Ohio's Medicaid Health Plan Facility Based Long Term Care by Jeronohnson

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									Ohio’s Medicaid Health Plan

 Facility Based Long Term
        Care Services
        Presented to the
     House Select Committee
              On
        Medicaid Reform

         October 10, 2002
                            Ohio Health Plans
   JFS MEDICAID / SCHIP* HEALTH PLAN
        2 Benefit Plans through 4 delivery systems




          Primary / Acute Care                            Long-term
                                                            Care

   Fee-for-Service          Managed            Community             Facility-
         (FFS)               Care                                     Based




* SCHIP stands for the State Children’s Health Insurance Program


                                                                   Ohio Health Plans
             Purpose

• Who do we serve?

• What do we do?

• What do we spend?

• Where are we going?
                        Ohio Health Plans
        Program Objectives
• Ensure access to high quality, efficient
  and accountable long term care facility
  services for aged and disabled
  Medicaid consumers through:
  – Contracting with long term care facilities
  – Setting rates
  – Managing quality oversight activities
  – Managing the estate recovery program
  – Administering the franchise fee program

                                     Ohio Health Plans
          Who We Serve
         An Aging Population

• The fastest growing segment of the
  population is aged 85 and over
• 3.4 million people aged 85 and over in
  1994
• 7 million people aged 85 and over by
  2020
• 19-27 million people aged 85 and over
  by 2050
                               Ohio Health Plans
  The Ohio Population Between
        1995 and 2000

• Total population grew by 2.1%
• Population aged 65 and over grew by
  10%
• Population 65-74 decreased by 5.6%
• Population aged 75-84 grew by 11%
• Population aged 85 and over grew by
  17%
                             Ohio Health Plans
     Long Term Care Facility
           Residents
• Approximately 80,000 Ohioans receive
  services in nursing facilities.
• Approximately 6,000 Ohioans receive
  services in intermediate care facilities
  for the mentally retarded.
• Approximately 70% of nursing facility
  residents and 100% of intermediate
  care facility residents are Medicaid
  consumers.
                                 Ohio Health Plans
Nursing Facility Resident
        Gender


      Male
      28%
                       Female
                       Male
             Female
              72%




                      Ohio Health Plans
Nursing Facility Resident Age
     Under 40    41-50
       1%         3%
                         51-60
                          5%               Under 40
    Over 90     61-70                      41-50
     23%         8%                        51-60
                                           61-70
                                           71-80
                 71-80                     81-90
                  21%                      Over 90
     81-90
      39%




                                 Ohio Health Plans
Nursing Facility Length of Stay

• 50% of consumers admitted to a
  nursing home leave within 3 months
• 63% of consumers admitted to a
  nursing home leave within 6 months.
• The average length of stay for the
  remaining consumers admitted to a
  nursing home is approximately 30
  months.
                              Ohio Health Plans
           What We Do
     Contract With Long Term
          Care Facilities
• 936 nursing facilities with approximately
  91,000 beds
• 393 intermediate care facilities for the
  mentally retarded with approximately
  6000 beds (excludes developmental
  centers)


                                Ohio Health Plans
  Establish Rates for Long Term
          Care Facilities

• Long term care facility rates are calculated for
  a fiscal year using the cost report for the
  previous calendar year
• For example, the calendar year 2001 cost
  report was used to calculate the state fiscal
  year 2003 rates.
• Based on 4 cost centers

                                      Ohio Health Plans
          Direct Care Costs

• Includes direct care wages, benefits and
  payroll taxes
• Reimbursable purchased nursing expenses
  are limited for nursing facilities
• Adjusted for case mix quarterly
  – MDS 2.0 for Nursing Facilities
  – Individual Assessment Form (IAF) for Intermediate
    Care Facilities for the Mentally Retarded


                                       Ohio Health Plans
   Indirect Care Cost Center

• Includes administrative expenses, food
  and dietary costs, incontinence
  supplies, and repairs and maintenance
• An imputed occupancy factor may be
  applied




                               Ohio Health Plans
           Capital Costs

• Includes interest, depreciation ,
  amortization, and lease expense
• For profit facility rates may include
  reimbursement for “Return on Equity”
• An imputed occupancy factor may be
  applied


                               Ohio Health Plans
     Other Protected Costs
• Includes taxes, utilities, and medical
  supplies
• Only cost center not subject to a ceiling




                                 Ohio Health Plans
Percent of Filed Costs

                      Capital
Other Protected        10%
      6%


                                Direct Care
                                   50%

      Indirect Care
           34%




                                          Ohio Health Plans
 Nursing Facility Stabilization
     Fund Components
• Created in SFY 2002-2003 biennial
  budget with increase in franchise fee
• SB 261 extended through SFY 2005
• Funds a rate add-on of $2.25 per day
  for quality of care
• Funds also may be used for general NF
  Medicaid reimbursement

                              Ohio Health Plans
           Nursing Facility Rates

                                                                                            $152.07
$160.00                                                                           $143.92
                                                                        $132.55
$140.00
                                                              $121.76
                                                  $112.76
$120.00
                                        $108.96
                              $101.77
                     $97.51
           $91.18
$100.00


 $80.00
                                                                                                          Average Per Diem

 $60.00


 $40.00


 $20.00


  $0.00
          1995      1996      1997   1998         1999      2000        2001      2002   2003
                                          State Fiscal Year




                                                                                                Ohio Health Plans
                        ICF-MR Rates

$250.00
                                                                                          $216.51
                                                                                $208.90
                                                                      $201.33
                                                            $184.26
$200.00                           $175.23 $180.99
          $159.48 $165.21 $170.97
                                                                                                           1995
                                                                                                           1996
$150.00                                                                                                    1997
                                                                                                           1998
                                                                                                           1999
$100.00                                                                                                    2000
                                                                                                           2001
                                                                                                           2002
 $50.00                                                                                                    2003




  $0.00
          1995   1996    1997    1998        1999           2000      2001      2002      2003
                                        State Fiscal Year




                                                                                       Ohio Health Plans
     Services Not Included in the
    Long Term Care Facility Rate
•   Pharmaceuticals, Lab & X-rays
•   Specialized Equipment and Transportation
•   Dental, Vision and Podiatry Services
•   Prostheses and Orthoses
•   Oxygen and Oxygen Concentrators
•   Physician Services
•   Physical, Occupational and Speech Therapy
    (for Nursing Facilities)

                                   Ohio Health Plans
  Manage Quality Oversight
• Inter-agency agreement with the Ohio
  Department of Health
  – Licensure and certification surveys
  – Sharing MDS and licensure data
• Exception reviews of MDS submissions




                                   Ohio Health Plans
 Manage the Estate Recovery
          Program
• Medicaid consumers aged 55 and over
• Limited to the probate estate and the total of
  correctly paid Medicaid claims
• Approximately $51 million collected since
  state fiscal year 1995
• $11.2 million collected in State Fiscal Year
  2002
• Attorney General administers collection
  activities

                                     Ohio Health Plans
Administer the Franchise Fee
          Program

• Calculated annually based on number of
  licensed and registered long term care beds
  that existed on May first of each year
• The Nursing Facility Franchise Fee funds
  PASSPORT ($1.00) and the Nursing Facility
  Stabilization Fund ($3.30)
• The ICF-MR Franchise Fee funds community
  options in the MRDD delivery system

                                  Ohio Health Plans
Nursing Facility Utilization

100.00%
 90.00%
 80.00%
 70.00%
 60.00%
 50.00%                                 Occupancy
 40.00%
 30.00%                                 Medicaid
 20.00%                                 Utilization
 10.00%
  0.00%
       1991 1993 1995 1997 1999
             Calendar Year
                                  Ohio Health Plans
         What We Spend

• Approximately $6 billion all funds over
  the 2002-2003 biennium
• 33% of the Medicaid budget on nursing
  facilities
• 6% of the Medicaid budget on
  intermediate care facilities for the
  mentally retarded

                               Ohio Health Plans
             Spending by Provider
                  Category
                        Near Final for SFY 2001
! Nursing Facilities: $2.46
  billion                                                 Waiver 2.1%
                                                     Physicians

! ICFs/MR: $417 million                        HMO 6.2%
                                                       6.1%

                                                                                        Nursing

! Hospitals: $1.6 billion                                                              Facilities
                                                                                         33.1%


! Prescribed Drugs: $1.2 billion        Other 9.9%


! Physicians: $470 million
! HMO: $597 million
! Waiver: $162 million                      Prescribed
                                           Drugs 15.3%
                                                                                       ICFs/MR
                                                                                         5.8%

! Other: $844 million
                                                                           Hospitals
                                                                            21.5%
 Note: “Other” includes dental,
 hospice, home health, therapies,
 Durable medical equipment, buy-in, &
 600-426 used for CHIP II.                                              Ohio Health Plans
      Long Term Care Facility
       Spending Over Time
$3,500,000,000
$3,000,000,000
$2,500,000,000
$2,000,000,000           Total
                         Nursing Facility
$1,500,000,000
                         ICF-MR
$1,000,000,000
 $500,000,000
           $0
               95
               96
               97
               98
               99
               00
               01
               02
            19
            19
            19
            19
            19
            20
            20
            20




                        Ohio Health Plans
      Where Are We Going?
• Slow the growth of Medicaid nursing home
  expenditures while maintaining a viable,
  efficient nursing facility industry in Ohio.
• Create fiscal incentives related to patient
  care.
• Promote “right-sizing” of the nursing home
  industry.
• Provide regulatory relief while maintaining
  quality.
• Realign existing resources to facilitate
  consumer choice.
                                     Ohio Health Plans
               Summary

• Quality long term care facilities are an
  essential piece of the long term care
  delivery system.
• Slowing the growth in long term care
  expenditures while maintaining quality
  of care is a challenge now and in the
  future.

                                 Ohio Health Plans

								
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