April 2018 March 2019 Medicaid Managed Long Term Care Partial - - PowerPoint PPT Presentation

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April 2018 March 2019 Medicaid Managed Long Term Care Partial - - PowerPoint PPT Presentation

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April 2018 March 2019 Medicaid Managed Long Term Care Partial Capitation Premium Rates Bureau of Managed Long Term Care Rate Setting Division of Finance and Rate Setting Office of Health Insurance Program Department of Health April 2018

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SLIDE 1

April 2018 – March 2019 Medicaid Managed Long Term Care Partial Capitation Premium Rates

April 2018 Bureau of Managed Long Term Care Rate Setting Division of Finance and Rate Setting Office of Health Insurance Program Department of Health

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SLIDE 2

Partial Capitation Rate Methodology

April 2018 2

SFY 2018-19 Premiums Base Rate Alignment

Base rate developed by Deloitte using Partial Cap, MAP and FIDA CY 2016 Cost Report Data

Region-Specific Base

NYC, Mid-Hudson/Northern Metro, Northeast/Western and Rest of State medical base rate set based on region- specific cost report data

Care Management

Care Management developed by Deloitte to continue rate- setting alignment

Administrative Cap

$200 pmpm – includes SFY 2018-19 Budget action to reduce admin

Minimum Wage Adjustment

Adjustment to comply with Minimum Wage effective December 31, 2017 and December 31, 2018

Acuity Factor

Program region base adjusted to reflect acuity of enrollees in partial capitation program as of January 1, 2018

Risk Scores

Risk scores developed for each of the four regions

Surplus

1% in alignment with Mainstream Managed Care

Nursing Home Rate Blend

Projected SFY2018-19 Enrollment based on survey data with actuals through September 2017

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SLIDE 3

Base Risk Rate Methodology

April 2018 3

  • Base year long term care services data (Line 1 Schedule B) adjusted for following:
  • Minimum Wage
  • NHT Population Exclusion
  • Provider Incentives
  • Reinsurance
  • IBNR
  • HRR
  • 27 month trend of the base year long term care services to April 1, 2018 – March 31,

2019 contract period

3 NYC Mid‐Hudson/Northern Metro Northeast/Western Rest of State

Medical Trend

1.60% 4.85% 4.83% 4.81%

Trend to Contract Period 3.63% 11.25% 11.19% 11.14%

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SLIDE 4

Base Risk Rate Methodology – Continued

April 2018 4

  • Medical Categories of Service are risk‐adjusted for community‐based

members:

  • All long term care services in benefit package
  • Base average administrative cost calculated using the lower of plans’ actual or

capped administrative cost PMPM

  • Administrative cost PMPM held to $200 PMPM
  • Rates include a 1% surplus
  • Spenddown/NAMI adjustment is made on a plan‐specific basis on the

Community rate. The Nursing Home rate is based on the region average.

  • Under risk adjusted methodology, every plan within a region will receive the

same Partial Capitation regional average premium, adjusted by a plan‐specific risk adjustment factor that accounts for differences in enrollee acuity.

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SLIDE 5

Composition of Regions

April 2018 5

  • The following four regions will be used to set regional average premiums:
  • NYC Region ‐ Region 1: NYC; Nassau, Suffolk, Westchester counties
  • Mid‐Hudson/Northern Metro ‐ Region 2: Dutchess, Orange, Putnam, Rockland,

Sullivan, Ulster counties

  • Northeast/Western ‐ Region 3: Albany, Erie, Fulton, Genesee, Madison, Monroe,

Montgomery, Niagara, Onondaga, Orleans, Rensselaer, Saratoga, Schenectady, Warren, Washington, Wyoming counties

  • Rest of State ‐ Region 4: Rest of state’s counties

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SLIDE 6
  • On a statewide basis, the following is the impact of regional change from

SFY 2017‐18 to SFY 2018‐19:

Statewide Community Premium Change Excluding Minimum Wage

April 2018 6 6

Region Rate Impact NYC ‐0.5% Mid‐Hudson/Northern Metro 3.4% Northeast/Western 16.2% Rest of State 15.7% Statewide 0.3%

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SLIDE 7
  • On a statewide basis, the following is the impact of the regional change

from SFY 2017‐18 to SFY 2018‐19:

Statewide Community Premium Change Including Minimum Wage

April 2018 7 7

Region Community Rate Impact NYC 6.5% Mid‐Hudson/Northern Metro 3.6% Northeast/Western 16.4% Rest of State 17.1% Statewide 6.9%

Rate Update Payment Rate Impact

Base/Trend/Program Changes 0.3% Minimum Wage 6.6% Total 6.9%

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SLIDE 8
  • On a statewide basis, the following is the impact of the regional change

from SFY 2017‐18 to SFY 2018‐19:

  • Shift from FFS base to MLTC Cost Report base
  • Admin aligned with Community Rate
  • Surplus aligned with Community Rate

Statewide Nursing Home Premium Change

April 2018 8 8

Region Nursing Home Rate Impact NYC ‐3.2% Mid‐Hudson/Northern Metro ‐6.2% Northeast/Western ‐7.1% Rest of State ‐5.6% Statewide ‐4.6%

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SLIDE 9

Nursing Home Transition

April 2018 9

  • SFY2018‐19 provides one projected enrollment for the year
  • Projection based on survey results through September 2017 and plan enrollment mix
  • Rates will be adjusted during year to address budget action limiting NH

benefit

Region Projected April 2018 NYC 13,293 Mid Hudson/Northern Metro 1,512 Northeast/Western 6,604 Rest of State 5,143 Statewide 26,552

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SLIDE 10

Minimum Wage

  • Premiums incorporate minimum wage adjustments effective

12/31/17 and 12/31/18.

  • Wage Increase Calculated and applied to Personal Care and Home

Health COS.

  • Schedule F to be released with projected total funding

10 April 2018 10

Region December 31, 2017 First 9 Months SFY2018‐19 December 31, 2018 Last 3 Months SFY2018‐19 NYC Metro $13 $15 Long Island & Westchester $11 $12 Rest of State $10.40 $11.10

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SLIDE 11

2018-19 Minimum Wage Adjustment

11 April 2018 11

Line Description CY 2018 CY 2019 SFY 2018-19 NYC Metro (5 boroughs)

Minimum Wage Growth $2.99 $5.34 $3.58 Additional Wage Growth $0.54 $0.54 $0.54 TOTAL Wage Growth $3.52 $5.87 $4.11

Downstate (Nassau / Suffolk / Westchester)

Minimum Wage Growth $0.64 $1.82 $0.93 Additional Wage Growth $0.54 $0.54 $0.54 TOTAL Wage Growth $1.18 $2.35 $1.47

NYC AREA RATE REGION

Minimum Wage Growth $2.75 $4.99 $3.30 Additional Wage Growth $0.54 $0.54 $0.54 TOTAL Wage Growth $3.29 $5.52 $3.84

UPSTATE

Minimum Wage Growth $1.16 $1.98 $1.37 Additional Wage Growth $0.48 $0.48 $0.48 TOTAL Wage Growth $1.64 $2.46 $1.85

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SLIDE 12

Partial Capitation Program Pool Distributions

April 2018 12

  • SFY 2018‐19 Quality Incentive Pool Projection – capped at $150 Million
  • Budget reductions may decrease total pool value below $150M
  • SFY 2018‐19 High Cost High Need Risk Pool Projection‐ $190 million
  • Withhold of 2% and payout of pool done simultaneously six months following

end of SFY18‐19

  • SFY 2018‐19 Nursing Home Price Mitigation Pool ‐ TBD
  • Requires accurate encounter data reporting including begin and end service

dates

  • SFY 2018‐19 QIVAPP – $73.5 Million

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SLIDE 13

SFY 2018 – 19 Budget Actions

April 2018 13 13

Budget Action Effective Date Rate Implementation Date Admin Reduction to $200 April 2018 April 2018 Physical Therapy Visit Limitations April 2018 TBD NH Benefit Limitation July 2018 July 2018 Limit LHCSA Contracts w/MLTC Plans October 2018 October 2018 Restrict MLTC members from plan transitioning for 12 months October 2018 October 2018 Social Adult Day Health Benefit Efficiency October 2018 October 2018

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SLIDE 14

Next Steps

April 2018 14

  • SFY 2017‐18 Rates:
  • Final SFY 17‐18 NHT Survey and rate update for actual NH enrollment
  • Quality Pool allocation
  • High Cost High Need Risk Pool allocation
  • NHPM Pool allocation
  • QIVAPP Allocation
  • SFY 2018‐19 Rates:
  • Budget action adjustments
  • Transportation Minimum Wage Adjustment ‐ July
  • New CFCO Services –January 2019
  • Quality Pool allocation
  • High Cost High Need Risk Pool allocation
  • NHPM Pool allocation
  • QIVAPP allocation

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SLIDE 15

Questions

April 2018 15

  • Questions regarding the MLTC Rates can be

submitted via e‐mail to:

MLTC Bureau Mail Log – mltcrs@health.ny.gov

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