Access to Health Care Nevada Medicaid

(1)

Brian Sandoval

Governor

Richard Whitley

Interim Director

Laurie Squartsoff

Administrator

Division of Health Care Financing and Policy

Access to Health Care

Nevada Medicaid

Assembly Health and Human Services

Presented by Laurie Squartsoff

March 25, 2015

Assembly

Committee:

Health

and

Human

Services

Exhibit:

E

Page

1 of

16 Date:

03/25/2015

Submitted

by:

Laurie

Squartsoff

(2)

Division of Health Care Financing and Policy

Issue - Access to Care

• When the number of Nevadans with health

care coverage increases and the statewide

provider pool remains the same, access to

care becomes a state wide issue.

–

The good news:

• Reduced uninsured rate from 23% to 11%.

• More people are getting needed care.

2

(3)

Increased

Enrollment

ACCESS

Services

Reimbursement

Workforce

Capacity

Healthcare

System

Preventative

health vs.

Health care

Consumer

Service

Needs

E-3

(4)

Division of Health Care Financing and Policy

Current structure of provider networks

Fee-for-Service

and

Managed Care

4

(5)

5

5,000 10,000 15,000 20,000 25,000 30,000

SFY 2013 SFY 2014 SFY 2015 (as of Feb. 2015) 16,602 19,362 22,306 3,576 4,415 2,735

FFS Providers by State Fiscal Year

Previously Enrolled FFS Providers Newly Enrolled FFS Providers

E-5

(6)

6

14,363 3,493 430,578 83,343 50,000 100,000 150,000 200,000 250,000 300,000 350,000 400,000 450,000 Clark Washoe

Clark and Washoe FFS Providers and Total Clients (includes MCO Clients)

FFS Providers Medicaid and CheckUp Clients

E-6

(7)

7

726 186 218 229 1 9 78 31 26 281 31 315 24 5 81 11,525 5,092 5,758 6,465 114 131 2,645 869 644 10,508 1,083 11,148 777 143 1,433 2,000 4,000 6,000 8,000 10,000 12,000 Carson

City Churchill Douglas Elko Esmeralda Eureka Humboldt Lander Lincoln Lyon Mineral Nye Pershing Storey White Pine

Rural Nevada FFS Providers and Clients by County

FFS Providers Medicaid and CheckUp Clients

E-7

(8)

Division of Health Care Financing and Policy

Steps to address adequate provider network

• Maximizing existing network

• Increased accountability of MCOs

• Provider outreach

8

(9)

Division of Health Care Financing and Policy

Actions taken to address Access to Care

• Implementation of Telehealth policy change

• Expanded use of Advanced Practice Registered Nurses

• Physician Forums with FFS and MCO

• Prior Authorization Alignment between FFS and MCO

• Health Care Guidance Program for high need Fee for

Service Recipients

• Increased Inpatient Psychiatric Rate

• Implemented the “In Lieu of” option for MCO

9

(10)

Division of Health Care Financing and Policy

Any questions?

Thank you…

10

(11)

Urban Nevada – Washoe County FFS Providers by Provider Type

Provider Types Provider Totals

Washoe

3487

Adult Day Health Center 1

Adult Group Care Waiver 62

Ambulance,Air/Ground 4

Ambulatory Surgical Centers 9

Audiologist 17

Certified R.N. Practitioner 164

Chiropractor 9

Critical Access Hosp/Inpatient 1

Dentist 154

DME, Disposable, Prosthetics 79

ESRD Facility 8

Hearing Aid Dispenser/Rel Ltd 1

Home Health Agency 5

Home/Comm Based Waiver-Mr 72

Hospice 5

Hospice,Long Term Care 4

Hospital, Inpatient 6

Hospital, Outpatient 5

ICF-MR / Public 1

IHS And Tribal Clinics 3

Intravenous Therapy 1

Laboratory,Pathology/Clinical 4

Mental Health, Outpatient 868

Mental Hlth Rehab Svc/Non-Res 174

Mental Hosp(Rehab/Sp), Inpat 2

Nurse Anesthetist 7

Nurse Midwife 9

Nursing Facility 7

Optician,Optical Business 3

Optometrist 62

Outpatient Psych Hosp.,Private 2

Outpatient Surgery, Hosp Based 5

Pers Care Aid-Inter Serv Orgn 4

Personal Care Aid-Prov Agncy 10

Pharmacy 79

Physically Disabled Waiver 55

Physician, M.D.,Osteopath 1166 Physicians Assistant 96 Podiatrist 12 Psychiatric, Inpatient 2 Psychologist 48 Radiology/Noninvasive Diag Ctr 3 Residential Treatment Ctr 1 School Based 1

Senior Waiver(Frail Elderly) 13

Special Clinics 26

Targeted Case Management 11

Therapy 204

Treatment Home Room & Board 2

Grand Total 3487

(12)

Provider Type Provider Totals

Clark

14363

Adult Day Health Center 13 Adult Group Care Waiver 76 Ambulance,Air/Ground 12 Ambulatory Surgical Centers 33 Audiologist 42 Certified R.N. Practitioner 478 Chiropractor 30 Critical Access Hosp/Inpatient 2 Dentist 649 DME, Disposable, Prosthetics 302 ESRD Facility 29 Facility Based Assisted Living 2 Health Maint Org (HMO) 4 Hearing Aid Dispenser/Rel Ltd 3 Home Health Agency 56 Home/Comm Based Waiver-Mr 37 Hospice 26 Hospice,Long Term Care 21 Hospital, Inpatient 15 Hospital, Outpatient 21 ICF-MR / Private 6 ICF-MR / Public 1 IHS And Tribal Clinics 2 Intravenous Therapy 3 Laboratory,Pathology/Clinical 11 Mental Health, Outpatient 4915 Mental Hlth Rehab Svc/Non-Res 982 Mental Hosp(Rehab/Sp), Inpat 9 Nurse Anesthetist 72 Nurse Midwife 3

Nursing Facility 27 Optician, Optical Business 11 Optometrist 230 Outpatient Psych Hosp.,Private 1 Outpatient Surgery, Hosp Based 15 Pers Care Aid-Inter Serv Orgn 9 Personal Care Aid-Prov Agncy 81 Pharmacy 335 Physically Disabled Waiver 63 Physician, M.D.,Osteopath 4354 Physicians Assistant 384 Podiatrist 67 Psychiatric, Inpatient 10 Psychologist 120 Radiology/Noninvasive Diag Ctr 25 Residential Treatment Ctr 3 School Based 1 Senior Waiver(Frail Elderly) 55 Special Clinics 38 Targeted Case Management 14 Therapy 664 Trans Rehab Center, Outpatient 1

Urban Nevada – Clark County FFS providers by Provider Type

(13)

County

Provider Totals

Carson City

726 Churchill

186 Clark

14363

Douglas

218 Elko

229 Esmeralda

1 Eureka

9 Humboldt

78 Lander

31 Lincoln

26 Lyon

281 Mineral

31 Nye

315 Pershing

24 Storey

5 Washoe

3493

White Pine

81 Grand Total

20097

Enrolled FFS Providers as of February 2015 by County

(14)

Carson City

726

Ambulance, Air/Ground 1

Ambulatory Surgical Centers 5

Audiologist 6

Dentist 19

ESRD Facility 3

Facility Based Assisted Living 1

ICF-MR / Private 1

Mental Hlth Rehab Svc/Non-Res 11

Mental Hosp(Rehab/Sp), Inpat 2

Nurse Anesthetist 3

Nursing Facility 3

Optician,Optical Business 1

Optometrist 26

Personal Care Aid-Prov Agncy 1

Pharmacy 14

Physician, M.D.,Osteopath 241

Physicians Assistant 31

Podiatrist 4

Psychologist 12

School Based 1

Senior Waiver(Frail Elderly) 1

Special Clinics 4

Therapy 33

Treatment Home Room & Board 1

Churchill

186

Chiropractor 2

Dentist 8

ESRD Facility 1

Hospice 1

Nurse Anesthetist 13

Nursing Facility 1

Optometrist 9

Pharmacy 5

Physicians Assistant 12

Psychologist 1

School Based 1

Special Clinics 3

Therapy 4

Rural Nevada FFS Providers by County and Provider Type

(15)

Provider Type

Provider Totals

Douglas

218 Adult Group Care Waiver

1 Ambulance,Air/Ground

2 Ambulatory Surgical Centers

1 Certified R.N. Practitioner

8 Chiropractor

1 Critical Access Hosp/Inpatient

1 Dentist

4 DME, Disposable, Prosthetics

4 ESRD Facility

1 Home Health Agency

1 Home/Comm Based Waiver-Mr

1 Hospital, Outpatient

1 IHS And Tribal Clinics

1 Mental Health, Outpatient

64 Mental Hlth Rehab Svc/Non-Res

1 Nurse Midwife

1 Nursing Facility

1 Optometrist

4 Outpatient Surgery, Hosp Based

1 Pharmacy

7 Physically Disabled Waiver

1 Physician, M.D.,Osteopath

85 Physicians Assistant

5 Psychologist

1 Special Clinics

5 Targeted Case Management

1 Therapy

14 Grand Total

218 Provider Type

Provider Totals

Elko

229 Adult Day Health Center

1 Ambulance,Air/Ground

6 Ambulatory Surgical Centers

1 Audiologist

1 Certified R.N. Practitioner

13 Dentist

18 DME, Disposable, Prosthetics

9 ESRD Facility

1 Hearing Aid Dispenser/Rel Ltd

1 Home/Comm Based Waiver-Mr

1 Hospital, Inpatient

1 Hospital, Outpatient

1 IHS And Tribal Clinics

2 Mental Health, Outpatient

19 Nurse Anesthetist

10 Nursing Facility

1 Optometrist

10 Outpatient Surgery, Hosp Based

1 Personal Care Aid-Prov Agncy

1 Pharmacy

8 Physically Disabled Waiver

2 Physician, M.D.,Osteopath

90 Physicians Assistant

6 Psychologist

1 Senior Waiver(Frail Elderly)

1 Special Clinics

5 Targeted Case Management

1 Therapy

17 Grand Total

229 Rural Nevada FFS Providers by County and Provider Type

(16)

Esmeralda

1

Grand Total 1

Eureka

9

Ambulance,Air/Ground 1 Certified R.N. Practitioner 2 Physician, M.D.,Osteopath 3 Physicians Assistant 1 Special Clinics 2 Grand Total 9

Humboldt

78

ESRD Facility 1

Nurse Anesthetist 1

Nursing Facility 1

Optometrist 4

Pharmacy 4

Special Clinics 4

Swing-Bed,Acute Hospital 1

Therapy 9

Grand Total 78

Lander

31

Dentist 1

Nursing Facility 1

Pharmacy 2

Special Clinics 4

Swing-Bed,Acute Hospital 1

Grand Total 31