schedule viiib to house health approps.ppt

Agency for Health Care Administration

Overview of Schedule VIIIB Reductions

Phil Williams, Interim Deputy Secretary for Medicaid

Presented to the

House Health Care Appropriations Committee

November 3, 2009

Agency for Health Care Administration – Budget Overview

Total AHCA Budget FY 2009-2010 $18,239,862,302

Administration/ Support Services $28,622,163

Children’s Special Health Care $471,945,857

Executive Direction/ Support Services $142,465,545

Fiscal Agent Appropriations $78,274,844

Medicaid Services to Individuals $13,038,419,437

Medicaid Long Term Care $4,430,656,520

Health Facility Regulation $49,477,936

Non-Recurring General Revenue $273,726,574

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Percentage of Agency Budget Spent on Administration ~ FY 2009-2010

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General Revenue vs. Trust Funds Appropriations ~ FY 2009-2010

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Agency’s Guiding Principles for Identifying Schedule VIII B

Reductions Better manage utilization and find efficiencies. Attempt to minimize impacts on beneficiaries. Target most recent services and fee increases. Maintain integrity of mandatory Medicaid services to avoid Federal

compliance issues. Examine optional Medicaid eligibility groups, consistent with

Stimulus maintenance of eligibility requirements.

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The federal government contributes 67.64% of every dollar spent on Medicaid services for FY 2009-2010.

For FY 2010-11, the blended FMAP will be 60.71% with an FMAP of 66.44% for July – December 2010 and an FMAP of 54.98% for January-June 2011.

Reductions of General Revenue result in a larger reduction to the providers or of services. Based on an FMAP of 67.64%: If there is a $1 million GR

reduction, there is a total reduction of $3.9 million. Based on an FMAP of 60.71%: If there is a $1 million GR

reduction, there is a total reduction of $2.5 million.

Reality of Reductions

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Within Medicaid, there are mandatory and optional services and mandatory and optional eligibility groups.

There is less flexibility to make changes to the mandatory services and mandatory eligibility groups. In some cases, level of service can be reduced, but not eliminated.

There are mandatory eligibility and services levels for Children and certain Pregnant Women – those mandatory groups MUST receive ALL medically necessary services.

Reality of Reductions

Optional Medicaid Eligibility Groups

Medicaid for Aged/Disabled up to 88% FPL Institutional Care Program (ICP) Home and Community Based Services (HCBS) Medically Needy Family Planning Waiver Continuous Medicaid for children who become ineligible for Medicaid Breast and Cervical Cancer Program Children age 19-20 with income at the TANF eligibility level Former foster care children age 18-20 Pregnant women with income between 150% and 185% FPL Presumptively Eligible Pregnant Women Children under age one with family income between 150% and 185% of the FPL

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Florida Medicaid Mandatory Services

Advanced Registered Nurse Practitioner Services

Early & Periodic Screening, Diagnosis and Treatment of Children (EPSDT)/Child Health Check-Up

Family Planning Home Health Care Hospital Inpatient Hospital Outpatient Independent Lab Nursing Facility Personal Care Services

Physician Services Portable X-ray Services Private Duty Nursing Respiratory, Speech,

Occupational Therapy Rural Health Therapeutic Services for

Children Transportation

Florida Medicaid Mandatory Services forAll Eligibles FY 2009-10

Mandatory40.22% of $17.9 Billion

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Florida Medicaid Optional Services* Adult Dental Services Adult Health Screening Ambulatory Surgical Centers Assistive Care Services Birth Center Services Children’s Dental Services Hearing Services Vision Services Chiropractic Services Community Mental Health County Health Department

Clinic Services Dialysis Facility Services Durable Medical Equipment Early Intervention Services Healthy Start Services Home and Community-Based

Services Hospice Care

Intermediate Care Facilities/ Developmentally Disabled

Intermediate Nursing Home Care

Optometric Services Orthodontic Services Physician Assistant

Services Podiatry Services

Florida Medicaid Optional Services forAll Eligibles FY 2009-10

Optional59.78% of $17.9 Billion

Prescribed Drugs Primary Care Case

Management (MediPass)

Registered Nurse First Assistant Services

School-Based Services State Mental Hospital

Services Subacute Inpatient

Psychiatric Program for Children

Targeted Case Management)

*States are required to provide any medically necessary care required by child eligibles. 10

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Summary of FY 2009-2010 Schedule VIII B

Reductions (10% Exercise)

Description GR Total Trust Fund Total Reduction

HQA and Admin Reductions (57,070) (2,099,437) (2,156,507)

Medicaid Rate Reductions (371,911,631) (455,293,703) (827,205,334)Medicaid Optional Services Reductions (48,993,862) (60,302,616) (109,296,478)Medicaid Optional Groups Reductions (96,759,962) (148,341,188) (245,101,150)

Other Medicaid Reductions (78,660,921) (13,142,453) (91,803,374)

TOTAL (596,383,446) (679,179,397) (1,275,562,843)

Given the ARRA stimulus maintenance of effort eligibility requirements that are in effect through the recovery period, which ends December 31, 2010, the Medicaid proposals reflect an annualized amount of savings, but are not effective until January 1, 2011.

Health Quality Assurance and Administrative Services FY 2009-2010 Schedule VIII B

Reductions

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Div. Description GRTotal Trust

FundTotal

ReductionHQA Bring the Call Center In-house (354,273) (354,273)HQA Delete the Quality of Long-Term Care Facility Improvement TF ($1,000,000) ($1,000,000)HQA Decrease the Emergency Alternative Placement Allocation ($470,091) ($470,091)Admin Eliminate 5 FTEs (from Administration and Support) & Cont Serv (57,070) (275,073) (332,143)

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State Operation of Facilities Call Center

This issue proposes: Reduction of $354,273 from the Health Care Trust Fund. Operation currently contracted to a private entity. Current annual cost of contract $1,050,482. In house operation would increase quality of complaint intake,

improve efficiency and reduce costs to the state. Requires 10 new FTEs.

Total reduction: $354,273

General Revenue: ($0)Health Care Trust Fund: ($354,273)

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Delete the Quality of Long-Term Care Facility Improvement Trust Fund

This issue proposes: Delete authority for the Quality of Long-Term Care Facility

Improvement Trust Fund. Funds deposited are derived from federal civil monetary penalty

receipts. Funds used for projects related to care improvement in nursing

homes.

Total reduction: $1,000,000

General Revenue: ($0)Quality of Long Term care FacilityImprovement Trust Fund: ($1,000,000)

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Decrease the Emergency Alternative Placement Allocation

This issue proposes: Reduction of $470,091 from the Emergency Alternative

Placement Allocation of the Health Care Trust Fund. These funds can be used to make alternative placements of

nursing home residents when an existing nursing home is closed by the state for regulatory non-compliance reasons. The division has not spent all of the allocated budget in any year from the Resident Protection Trust Fund. The proposed cut in this trust fund allocation would not harm patients or the mission of the Agency.


General Revenue: ($0)Health Care Trust Fund: ($470,091)

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Eliminate 5 FTEs from Administration and Support

This issue proposes: Elimination of 5 FTEs from Administration and Support


General Revenue: ($57,070)Administrative Trust Fund: ($275,073)

FY 20010-2011 Schedule VIII B Medicaid Provider Rate Reductions

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All reductions are based on data from the August 2009 Social Services Estimating Conference

Description GRTotal Trust

FundTotal

ReductionReduce Clinic Services by 10% ($7,018,614) ($8,623,360) ($15,641,974)Hospital Inpatient Rate Reduction of 10% ($168,758,071) ($206,751,732) ($375,509,803)Hospital Outpatient Rate Reduction of 10% ($47,151,147) ($57,971,336) ($105,122,483)Nursing Home Rate Reduction of 10% ($138,174,809) ($168,746,959) ($306,921,768)ICF/DD Rate Reduction of 10% ($10,808,990) ($13,200,316) ($24,009,306)

FY 2010-2011 Schedule VIII B Reductions to Medicaid Optional

Services

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Fund Total ReductionElimination of the Podiatrist Program ($1,391,209) ($1,721,638) ($3,112,847)Elimination of the Chiropractic Program ($521,123) ($644,897) ($1,166,020)Elimination of Adult Vision & Hearing Services ($6,067,218) ($7,696,851) ($13,764,069)Discontinue Cov of Adult Dental Ser for Partial Dentures ($368,703) ($457,148) ($825,851)Elimination of Adult Dental Services ($7,261,269) ($9,003,102) ($16,264,371)Elimination of Hospice Services ($33,384,340) ($40,778,980) ($74,163,320)

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Elimination of Podiatric Services

This issue eliminates podiatric services as a covered Medicaid service. Services include routine foot care for persons with metabolic

disease or circulatory impairment and surgical procedures. Currently Medicaid beneficiaries can receive up to 2 podiatric

visits per month. Estimated 21,990 individuals would use this service in FY 2010-

2011. Total reduction: $3,112,847

General Revenue: ($1,391,209)Medical Care Trust Fund: ($1,711,443)Other Trust Fund: ($10,195)

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Elimination of Chiropractic Services

This issues eliminates chiropractic services as a covered Medicaid benefit. Services include new patient visit, manipulation of the spine and

spinal x-rays. Currently Medicaid beneficiaries can receive up to 10 Chiropractic

visits without prior authorization. Estimated 8,777 individuals would use this service in FY 2010-2011.


General Revenue: ($521,123)Medical Care Trust Fund: ($641,078)Other Trust Fund: ($3,819)

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Elimination of Adult Vision & Hearing Services

This issue eliminates the Adult Vision and Hearing Services program: Adult Vision:

Services include eyeglasses, eyeglass repairs as required, prosthetic eyes and medically necessary contact lenses.

Currently Medicaid beneficiaries can receive one pair of eyeglasses per recipient every two years, except a second pair may be provided during that period after prior authorization. Eyeglass lenses for adult recipients are limited to one pair of lenses per year.

Adult Hearing: Services include diagnostic testing, cochlear implant services, hearing aid

evaluation, repair and accessories and hearing aids. Currently Medicaid beneficiaries can receive hearing aids one per ear per

beneficiary every three years and cochlear implants are limited to one in either ear, but not both.

Estimated 753,545 individuals would use these services in FY 2010-2011



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Elimination of Coverage of Partial Dentures for Adults

This issue eliminates coverage for partial dentures for Adults as part of the Medicaid covered adult dental program.

Estimated 1,987 individuals would use this service in FY 2010-2011.


General Revenue: ($368,703)Medical Care Trust Fund: ($450,273)Other Trust Fund: ($6,875)

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Elimination of Adult Dental Services

This issue eliminates Adult Dental Services as a covered Medicaid Service. Services include partial dentures, comprehensive oral

evaluations, full dentures and other diagnostic and surgical procedures.

Currently Medicaid beneficiaries can receive oral evaluations only for determining the need for dentures or acute emergency services.




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Elimination of Hospice Services

This issue eliminates coverage of hospice services under the Medicaid program. Services include hospice care provided by a designated hospice, direct

care services of a hospice physician and nursing facility room and board. Currently once Medicaid beneficiaries elect hospice care, Medicaid will not

reimburse for other Medicaid Services that treat the terminal condition. Estimated 2,159 individuals would use this service in FY 2010-2011. This reduction reflects savings from elimination of hospice service and an

offset for costs incurred by these recipients in other/ institutional settings. Total reduction: $74,163,320


FY 2009-2010 Schedule VIII B Other Medicaid Reductions

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Funds Total ReductionNH County Billing Increase, Fund Shift ($66,557,484) $0 ($66,557,484)CMS Primary Care Center TCM Fee Reduction ($1,128,526) ($1,378,196) ($2,506,722)Cost Reduction for Behavioral Health Overlay Services ($1,535,251) ($1,874,902) ($3,410,153)Collection of Manufacturer Rebates on J-code ($762,860) $762,860 $0Eliminate MediPass ($8,676,800) ($10,652,215) ($19,329,015)

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Increase County Contributions for Medicaid Nursing Home Care

Section 409.915, Florida Statutes, requires counties to reimburse the State a portion of the cost of county resident care in nursing homes.

Increase amount paid by counties from $55 per month to $202 per month for their Medicaid residents who are in nursing homes. $202 represents approximately 3.7% of monthly Medicaid costs. Proportionally the same as the county contribution in late 1980’s.

Total Reduction: $0 million

General Revenue: ($66,557,484)Medical Care Trust Fund: ($66,557,484)

Primary Care Center Targeted Case Management Reduction

Proposes to eliminate the Children’s Medical Services (CMS) Primary Care Center Targeted Case Management Program. Eliminates duplication in payment of case management fees for

those enrolled in MediPass and in CMS. Eliminates duplication in provision of case management services

and payments of case management services funded through CMS administrative claiming.

Total Reduction: $2,506,722


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Cost Reduction for Behavioral Health Overlay Services (BHOS)

BHOS Services are mental health and substance abuse services for children and adolescents: In low to moderate risk Juvenile Justice commitment programs; or Abused or neglected and placed in group child care residential settings. Services: Individual, family and group therapy, substance abuse

treatment and individualized interventions by mental health technician staff.

Reduction is a result of: Limiting services to 6-days a week instead of 7-days a week.

Total Reduction: $3,410,153 million


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Collection of Manufacturer Rebates on J-codes

Claims systems enhancement will capture specific validated National Drug Code (NDC) information for each claim paid through Physician Services for injectable drugs.

This will allow for rebate invoicing to bill manufacturers for rebates for all claims of this type.


General Revenue: ($762,860)Medical Care Trust Fund: ($931,630)

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Eliminate MediPass Case Management Fee

MediPass providers currently receive a $2.00 monthly management fee for each enrollee who selects or is assigned to them in addition to regular fee-for-service reimbursement for health care services rendered.

This proposes the elimination of the MediPass $2.00 per member per month management fee.




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FY 2009-2010 Schedule VIII B Reductions to Medicaid Optional

Eligibility Groups

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Fund Total ReductionElimination of Eligibility for 19 and 20 year old Kids ($11,303,289) ($13,803,972) ($25,107,261)Elimination of Family Planning Waiver ($2,688,201) ($5,241,818) ($7,930,019)Elimination of Medically Needy Preg Women & Kids ($62,192,200) ($84,791,846) ($146,984,046)Elimination of Breast & Cervical Cancer Treatment ($3,555,482) ($4,752,886) ($8,308,368)Elimination of Eligibility for PW w ith 150-185% FPL ($17,020,789) ($39,750,666) ($56,771,455)

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Eliminate Eligibility for 19 and 20 year old Beneficiaries

This issue eliminates optional coverage for children aged 19 and 20. These individuals use a wide range of services in many different appropriation categories. Optional eligibility group; 10,169 individuals



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Eliminate Family Planning Waiver This issue eliminates optional coverage for the family planning

waiver. This program extends contraceptive products and limited

medical services to women who have lost Medicaid eligibility for up to two years. The women must be:

ages 14-55; at or under 185% of the federal poverty level; not eligible for Medicare, Medicaid, State Children’s Health

Insurance Program or commercial coverage; and still able to have children.

These individuals use services in many different appropriation categories.

Optional eligibility group; 60,940 individuals


General Revenue: ($2,688,201)Grants and Donations: ($842,014)Medical Care Trust Fund: ($4,399,804)

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Elimination of Medically Needy Program for Children and Pregnant Women

This issue eliminates optional coverage for Medically Needy children and pregnant women.

Under statute, this program is currently reduced to coverage of women and children as of January 1, 2011. This proposal would eliminate that coverage. Optional eligibility group; 4,572 individuals. Of these, 37 are children and 4,535 are pregnant women.


General Revenue: ($62,192,200)Medical Care Trust Fund: ($75,952,178)Grants and Donations Trust Fund: ($8,839,668)

Eliminate the Breast and Cervical Cancer Treatment Program

This issue eliminates optional coverage for women currently eligible for services due to a diagnosis of breast or cervical cancer through the Department of Health’s early detection program.

For fiscal year 2010-2011, there are an estimated 472 individuals who will use these services.


General Revenue: ($3,555,482)Medical Care Trust Fund: ($4,392,848)Grants and Donations Trust Fund: ($360,038)

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Eliminate Eligibility for Pregnant Women Between 150-185 percent of

the Federal Poverty Level This issue eliminates optional coverage for pregnant women with

income of 150 percent up to 185 percent of the federal poverty level. These individuals use a wide range of services in many different appropriation categories. Optional eligibility group; 5,846 individuals


General Revenue: ($17,020,789)Grants and Donations: ($480,555)Medical Care Trust Fund: ($31,034,569)Other Trust Fund: ($8,235,542)

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