Kentuckys Medicaid Overview Prepared for the LRC Medicaid Oversight and Advisory Committee Wednesday June 17 2015 Medicaid Overview Federalstate partnership designed to provide healthcare to qualifying individuals ID: 440257
Download Presentation The PPT/PDF document "Cabinet for Health and Family Services" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Cabinet for Health and Family Services
Kentucky’s Medicaid Overview
Prepared for the LRC Medicaid Oversight and Advisory Committee
Wednesday, June 17, 2015Slide2
Medicaid Overview
Federal/state partnership designed to provide healthcare to qualifying individuals
Provides healthcare to over 1 million Kentuckians
Continues to evolve to meet the healthcare needs of population servedSlide3
CY 2014 State Fund Expenditures
Total: $1.99 billion
* Excludes programmatic costs not tied directly to individual.Slide4
Medicaid Enrollment as of 12/31/2014
Total: 1,268,481Slide5
Medicaid enrollment since 2012Slide6
In 2014 Medicaid paid for…
99,000 breast cancer screenings…
93,000 cervical cancer screenings…
59,000 colorectal cancer screenings…
394,000 annual wellness exams…603,000 preventive dental services…31,000 newborn deliveries…734,000 immunizations and vaccinations…Nursing home care for 26,948 patients…Hospice care for 1,871 patients…40,000 days of NICU care for 2,700 newborns
…45,530,854 unique claims to Medicaid providers… Slide7
In 2014 Medicaid provided care for…
131,000 Kentuckians with
COPD…
142,000 Kentuckians with
depression…110,000 Kentuckians with arthritis…17,000 Kentuckians recovering from a stroke…4,900 Kentuckians with breast cancer…
3,000 Kentuckians with colorectal cancer…1,600 Kentuckians with prostate cancer…
13,000
Kentuckians sufferings from Alzheimer’s or
dementia…Slide8
All Medicaid payments to providers
Payments made in CY
2014
Hospital
$ 2,132,129,189
Pharmacy
$ 934,986,349
Nursing
Facility
$ 930,701,639
Waiver
Providers
$ 719,223,142
Primary
Care
$ 811,919,281
Other
$ 630,124,940
Behavioral
health providers $ 259,748,549 ICF-IDD facilities $ 139,944,052 Dentists $ 132,763,677 Total $ 6,691,540,817
* Includes claim, DSH, and supplemental paymentsSlide9
Update on Medicaid Expansion
To see the update to the Medicaid Whitepaper regarding the
Medicaid
expansion in Kentucky after one year of implementation,
go to:
http://governor.ky.gov/Pages/default.aspxSlide10
Preventive services for Medicaid Expansion
1
More Screenings = Better Health
17,000 screened for colorectal cancer
26,000 received mammograms
34,000 screened for cervical cancer
46,000 screened for diabetes
13,000 received treatment for substance abuse
80,000 had preventive dental visits
1 – Calendar Year 2014Slide11
Medicaid Expansion payments
to providers
Payments from 1/2014 through 6/10/2015
Hospital
$
918,685,939
Pharmacy
$
487,054,134
Physician,
FQHC,
Primary Care,
etc.
$
416,767,441 Other $ 119,947,655 Dental $ 44,605,246 Behavioral health $ 29,808,286 Medical equipment $ 24,810,524 Total $ 2,041,679,225 Slide12
Report findings and estimates
Enrollees
Uncompensated care
Job creation
Medicaid added 375,175 newly eligible enrollees by the end of calendar year (CY) 2014; the expansion population represents 8.5 percent of the total state population
Compared with all other states, Kentucky experienced the second largest decrease in its uninsured rate; the uninsured rate dropped from 20.4 percent in 2013 to 11.9 percent in mid-2014
The net difference between expanding and not expanding is expected to be a positive $
919.1 million
from
SFY2014 to
SFY2021
Uninsured rate
Avoided costs
Uncompensated care costs for Kentucky hospitals were $1.15 billion lower during the first three quarters of CY2014 compared with the same period in CY2013
Medicaid expansion created more than 12,000 jobs in SFY2014 and is estimated to add more than 40,000 jobs by the end of SFY2021
Cumulative impact on state economy
Between SFY2014 and SFY2021, Medicaid expansion is estimated to have a net positive cumulative impact of $30.1 billion on Kentucky’s economy Slide13
Uninsured Rates by State, 2014Slide14
Uninsured population per capitaSlide15
An explanation of DSH reductions
DSH payments are not going away, they are only being reduced. The reductions are scheduled to begin in 2018.
The 2018 reduction is approximately 12%. By 2024 the reduction will be 49% of current expenditures.
As a matter of comparison, hospitals have been paid $918 million to date due to Medicaid expansion. Cumulative DSH reductions from 2018 – 2024 are expected to be $427 million.Slide16
Comparison of Expansion and DSH Payments in 2014
16Slide17
Billed charges for uncompensated careSlide18
Managed Care Overview
Implemented November 1, 2011
5 MCOs Serving Medicaid Members
Anthem
Coventry/AetnaHumanaPassportWellCareMust provide medically necessary services as outlined in Medicaid regulations with approvals from CMS (federal)
Flexibility regarding prior authorizations, rates and structure of contractsFlexibility to create value-added servicesDoes not serve Medicaid members in long term care facilities or 1915(c) waiversSlide19
Medicaid MCO Oversight
Contract with Department of Insurance to investigate timely payment complaints
Rector and Associates – Market Conduct Survey and Financial Review
External Quality Review Organization (EQRO)
Island Peer Review Organization (IPRO)
Performance Improvement Plans (PIP)EQRO Studies
Website for Program Quality and Outcomes
http
://
chfs.ky.gov/dms/pqomcoqbreports.htm
19Slide20
Monthly Contractual Compliance Monitoring
EXAMPLE……not inclusive
Anthem
Coventry
Humana
Passport
WellCare
Prompt Payment of Claims
90% paid in 30 Days
99.94%
99.91%
94.63%
98.62%
99.60%
99% paid in 90 Days
100%
100%
98.73%
100%
99.85%
Member Calls
5% or fewer abandoned calls
0.48%
3.46%
0.95%
0.99%
1.43%
Average time to answer (30 second limit
)
8
34
20 25 8 Provider Calls5% or fewer abandoned calls0.69%1.46%0.64%1.26%2.08%Average time to answer (30 second limit)19 28 19 25 18 Behavioral Calls
7% or fewer abandoned calls0.77%
0.12%2.35%0.26%3.19%Average time to answer (30 second limit)6 13 13 8 9 99% answered by 4th ring100%100%100%100%100%Calls receivng busy signal0%0%0%0%0%80% answered within 30 seconds96.00%99.50%85.89%91.00%91.00%Average call length under 10 minutes8 4351
All Calls
5% or fewer abandoned calls0.58%2.68%0.86%1.08%1.64%20Slide21
Medicaid MCO Oversight
Monthly Operational Meetings
Reporting
Monthly
QuarterlyAnnual
Actions Taken in 2014 and 201520 Inquiry Letters
44
Letters of Concern
8
4 Corrective Action Plans (CAP)
21Slide22
Medicaid MCO Oversight
Encounter Claims Submission
Penalties
Withholds
TOTAL ALL MCOS
December
January
February
Total
Capitation
$563,211,146.25
$574,732,213.45
$600,455,225.03
$1,738,398,584.73
-
Penalties Assessed
$94,500.00
$106,000.00
$81,500.00
$282,000.00 - Withhold Assessed$6,160,552.37 $16,045,715.30 $6,556,661.72 $28,762,929.39 Total Withhold released$6,160,552.37 $16,045,715.30 $6,556,661.72
$28,762,929.39
Total Penalty/Withhold remaining
$94,500.00
$106,000.00
$81,500.00
$282,000.00
Total Percentage of cap
1.11%2.79%
1.11%
1.67%Slide23
Waivers: Defined
Waivers provide states with flexibility to deliver and pay for health care services in Medicaid
There are 4 types of waivers:
Section 1115 Research and Demonstration Projects
: States
can apply for program flexibility to test new or existing approaches to financing and delivering Medicaid and
CHIP.
Section 1915(b) Managed Care Waivers
: States
can apply for waivers to provide services through managed care delivery systems or otherwise limit people's choice of
providers.
Section 1915(c) Home and Community-Based Service Waivers
: States
can apply for waivers to provide long-term care services in home and community settings rather than institutional
settings.
Concurrent Section 1915(b) and 1915 (c) Waivers
: States
can apply to simultaneously implement two types of waivers to provide a continuum of services to the elderly and people with disabilities, as long as all Federal requirements for both programs are met.Slide24
Kentucky’s Waiver
Programs
Kentucky has six
waiver programs which include:
Home
and Community Based (HCBW)
Supports
for Community Living (SCL)
Michelle
P. (MPW)
Model
Waiver II (MWII)
Acquired
Brain Injury – Acute Care (ABI)
Acquired
Brain Injury/Long Term Care (ABI/LTC)Slide25
Case Management
Community Access
Community Guide
Community Transition
Consultative Clinical and Therapeutic Service
Day Training
Occupational Therapy
Person Centered Coach
Personal Assistance
Physical Therapy
Residential Support Services
Respite
Specialized Medical
E
quipment
Speech Therapy
Supported Employment
Community
Access
Community GuideDay TrainingEnvironmental AccessibilityFinancial ManagementGoods and ServicesNatural Supports Training
Personal Assistance
Respite
Shared Living
Supported Employment
Transportation
Vehicle Adaptation
Waiver ServicesSlide26
Kentucky’s Waiver ProgramsSlide27
2008
2014
Cost of Waiver Programs Over Time
Enrollees
2008
2014
ABI
170
200
ABI-LTC
-
234
HCB
14,061
11,221
Model II
68
70
Michelle P
-10,250SCL3,1574,469Slide28
HCBS Federal Final Rules Overview
The Centers for Medicare & Medicaid Services (CMS) implemented new regulations for Medicaid’s 1915(c) Home and Community-Based Services (HCBS) waivers on March 17, 2014. Key elements of the rule include:
PERSON-CENTERED SERVICE PLAN
PROVIDER SETTINGS
PERSON-CENTERED PLANNING
CONFLICT-FREE CASE
MANAGEMENT
Providers of
HCBS waiver services
for the individual must not provide case management
for that same individual,
except
if they are the only willing and qualified provider within 30 miles of the participant’s residence
The service plan must reflect
the needs identified through an assessment, as well as the individual's strengths, preferences, identified goals, and desired outcomes
Individual leads the process to the maximum extent possible and is provided information and support to make informed choices regarding his/her services, as well as
choice of providers
The setting is integrated in and supports full access of individuals receiving HCBS to the greater community, giving the individual initiative and independence in
making
life choicesSlide29
Cabinet for Health and Family Services
Questions?
Thank you