in Colorado Medicaid May 4, 2016 Alex Weichselbaum Rehabilitation - PowerPoint PPT Presentation

Outpatient SLP Benefit in Colorado Medicaid May 4, 2016 Alex Weichselbaum Rehabilitation and Behavioral Health Benefit Policy Specialist 1

Our Mission Improving health care access and outcomes for the people we serve while demonstrating sound stewardship of financial resources 2

Meeting Objectives • Review SLP utilization • Discuss the benefit with stakeholders • Address concerns 3

General Description • Outpatient Speech-Language Pathology (SLP, or speech therapy) is a State Plan benefit available to children and adults. • It consists of speech therapy services. • Providers are licensed speech-language pathologists and their supervised assistants. • Utilization is distinct from speech therapy services available through the Home Health benefit and school-based services; however the treatment is comparable as the same providers may work in any of those settings. 4

Additional Details • State Plan, fee-for-service • Requires a physician/nurse order and 90 day treatment plan increments • No annual limit • Children have rehabilitative and Habilitative therapies covered (acute and chronic) • Adults only have rehabilitative therapies covered (acute)  Adults on the ACA Medicaid Plan have Habilitative therapies covered too. Requires a PAR. 5

Expenditure Snapshot Outpatient SLP 1.30% Outpatient SLP 0.43% All FFS All FFS Benefits Benefits 98.70% 99.57% Utilizer Count Relative Cost FY 2015 Utilizer Count Total Cost Outpatient SLP 14,232 $21,863,599 All FFS Benefits 1,066,690 $5,044,611,533 6

Utilizer and Provider Counts 9,000 320 8,000 300 7,000 280 Provider Count Utilizer Count 6,000 260 5,000 240 4,000 220 3,000 200 Utilizer Count Provider Count 7

Utilizer Count to Total Enrolled 9,000 1,600,000 1,400,000 8,000 1,200,000 Total Clients Enrolled 7,000 1,000,000 SLP Utilizers 6,000 800,000 600,000 5,000 400,000 4,000 200,000 3,000 0 Utilizer Count Total Enrolled 8

Utilizer Trends by Age Group 4,000 3,500 3,000 2,500 2,000 1,500 1,000 500 0 Child 0-3 Child 4-9 Child 10-20 Adult 21-34 Adult 35-64 Adult 65+ 9

Utilization by Age Group 12,000 10,000 269 257 730 712 257 348 238 356 746 215 665 8,000 346 675 309 300 Utilizers 4,046 3,943 6,000 3,544 3,579 3,232 4,000 4,193 4,012 3,846 3,773 2,000 3,673 0 Q2 FY15 Q3 FY15 Q4 FY15 Q1 FY16 Q2 FY16 Ages 0 to 4 Ages 5 to 20 Ages 21 to 34 Ages 35 to 64 Ages 65+ 10

Demographic Comparison Pregnant Other Elderly Other Disabled Pregnant Women Elderly 1% 6% 0% 6% Women 0% 7% 3% Adult 8% Disabled 24% Child Adult 43% 41% Child 61% Outpatient SLP Utilizers All FFS Utilizers 11

Length of Treatment 25 to 36 Months 37+ Months 19 to 24 Months 3% 3% 3% 13 to 18 Months 5% 7 to 12 Months Less Than 1 14% Month 54% 4 to 6 Months 7% 1 to 3 Months 11% 12

Payment Rate Comparison 92507 State Reimbursement % Difference from Colorado Medicaid Colorado (Medicaid) $60.16 - Idaho $68.20 13.36% Colorado (Medicare) $64.09 6.53% Utah $62.52 3.92% Oregon $55.87 -7.13% Minnesota $55.80 -7.25% Iowa $41.53 -30.97% Washington $39.35 -34.59% Texas $31.25 -48.06% 13

Open Discussion 14

Contact Information Alex Weichselbaum Rehabilitation and Behavioral Benefit Policy Specialist Alex.Weichselbaum@state.co.us 15

Thank You! 16