALTH <br />AGENDA ITEM SUMMARY <br /> <br />Meeting Date: August 23, 2017 <br /> <br />Agenda Item Subject: 2013 Medicaid Cost Settlement Program <br />Reimbursement <br /> <br />Attachment(s): LHD Desk Review NPR Letter <br /> <br />Staff or Board Member Reporting: Rebecca Crawford <br /> <br />Purpose: _ _Action <br /> _X_ Information only <br /> ___ Information with possible action <br /> <br /> <br /> <br />Summary Information: <br /> <br />The Health Department received official notification of a Notice of Program <br />Reimbursement on August 3rd from the NC DHHS Department of Medical Assistance <br />(DMA). This notice referenced the 2013 Medicaid Cost Settlement report (period ending <br />June 30, 2013.) As you may remember, the Medicaid cost settlement process has been <br />contested since DMA required a new cost report methodology beginning in State Fiscal <br />Year (SFY) 2011. The main point of contention is the calculation of the Medicaid <br />population statistic. After a long debate, the primary issue of the Medicaid population <br />statistic has been clarified by a recent ruling in a lawsuit between DMA and Cabarrus <br />County. DMA prevailed and will retroactively settle all Local Health Department (LHD) <br />cost settlements beginning with SFY 2013. SFY 2013 will be the only year where an <br />overpayment (by DMA) is applied since DMA started using the new statistic prior to <br />payments made in SFY 2014. <br /> <br />Orange County is in a payback situation and owes a total of $200,524 to DMA. We <br />received funds in 2015 from the state legislature to offset the loss incurred by the SFY <br />2013 overpayment in the amount of $219,043.90, which when combined with the <br />payback amount referenced above, leaves us with a net gain of $18,519.90. <br /> <br />DMA has offered LHD’s the option to either accept the payback amount and remit <br />payment or appeal the proposed payback by “scrubbing” our data according to the <br />agreed upon process listed in the Cabarrus County court ruling. We’ve learned this <br />made a significant reduction in the payback amount for Cabarrus County. Our staff have <br />determined it is in our best interest to work with the NC Public Health Association (who <br />historically has prepared our annual cost settlement report) to “scrub” our 2013 data.