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SFY 2017 non-emergency medical transportation rate development

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Presentation on theme: "SFY 2017 non-emergency medical transportation rate development"— Presentation transcript:

1 SFY 2017 non-emergency medical transportation rate development
MO Healthnet Division and Department of Mental Health FEBRUARY 24, 2016 Elizabeth Larson, FSA, MAAA Angela WasDyke, ASA, MAAA

2 Introduction/Overview
General Background State Fiscal Year (SFY) 2017 Rate-Setting Overview Base Data Development SFY 2017 Rate Range Development Performance Questions

3 General Background

4 General Background Non-Emergency Medical Transportation (NEMT) programs: Missouri HealthNet Division (MHD) Transportation services to Medical services offered by MHD Department of Mental Health (DMH) Transportation to certain DMH Community Psychiatric Rehabilitation and Medication Management (CPR) and Community Substance Abuse Treatment and Alcohol Rehabilitation (CSTAR) services Separate rates are developed for MHD and DMH services

5 General Background Populations covered by NEMT contractors:
Aged, Blind and Disabled (ABD) Medical Assistance for Families, Children and Pregnant Women (MAFCPW) Rate regions Refer to RFP for detailed population and service coverages Region Counties ABD-1 Franklin, Jefferson, St. Charles, St. Louis County, St. Louis City ABD-2 Cass, Clay, Jackson, Johnson, Lafayette, Platte, Ray ABD-3 All other counties not identified in ABD-1 or ABD-2 regions MAFCPW Statewide for non-managed care (MC) eligibles

6 SFY 2017 Rate-setting Overview

7 SFY 2017 Rate-Setting Overview
Financial Data from SFYs 2014 and 2015 - Trend - Program Changes - Adjustments SFY 2015 Base Data - Trend - Program Changes - MC Adjustments - Administration/Underwriting Gain SFY 2017 (July 1, 2016 through June 30, 2017) Rate Ranges

8 SFY 2017 Rate-Setting Overview Documentation Materials Available
SFY 2017 rate-related RFP attachments: Attachment 2: Financial data summaries Attachment 4: Description of rate-setting methodology and program changes Attachment 11: Template for quarterly financial reporting

9 Base Data Development

10 Base Data Development Transportation vendor-reported experience from Attachment 11 includes: Transportation modes Ancillary services Gas reimbursement Costs reported separately for MHD and DMH programs and regions Desk review: Check for completeness, consistency and reasonability Review of outstanding claims: Analyze lag triangles Apply incurred but not paid adjustment

11 Base Data Development Establish base data using SFY 2014 and SFY 2015 time periods Apply historical program changes with effective dates through SFY 2015: Developmental Disabilities waiver Medical Transportation coverage for MHD eligibles effective July 1, 2014 Trend SFY 2014 data to SFY 2015 (5.5% to 7.5% by region) Blend two years of data placing 20.0% weight on SFY 2014 data and 80.0% weight on SFY 2015 data

12 SFY 2017 Rate Range Development

13 SFY 2017 Rate Range Development Trend
Trend is the projection of utilization and unit cost changes over time Trend sources: Vendor reported financial data Vendor responses to financial data desk review questions Other state NEMT programs, and national indices Trend varies by region: Apply 24 months of trend from midpoint of base data year (January 1, 2015) to midpoint of contract year (January 1, 2017) Region MHD DMH ABD 1 3.9% ABD 2 ABD 3 2.9% MAFCPW 1.9%

14 SFY 2017 Rate Range Development Program Changes
Gas price normalization: Mercer researched United States Department of Energy gas price projections to try to mitigate the influence of gas price variability as it relates to the unit cost trend for the various NEMT transportation modes The portion of the unit cost for the various modes of transportation attributable to gas was modified to reflect the anticipated gas price levels identified by the United States Department of Energy in SFY 2017 The financial impact is a 1.6% decrease to the MHD rate ranges and 1.9% decrease to the DMH rate ranges Reimbursement of gas expenses for automobiles has ranged from $0.31 to $0.47 during the two years of base experience Mercer assumed mileage reimbursement equal to the midpoint of the Internal Revenue Service standard rate for medical ($0.23) and business use ($0.575) The financial impact is a 0.4% increase to the MHD rate ranges and 7.0% decrease to the DMH rate ranges for this change

15 SFY 2017 Rate Range Development Program Changes
Program changes (continued) Trip reallocation: In the SFY 2014 and SFY 2015 time periods, the DMH experience exhibited a lower than expected claim volume After further consultation with the State and the Transportation vendor, it was determined that DMH trips were coded inaccurately as MHD trips Call center service system changes were made in October 2015 Emerging experience exhibited a higher proportion of DMH trips Mercer remapped the experience between MHD and DMH to proxy the trip distribution developed during the SFY 2015 and SFY 2016 rate cycles The financial impact is a 3.5% decrease to the MHD rate ranges and a 806.6% increase to the DMH rate ranges

16 SFY 2017 Rate Range Development Managed Care Assumptions
Provision of services to eligible members reviewed on a regional basis to determine the most appropriate and cost-effective mode of transportation Reduction in trips associated with taxi, para-lift van, stretcher van and ambulance based on actual service provision in program over time Shift to other modes of transportation such as bus, multi-passenger van and gas mileage reimbursement The financial impact is a 1.1% decrease to the MHD rate ranges and there is no impact to the DMH rate ranges

17 SFY 2017 Rate Range Development Administration/Contingencies Load
Sources of information: Vendor experience Other state Medicaid programs Consideration given for: General costs associated with business operations Intake and dispatch call centers Withhold performance metrics Contingencies MHD DMH Administration 15.4% Contingencies 2.0% Total 17.4%

18 SFY 2017 Rate Range Development Capitation Rates by Program
MHD DMH Base Data $5.40 $0.01 Annual Trend (apply for 2 years) 3.2% 3.0% Program Changes -4.6% 727.2% Gas price normalization -1.6% -1.9% Gas reimbursement 0.4% -7.0% Trip reallocation -3.5% 806.6% Managed Care Adjustments -1.1% 0.0% Administration/Contingencies Load 17.4% Average SFY 2017 Capitation Rate $6.57 $0.13

19 Performance Standards

20 Performance Standards
Aggregate 2.0% withhold applied to capitation payments Withhold returned for meeting a metric with prorating for partially meeting a metric Adjustment to administrative component of capitation rates made to reflect portion of withhold expected to be returned Withhold returned for metrics met within 90 days from the end of each reporting quarter

21 Performance Standards
Performance Metric Application Frequency Withhold Call Center Service Call wait time Call abandonment Statewide Quarterly 0.20% 2. Timeliness of Transport Pick-up wait time Will-call Hospital Discharge 0.10% 3. Service 0.60% 4. Dialysis/Cancer Treatments

22 Questions?

23

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