Background Centers for Medicare and Medicaid Services(CMS) - - PowerPoint PPT Presentation

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Background Centers for Medicare and Medicaid Services(CMS) - - PowerPoint PPT Presentation

Jan 05, 2024 11 likes •175 views

Brian Sandoval Marta Jensen Governor Acting Administrator Richard Whitley, MS Director Department of Health and Human Services Division of Health Care Financing and Policy Managed Care in Nevada Background Centers for Medicare and

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Managed Care in Nevada

Department of Health and Human Services

Division of Health Care Financing and Policy

Brian Sandoval Governor Richard Whitley, MS Director

Marta Jensen Acting Administrator

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DHHS – Division of Health Care Financing and Policy

Background

  • Centers for Medicare and Medicaid

Services(CMS) established the Triple Aim

– Better care for individuals – Improved population health – Reduced costs by improving health outcomes

  • Ensuring Medicaid program sustainability
  • Passage of SB514
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DHHS – Division of Health Care Financing and Policy

Caseload

567,952 646,885 100000 200000 300000 400000 500000 600000 700000 100,000 200,000 300,000 400,000 500,000 600,000 700,000 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018

Total Medicaid Recipients

Total Medicaid

  • Leg. Approved

January 2016 Projection

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DHHS – Division of Health Care Financing and Policy

Costs

* FY 2016 Data represents

500 1,000 1,500 2,000 2,500 3,000 3,500 FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 FY 2010 FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016* Millions

Fiscal Year Expenditures

* FY 2016 Data represents Fiscal YTD expenditures

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DHHS – Division of Health Care Financing and Policy

Purpose Statement

The Department of Health and Human Services is evaluating alternative service delivery models aimed at achieving better care for patients, better health for our communities and lower costs through improved health outcomes.

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DHHS – Division of Health Care Financing and Policy

Medicaid in Nevada

  • Nevada Medicaid provides services under two

different delivery models:

– Fee-For-Service – Managed Care

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DHHS – Division of Health Care Financing and Policy

What is Fee-for-Service?

  • Individuals can receive services from any

provider enrolled with Nevada Medicaid

  • No referrals from a primary care physician are

required to see a specialist

  • Individuals must coordinate and manage their
  • wn care
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DHHS – Division of Health Care Financing and Policy

What is a Managed Care Organization?

  • A health care organization that:

– Helps people find a primary care physician – Helps people navigate the health care system – Maintains a network of health care providers

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DHHS – Division of Health Care Financing and Policy

Managed Care

  • Managed Care Organizations:

– Provide care coordination – Provide patient education – Provide preventative care – Connect individuals with specialty providers – Ensure the right service is provided at the right time

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DHHS – Division of Health Care Financing and Policy

What Does Medicaid Managed Care Look Like in Nevada Today?

  • All Medicaid recipients who live in urban

Washoe County (Reno) or Clark County (greater Las Vegas area) who are not determined disabled by the Social Security Administration are mandated

  • Medicaid currently contracts with two

Managed Care Organizations:

– Health Plan of Nevada – Amerigroup

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DHHS – Division of Health Care Financing and Policy

What Services Are Currently In Managed Care?

  • Managed Care covers most of the services that are in

the Medicaid-approved State Plan (not all-inclusive):

– Physician/Hospital Services – Pharmacy – Behavioral Health Services – Personal Care Services – Home Health – Therapy Services

  • Managed Care Organizations have the flexibility to
  • ffer additional services based on need and the plan

selected

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DHHS – Division of Health Care Financing and Policy

What is Not Currently Provided by Managed Care?

  • Hospice
  • Adult Day Health Care
  • Non-Emergency Transportation
  • Targeted Case Management
  • Home and Community-Based Waiver Services
  • Intermediate Care Facilities for Individuals with

Intellectual Disabilities

  • Nursing Facility Stays more than 45 days
  • Orthodontia
  • Residential Treatment Center stays more than 30 days
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DHHS – Division of Health Care Financing and Policy

What is the Future of Managed Care?

  • These are options that the State may consider:

– Expanding Managed Care statewide – Including additional services that are not currently covered by managed care – Expanding the population served by managed care to include aged, blind, or disabled individuals – Increasing the number of Managed Care Plans to

  • ffer greater choice and flexibility of services
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DHHS – Division of Health Care Financing and Policy

Next Steps

  • Continue Stakeholder Input
  • Re-procure current managed care contract
  • Hire a contractor to assist in evaluating the

various options

– Final recommendation to Legislature and Governor late 2016

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DHHS – Division of Health Care Financing and Policy

Feedback

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DHHS – Division of Health Care Financing and Policy

Thank you!

  • Information can be found online at:

http://dhcfp.nv.gov/ Email questions or comments to: ManagedCareExpansion@dhcfp.nv.gov