Presentation on theme: "Data Profile of Ohio Medicaid Nursing Facility and Nursing Facility Level of Care Consumers State Fiscal Year 2007 July 2006 through June 2007 Dave Dorsky."— Presentation transcript:
Data Profile of Ohio Medicaid Nursing Facility and Nursing Facility Level of Care Consumers State Fiscal Year 2007 July 2006 through June 2007 Dave Dorsky Ohio Department of Job and Family Services Office of Ohio Health Plans Bureau of Health Plan Policy Health Services Research January 10, 2008
Overview 1. How many consumers lived in Nursing Facilities or participated in Nursing Facility Level of Care waivers or PACE? 2. What services were received? 3. How many consumers received these services? 4. How much did these services cost?
Nursing Facility Level of Care A. Waivers 1. Ohio Home Care 2. Assisted Living 3. Choices 4. PASSPORT 5. Transitions Aging Carveout B. PACE - Program of All-Inclusive Care for the Elderly C. Nursing Facility
Data Source Medicaid Decision Support System Decision Analyst: Licensed by Thomson Medstat Sourced from the ODJFS Data Warehouse Contains 84 rolling months (seven years) of data Updated Monthly
Data Source Medicaid Decision Support System (Continued) Limitations Snapshot of data at end of month Some retroactive adjustments to eligibility fields are not captured Some adjustments to claims are not captured Prescription drug rebates Gross adjustments not made at individual claim level State plan services billed to waiver
Key Concepts 1. Members vs. Consumers Members are how many persons were enrolled Consumers are how many persons used services Volume differs by time period due to churning 2. Net Payment versus Allowed Amount Net Payment is the amount paid through our claims systems after third party payment and other adjustments. Allowed Amount is the maximum reimbursement for a particular service code according to our rate setting system, before third party payments and other adjustments Only Allowed Amount is available for some service level reporting
Key Concepts (continued) 3. Incurred versus Paid Time Periods Incurred captures claims during time periods when services occurred up to a given paid date Paid captures claims paid during a given time period regardless of when incurred Incurred is a more consistent match with enrollment Incurred and Paid are reasonably close with sufficient run-out and stable enrollment trends
Key Concepts (continued) 3.Incurred and Paid Time Periods (Continued) – Examples: Incurred 7/06 – 6/07, paid through 11/07 Paid 7/06 – 6/07, incurred 7/02 – 6/07 4. Time Windows Capture all claims associated with a given population group in a given time period All claims incurred by waiver consumers while eligible for waiver All claims incurred during calendar dates that overlap a nursing facility stay
Data Tables – Waiver and PACE Consumers 1. Members, Consumers, and Payments for Waiver and PACE Services 2. Waiver Consumers and Allowed Amount for Selected Waiver Services by Waiver 3. Total Payments for All Medicaid State Plan and Waiver Services by Waiver 4. Total Payments for All Medicaid State Plan and Waiver Services by Category of Service Assisted Living Choices Ohio Home Care Passport Transitions Aging Carveout
Data Tables – Nursing Facility Consumers 5. Ohio Medicaid Nursing Facility Consumer Summary, State Fiscal Year 2007 6. Total Medicaid Payments by Category of Service for Nursing Facility Consumers
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