Medical Care Advisory Committee August 2017 Responsibly providing - - PowerPoint PPT Presentation

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Medical Care Advisory Committee August 2017 Responsibly providing - - PowerPoint PPT Presentation

Apr 16, 2023 245 likes •407 views

Medical Care Advisory Committee August 2017 Responsibly providing access to quality health coverage for vulnerable Mississippians 1 State Plan Amendment (SPA) Updates SPA 17-0002 Pharmacy Reimbursement Approved, Effective 4/1/2017 SPA

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Responsibly providing access to quality health coverage for vulnerable Mississippians 1

Medical Care Advisory Committee

August 2017

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State Plan Amendment (SPA) Updates

SPA 17-0002 Pharmacy Reimbursement

  • Approved, Effective 4/1/2017

SPA 17-0003 Screening, Brief Intervention Referral for Treatment (SBIRT)

  • Approved, Effective 7/1/17

SPA 17-0009 Medicaid Administration

  • Under Governor Review
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Waiver Updates

Elderly and Disabled Waiver

  • Approved, Effective 7/1/2017

Independent Living Waiver

  • Approved Effective 7/1/2017
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JULY MEETING FOLLOW UP DATA REQUEST

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Women with Low Birthweight (LBW) Infants

  • 1,879 women identified as having a

LBW (<2500g) infant

  • 50 of these women had a claim

submitted for 17-P

  • 202 total women with a claim

submitted for 17-P

SFY2015 and SFY2016

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17-P Prescribing

  • 11.6% (65) of the 560 OB/GYNs

prescribed 17-P

  • 36 physicians without an OB/GYN

specialty prescribed 17-P

Calendar Year (CY) 2016

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Costs of Family Planning Services

$17,927,281.58

Federal and State

CY2016

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Estimated Annual Costs to Expand Coverage for One Year Postpartum

$116,726,950.50

($4,877.85/beneficiary)

CY2016

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AUGUST MCAC REQUESTED DATA

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Average Annual Expenditure Per Patient

  • Fee for Service - $7,217.48
  • Magnolia Health Plan - $3,136.34
  • United Healthcare - $2,829.47

SFY2016

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Total Number of Providers by Type

See Handout

Active Providers with $5000+ Payments

See Handout

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Top 10 Diagnoses by Expenditure

7/1/2016 – 6/30/2017

Diagnoses Code Description Expenditure

I10 ESSENTIAL (PRIMARY) HYPERTENSION $461,322,623.47 E11.9 TYPE 2 DIABETES MELLITUS WITHOUT COMPLIC $149,821,058.87 K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT $149,355,572.03 F73 PROFOUND INTELLECTUAL DISABILITIES $139,898,284.95 E78.5 HYPERLIPIDEMIA, UNSPECIFIED $119,024,706.26 F32.9 MAJOR DEPRESSIVE DISORDER, SINGLE EPISOD $117,857,628.87 M62.81 MUSCLE WEAKNESS (GENERALIZED) $112,812,896.81 J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, U $99,890,255.98 F03.90 UNSPECIFIED DEMENTIA WITHOUT BEHAVIORAL $86,103,405.29 I50.9 HEART FAILURE, UNSPECIFIED $85,265,351.34

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Top 10 Diagnoses by Frequency

7/1/2016 – 6/30/2017

Diagnoses Code Description Utilization

I10 ESSENTIAL (PRIMARY) HYPERTENSION 913,493 E11.9 TYPE 2 DIABETES MELLITUS WITHOUT COMPLIC 371,701 J44.9 CHRONIC OBSTRUCTIVE PULMONARY DISEASE, U 264,317 K21.9 GASTRO-ESOPHAGEAL REFLUX DISEASE WITHOUT 184,591 N18.6 END STAGE RENAL DISEASE 173,273 E78.5 HYPERLIPIDEMIA, UNSPECIFIED 169,497 I50.9 HEART FAILURE, UNSPECIFIED 147,199 F32.9 MAJOR DEPRESSIVE DISORDER, SINGLE EPISOD 147,067 I25.10 ATHSCL HEART DISEASE OF NATIVE CORONARY 141,339 Z79.899 OTHER LONG TERM (CURRENT) DRUG THERAPY 138,953

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MEDICAL NECESSITY-PRIOR AUTHORIZATION AND RETROSPECTIVE REVIEW

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