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
April 2018 2 Partial Capitation Rate Methodology SFY 2018-19 Premiums Base rate developed by Deloitte using Partial Cap, MAP Base Rate Alignment and FIDA CY 2016 Cost Report Data NYC, Mid-Hudson/Northern Metro, Northeast/Western and Region-Specific Base Rest of State medical base rate set based on region- specific cost report data Care Management developed by Deloitte to continue rate- Care Management setting alignment $200 pmpm – includes SFY 2018-19 Budget action to Administrative Cap reduce admin Adjustment to comply with Minimum Wage effective Minimum Wage Adjustment December 31, 2017 and December 31, 2018 Program region base adjusted to reflect acuity of enrollees Acuity Factor 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 Projected SFY2018-19 Enrollment based on survey data Nursing Home Rate Blend with actuals through September 2017
April 2018 3 Base Risk Rate Methodology • 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 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% 3
April 2018 4 Base Risk Rate Methodology – Continued • 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. 4
April 2018 5 Composition of Regions • 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 5
April 2018 6 Statewide Community Premium Change Excluding Minimum Wage • On a statewide basis, the following is the impact of regional change from SFY 2017 ‐ 18 to SFY 2018 ‐ 19: Region Rate Impact NYC ‐ 0.5% Mid ‐ Hudson/Northern Metro 3.4% Northeast/Western 16.2% Rest of State 15.7% Statewide 0.3% 6
April 2018 7 Statewide Community Premium Change Including Minimum Wage • On a statewide basis, the following is the impact of the regional change from SFY 2017 ‐ 18 to SFY 2018 ‐ 19: Region Community Rate Impact Rate Update Payment Rate Impact NYC 6.5% Base/Trend/Program Changes 0.3% Mid ‐ Hudson/Northern Metro 3.6% Minimum Wage 6.6% Northeast/Western 16.4% Total 6.9% Rest of State 17.1% Statewide 6.9% 7
April 2018 8 Statewide Nursing Home Premium Change • 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 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% 8
April 2018 9 Nursing Home Transition • 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 Projected Region April 2018 NYC 13,293 Mid Hudson/Northern Metro 1,512 Northeast/Western 6,604 Rest of State 5,143 Statewide 26,552
April 2018 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 Region December 31, 2017 December 31, 2018 First 9 Months SFY2018 ‐ 19 Last 3 Months SFY2018 ‐ 19 NYC Metro $13 $15 Long Island & Westchester $11 $12 Rest of State $10.40 $11.10 10
April 2018 11 2018-19 Minimum Wage Adjustment SFY Line Description CY 2018 CY 2019 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 11
April 2018 12 Partial Capitation Program Pool Distributions • 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 12
April 2018 13 SFY 2018 – 19 Budget Actions 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 October 2018 October 2018 transitioning for 12 months Social Adult Day Health Benefit Efficiency October 2018 October 2018 13
April 2018 14 Next Steps • 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 14
April 2018 15 Questions • Questions regarding the MLTC Rates can be submitted via e ‐ mail to: MLTC Bureau Mail Log – mltcrs@health.ny.gov 15
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