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

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Alex Weichselbaum

Rehabilitation and Behavioral Health Benefit Policy Specialist

May 4, 2016

Outpatient SLP Benefit in Colorado Medicaid

Our Mission

Improving health care access and

• utcomes for the people we serve

while demonstrating sound stewardship of financial resources

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Meeting Objectives

• Review SLP utilization
• Discuss the benefit with stakeholders
• Address concerns

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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

• f those settings.

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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.

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Expenditure Snapshot

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Outpatient SLP 1.30% All FFS Benefits 98.70% Outpatient SLP 0.43% All FFS Benefits 99.57%

FY 2015 Utilizer Count Total Cost Outpatient SLP 14,232 $21,863,599 All FFS Benefits 1,066,690 $5,044,611,533

Utilizer Count Relative Cost

Utilizer and Provider Counts

7 200 220 240 260 280 300 320 3,000 4,000 5,000 6,000 7,000 8,000 9,000

Provider Count Utilizer Count

Utilizer Count Provider Count

Utilizer Count to Total Enrolled

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200,000 400,000 600,000 800,000 1,000,000 1,200,000 1,400,000 1,600,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000

Total Clients Enrolled SLP Utilizers

Utilizer Count Total Enrolled

Utilizer Trends by Age Group

9 500 1,000 1,500 2,000 2,500 3,000 3,500 4,000

Child 0-3 Child 4-9 Child 10-20 Adult 21-34 Adult 35-64 Adult 65+

Utilization by Age Group

10 3,673 3,846 4,012 4,193 3,773 3,232 3,544 3,943 4,046 3,579

300 346 356 348 309

675 746 712 730 665 215 257 257 269 238

2,000 4,000 6,000 8,000 10,000 12,000

Q2 FY15 Q3 FY15 Q4 FY15 Q1 FY16 Q2 FY16

Utilizers Ages 0 to 4 Ages 5 to 20 Ages 21 to 34 Ages 35 to 64 Ages 65+

Demographic Comparison

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Disabled 24% Child 61% Adult 8% Pregnant Women 0% Elderly 7% Other 0%

Outpatient SLP Utilizers

Disabled 6% Child 43% Adult 41% Pregnant Women 3% Elderly 6% Other 1%

All FFS Utilizers

Length of Treatment

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

Payment Rate Comparison 92507

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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%

Open Discussion

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Contact Information

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

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Thank You!