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James C. Frizzera
Jim Frizzera is the Vice President of Government Policy & Reimbursement with Gjerset & Lorenz, LLP, where he focuses on assisting institutional healthcare providers with their operations and participation in government reimbursement programs.
Mr. Frizzera has significant experience in the fields of Medicaid reimbursement and financing, including Medicaid upper payment limits (UPL), the Medicaid disproportionate share hospital (DSH) program, healthcare-related taxes, provider-related donations, intergovernmental transfers (IGTs), and certified public expenditures (CPEs).
Mr. Frizzera has experience working with hospital systems, hospital associations, and State agencies to develop Medicaid revenue streams necessary to ensure access to care for Medicaid beneficiaries and other low-income individuals. His experience includes:
- Developing healthcare-related tax programs at both the State and local government levels.
- Creating supplemental Medicaid payment streams financed by healthcare-related taxes.
- Providing technical assistance and compliance reviews regarding the Medicaid supplemental payment program.
- Negotiating Section 1115 Medicaid Waiver program terms with the Centers for Medicare and Medicaid Services (CMS).
- Establishing uncompensated care pools under the Section 1115 Medicaid Waiver programs.
- Designing compliant Medicaid managed care rate enhancements to support provider services.
- Advising clients regarding transactional arrangements to structure compliant public/private collaborations.
- Analyzing the hospital-specific impact of proposals to establish healthcare-related tax programs.
- Identifying incremental revenue opportunities available under existing federal statutory and regulatory requirements and creating new payment streams financed by IGTs.
- Assessing the impact of changes to Medicaid payment policies at both the federal and State levels on existing supplemental payment programs.
- Advising clients regarding the impact of States expanding their Medicaid managed care programs.
Prior to joining Gjerset & Lorenz, LLP, Mr. Frizzera worked for CMS for twenty years and for the private consulting firm Health Management Associates, Inc. for five years.
At CMS, Mr. Frizzera was the Director of the Financial Management Group (FMG). As the Director of FMG, Mr. Frizzera was responsible to the overall financial management of a $300 billion Medicaid program. Specifically, Mr. Frizzera directed the national oversight of federal Medicaid grant outlays, State budget and expenditure reporting, federal Medicaid reimbursement policy, and federal Medicaid financing policy. Mr. Frizzera also worked with elected representatives, State officials, local governments, and healthcare providers on the resolution of critical Medicaid reimbursement and financing issues.
During his tenure at CMS, Mr. Frizzera played an integral role in the development of several federal regulations governing Medicaid reimbursement and financing policy designed to promote the fiscal integrity of the Medicaid program. Mr. Frizzera also played a significant role in the development of the National Institutional Reimbursement Team and served as the Team Leader from its inception in July of 2002 through December of 2005. Mr. Frizzera was promoted to the Director of the Division of Reimbursement of Financing in January 2006.
Mr. Frizzera received numerous awards during his tenure at CMS, including four CMS Administrator’s Achievement Awards (1995, 1998, 2004, and 2005), the Department of Health and Human Services Secretary’s Award for Distinguished Service in 2003, and an appointment to Senior Executive Service in October 2008.
Mr. Frizzera also performed several speaking engagements at national conferences regarding Medicaid reimbursement and State financing.