Nursing Home Transition to Managed Care. Nursing Home Transition Workgroup Meeting July 23, 2014

Transcription

1 Nursing Home Transition to Managed Care Nursing Home Transition Workgroup Meeting July 23, 2014

2 Proposed Nursing Home Transition Plan For both duals and non duals: Persons permanently placed in a nursing home before the transition date (see Transition Timeline slide) will remain in FFS (fee for service) for the duration of their stay. Persons not permanently placed before the transition date will: If already in a managed care plan, they will remain in that plan upon permanent placement. If in FFS as of the transition date, they will remain in FFS until eligibility for permanent placement is determined then they will be mandated into managed care (MLTC for duals, MMC for non duals). If new to Medicaid, they will be required to enroll in a plan once Medicaid eligibility has been established.

3 FIDA Roll Out October 2014 Adults in the FIDA region may voluntarily enroll in FIDA. January 2015 Adults in the FIDA region will be passively enrolled in FIDA but may opt out back to MLTC (or back to FFS if they were enrolled in FFS as the time of passive enrollment into FIDA).

4 Nursing Home Transition Timeline Begin Date Affected Region Adults / Kids Jan 2014 FIDA Region Adults Apr 2014 Rest of State Adults Oct 2014 (FIDA voluntary roll-out) Jan 2015 (FIDA passive enrollment) FIDA Region FIDA Region Adults Adults Apr 2015 Entire State Kids FIDA - Fully Integrated Duals Advantage Plan FIDA Region - NYC, Westchester, Nassau, Suffolk Adults - Age 21 or older Kids - Under 21 years of age

5 Estimated Adult Nursing Home Population Transitioning to Managed Care (or Remaining in MC upon Permanent Placement) During First 12 Months of Transition (duals and non duals) Statewide FIDA Region Rest of State Total Nursing Home Population (inc. "New") 82,601 51,735 30,866 Total "New" Population Moving Into Managed Care (during first 12 months of transition) Total Nursing Home Population Remaining Outside Managed Care (after first 12 months) 20,576 12,364 8,212 62,025 39,371 22,654 Percent Transitioning in First 12 Months 25% 24% 27% Note 1: "New" is defined as receiving permanent placement status on or after January 1, 2014 in the FIDA region or April 1, 2014 in the Rest of the State. Note 2: This data is an estimate for the first 12 months of the adult transition and is based on Nov 1, 2010 to Oct 31, 2011 historical data. 18 to 20 year olds are included in this data, but should not be. Additionally, the figures for the "New" population are estimated to be about 10% low due to the manner in which the data was run (due to time constraints).

6 Estimated Adult Nursing Home Population Transitioning to Managed Care (or Remaining in MC upon Permanent Placement) During First 12 Months of Transition (duals vs. non duals) Statewide Duals Non-Duals Total Nursing Home Population (inc. "New") 82,601 74,849 7,752 Total "New" Population Moving Into Managed Care (during first 12 months of transition) Total Nursing Home Population Remaining Outside Managed Care (after first 12 months) 20,576 18,894 1,682 62,025 55,955 6,070 Percent Transitioning in First 12 Months 25% 25% 22% Note 1: "New" is defined as receiving permanent placement status on or after January 1, 2014 in the FIDA region or April 1, 2014 in the Rest of the State. Note 2: This data is an estimate for the first 12 months of the adult transition and is based on Nov 1, 2010 to Oct 31, 2011 historical data. 18 to 20 year olds are included in this data, but should not be. Additionally, the figures for the "New" population are estimated to be about 10% low due to the manner in which the data was run (due to time constraints).

7 Estimated Spend for Adult NH Population Transitioning to Managed Care (or Remaining in MC upon Permanent Placement) During First 12 Months of Transition (duals and non duals) Statewide FIDA Region Rest of State Total Spend on Population $ 5,969,605,431 $ 4,378,668,339 $ 1,590,937,092 Nursing Home Spend on Population $ 5,259,123,850 $ 3,780,194,064 $ 1,478,929,786 Total Spend on "New" Population Moving Into Managed Care Nursing Home Spend on "New" Population Moving Into Managed Care Total Spend on Population Remaining Outside Managed Care Nursing Home Spend on Population Remaining Outside Managed Care $ 953,293,967 $ 707,659,158 $ 245,634,809 $ 622,230,207 $ 426,746,274 $ 195,483,933 $ 5,016,311,464 $ 3,671,009,181 $ 1,345,302,283 $ 4,636,893,643 $ 3,353,447,790 $ 1,283,445,853 "New" Nursing Home Spend as Percent of Total 12% 11% 13% Note: This payment data is not annualized and should not be. It is the actual estimated impact for year one of the transition and assumes people move into (or stay in) managed care throughout the year and not all at once.

8 Estimated Spend for Adult NH Population Transitioning to Managed Care (or Remaining in MC upon Permanent Placement) During First 12 Months of Transition (duals vs. non duals) Statewide Duals Non-Duals Total Spend on Population $ 5,969,605,431 $ 4,949,339,369 $ 1,020,266,061 Nursing Home Spend on Population $ 5,259,123,850 $ 4,545,122,715 $ 714,001,135 Total Spend on "New" Population Moving Into Managed Care Nursing Home Spend on "New" Population Moving Into Managed Care Total Spend on Population Remaining Outside Managed Care Nursing Home Spend on Population Remaining Outside Managed Care $ 953,293,967 $ 746,734,090 $ 206,559,877 $ 622,230,207 $ 538,186,315 $ 84,043,892 $ 5,016,311,464 $ 4,202,605,279 $ 813,706,184 $ 4,636,893,643 $ 4,006,936,400 $ 629,957,243 "New" Nursing Home Spend as Percent of Total 12% 12% 12% Note: This payment data is not annualized and should not be. It is the actual estimated impact for year one of the transition and assumes people move into (or stay in) managed care throughout the year and not all at once.