Medical Care Advisory Committee January 11, 2018 Responsibly - - PowerPoint PPT Presentation

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Nov 04, 2023 198 likes •364 views

Medical Care Advisory Committee January 11, 2018 Responsibly providing access to quality health coverage for vulnerable Mississippians 1 State Plan Amendment (SPA) and Waiver Updates SPA 17-0001 Home Health CMS Submission 8/14/2017

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Responsibly providing access to quality health coverage for vulnerable Mississippians 1

Medical Care Advisory Committee

January 11, 2018

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State Plan Amendment (SPA) and Waiver Updates

SPA 17-0001 Home Health

CMS Submission 8/14/2017
RAI 11/2/2017

SPA 17-0004 Tribal Notification

CMS Submission 11/14/2017

SPA 17-0015 DME and Medical Supply Reimbursement

CMS Submission 12/14/2017

SPA 18-0001 LTC Updates

Under Governor Review
Public Notice Posted 12/28/2017

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State Plan Amendment (SPA) and Waiver Updates

SPA 18-0002 Physician UPL

Under Governor Review
Public Notice Posted 12/28/2017

SPA 18-0003 (renamed from 17-0009) Medicaid Administration

Under Governor Review

CHIP SPA #10

Submitted 1/9/2018

Healthier Mississippi Waiver Renewal

CMS Submission 9/28/2017

Family Planning Waiver

CMS approved 12/28/2017 (10 years; starting 1/1/2018)

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Physician Reimbursement

Top 5 CPT Physician E&M Codes Reimbursement by State Mississippi Florida Georgia Alabama Louisiana 99202 $62.12 $35.98 $54.57 $53.00 $42.77 99203 $89.69 $53.55 $76.53 $78.00 $62.18 99212 $36.02 $21.84 $29.67 $31.00 $24.83 99213 $61.01 $26.61 $40.70 $42.00 $41.53 99214 $90.08 $41.46 $62.71 $67.00 $62.65

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Physician Reimbursement – Primary Care Physician (PCP) Increase

Top 5 CPT Physician E&M Codes (PCP increase) Reimbursement by State Mississippi Florida Georgia Alabama Louisiana 99202 $69.02 *N/A $64.20 $69.27 *N/A 99203 $99.66 *N/A $93.42 $100.52 *N/A 99212 $40.02 *N/A $37.47 $40.36 *N/A 99213 $67.79 *N/A $63.14 $68.17 *N/A 99214 $100.09 *N/A $93.35 $100.91 *N/A

*Florida and Louisiana reported that they did not plan to continue the Affordable Care Act (ACA) primary care increase after the 100% federal funding ended on December 31, 2014.

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MS Physician Reimbursement

Top 5 CPT Physician E&M Codes 2012|2017 % Change Reimbursement by Fiscal Year 2017 2016 2015 2014 2013 2012 99202 3.4% $62.12 $61.89 $61.89 $61.65 $61.67 $60.10 99203 2.7% $89.69 $89.65 $89.80 $89.66 $89.70 $87.35 99212 2.9% $36.02 $35.75 $35.97 $35.88 $36.05 $35.00 99213 4% $61.01 $60.76 $60.48 $60.71 $60.51 $58.67 99214 3.5% $90.08 $89.85 $90.00 $89.90 $89.10 $87.01

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Pharmacy Dispensing Fee Reimbursement

Type of Dispensing Fee Dispensing Fee by State Mississippi Florida Georgia Alabama Louisiana Professional $11.29 $10.24 $4.63/$4.33 $10.64 $10.41 Specialty Professional $61.14 $10.24 $4.63/$4.33 $10.64 $10.41

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Dental Reimbursement

Top 5 CDT Codes Reimbursement by State Mississippi Florida Georgia Alabama Louisiana D2930 $134.79 $101.07 $158.25 $90.00 $127.54 D3220 $97.28 $74.32 $90.04 $82.00 $94.38 D0140 $40.73 $11.89(0-20) $8.00 (21+) $38.29 $29.00 Not a covered procedure D0330 $54.52 $44.59(0-20) $30.00(21+) $62.62 $49.00 $57.05 D7140 $82.91 $40.13(0-20) $27.00(21+) $70.59 $53.00 $79.07

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SEPTEMBER MEETING FOLLOW UP DATA REQUEST

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Estimated Cost of 17P for 20 Weeks

$12,800

Reimbursement for a Single Injection

$640

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17P Estimated Cost

Delivery Category Recipient Count for Pre- Term Deliveries (SFY16) Estimated Cost of 17P to Treat Pre-Term Delivery Recipients Early Pre-Term 273 $3,494,400.00 Late Pre-Term 1636 $20,940,800.00 Total 1909 $24,435,200.00

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Estimated Cost of General Medical Care for Pre-Term Mothers

Delivery Category Recipient Count for Pre-Term Deliveries (SFY16) Estimated Cost of One Year General Medical Care for Pre-Term Delivery Recipients* Early Pre-Term 273 $1,680,861.00 Late Pre-Term 1636 $10,072,852.00 Total 1909 $11,753,713.00

Based on average expenditures of beneficiary enrolled in COE 075 (parent caregiver) who had preventative or primary care claims during state fiscal year 2016 ($6,157).

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Cost of Preterm Birth Complications

Complication Age 0 – 1 Cost Respiratory $132,872.43 Cardiovascular $92,841.30 Neurological $186,906.98 Gastrointestinal $98,565.66 Failure to Thrive $68,246.05 Average $115,886.48 Healthy Child $5,847.83 Difference $110,038.65

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Average Expenditures for Early Pre-Term and Full Term Pregnancies

Early Pre-Term Full Term Mother Mother $13,878.35 $9,600.97 Infant w/Complication Healthy Infant First Year of Life Estimated Cost $110,038.65 $5,347.75 17-P Estimated Cost $10,200.00 − Total

$134,117 $14,949

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