GMH Successfully Secures $3.8 Million in TEFRA Reimbursement

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The reimbursement includes $1.5 million for 2007 and $2.3 million for 2008.

Guam – The Guam Memorial Hospital has just been approved for a federal reimbursement of $3.8 million in Medicare fees.

 

GMH Administrator Ted Lewis tells PNC that this reimbursement is a part of a TEFRA readjustment that the hospital has been aggressively seeking for years. TEFRA is the manner by which the hospital is reimbursed for Medicare and Medicaid fees.

For years, decades even, there’s been a disparity in the reimbursement rates for the hospital. Lewis says the $3.8 million includes $1.5 million for 2007 and $2.3 million for 2008.

CFO Benita Manglona has previously told GMH Board members that they plan to seek a readjustment for tax years up to 2013. If they are successful, GMH will be able to get a retroactive reimbursement that amounts to close to $18 million.

Lewis says although GMH has only gotten approval for two years so far, this is a good sign for the hospital going forward.

 

“It recognizes that they see that, first of all, the people in Guam and the hospital here is a very valuable service and I think there’s a greater awareness that’s been occurring in Washington of the uniqueness of Guam and the importance it plays to this part of the world,” says Lewis.

Lewis says they are expecting to receive the funds within 30 days.

You can read the press release below:

Centers for Medicare & Medicaid Service officials have approved Tax Equity and Fiscal Responsibility Act adjustments for fiscal years 2007 and 2008.

Governor Eddie Baza Calvo, who was joined by Guam Memorial Hospital’s Benita Manglona and Dr. Larry Lizama, met with CMS officials in Washington D.C. again this week to discuss the disparity of reimbursement levels for Guam when compared with the U.S.

 

“This is a great win for Guam,” said Governor Calvo. “Not only were we successful in increasing reimbursement rates for these two years, this helps pave the road for additional years moving into the future.”

 

The total adjustment for FY2007 is $1.5 million. The adjustment for FY 2008 is $2.3 million

 

CMS officials told Governor Calvo and GMH administration that each year a hospital can request a one-time adjustment to the automatic reimbursements. This request is based on a complex formula provided by CMS, which is intended to provide some relief when the standard reimbursement process fails to capture temporary fluctuations in costs. CMS recommended that GMHA utilize the adjustment requests to obtain immediate relief while it awaited the results of the longer rebasing process. In accordance with that advice, GMHA submitted the adjustment requests.

 

“Our collective efforts and persistence are paying off,” said Manglona, GMH chief financial officer. “We still have a lot to do so this is only the beginning.”

 

GMH Administrator Ted Lewis said this was “good news indeed.” 

 

“This is a very fine day for GMH patients and all of Guam. We are very pleased to see our federal healthcare funding partners finally responding to the funding disparity that GMH leadership has been advocating in support of for many years,” Lewis stated. 

 

Governor Calvo and the GMH Administrator thanked Manglona, Medical Director, Dr. Larry Lizama, the GMH fiscal staff and partners at the Department of Public Health, and the Governor’s fiscal team.