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
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
Increased
Enrollment
ACCESS
Services
Reimbursement
Workforce
Capacity
Healthcare
System
Preventative
health vs.
Health care
Consumer
Service
Needs
E-3
Division of Health Care Financing and Policy
Current structure of provider networks
Fee-for-Service
and
Managed Care
4
5
5,000 10,000 15,000 20,000 25,000 30,000SFY 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
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 WashoeClark and Washoe FFS Providers and Total Clients (includes MCO Clients)
FFS Providers Medicaid and CheckUp Clients
E-6
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 CarsonCity 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
Division of Health Care Financing and Policy
Steps to address adequate provider network
•
Maximizing existing network
•
Increased accountability of MCOs
•
Provider outreach
8
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
Division of Health Care Financing and Policy
Any questions?
Thank you…
10
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
Provider Types Provider Totals
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
Grand Total 14363
Provider Type Provider Totals
Urban Nevada – Clark County FFS providers by Provider Type
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
Provider Type Provider Totals
Carson City
726
Adult Group Care Waiver 3
Ambulance, Air/Ground 1
Ambulatory Surgical Centers 5
Audiologist 6
Certified R.N. Practitioner 34
Dentist 19
DME, Disposable, Prosthetics 17
ESRD Facility 3
Facility Based Assisted Living 1
Home/Comm Based Waiver-Mr 4
Hospital, Inpatient 2
Hospital, Outpatient 2
ICF-MR / Private 1
Mental Health, Outpatient 234
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
Outpatient Surgery, Hosp Based 2
Personal Care Aid-Prov Agncy 1
Pharmacy 14
Physically Disabled Waiver 2
Physician, M.D.,Osteopath 241
Physicians Assistant 31
Podiatrist 4
Psychologist 12
School Based 1
Senior Waiver(Frail Elderly) 1
Special Clinics 4
Targeted Case Management 1
Therapy 33
Treatment Home Room & Board 1
Grand Total 726
Provider Type Provider Totals
Churchill
186
Adult Group Care Waiver 3
Ambulance,Air/Ground 1
Certified R.N. Practitioner 3
Chiropractor 2
Dentist 8
DME, Disposable, Prosthetics 4
ESRD Facility 1
Hospice 1
Hospital, Inpatient 1
Hospital, Outpatient 1
IHS And Tribal Clinics 1
Mental Health, Outpatient 33
Nurse Anesthetist 13
Nursing Facility 1
Optometrist 9
Outpatient Surgery, Hosp Based 1
Pharmacy 5
Physically Disabled Waiver 1
Physician, M.D.,Osteopath 75
Physicians Assistant 12
Psychologist 1
School Based 1
Special Clinics 3
Targeted Case Management 1
Therapy 4
Grand Total 186
Rural Nevada FFS Providers by County and Provider Type
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
Provider Type Provider Totals
Esmeralda
1
Ambulance, Air/Ground 1
Grand Total 1
Provider Type Provider Totals
Eureka
9
Ambulance,Air/Ground 1 Certified R.N. Practitioner 2 Physician, M.D.,Osteopath 3 Physicians Assistant 1 Special Clinics 2 Grand Total 9Provider Types Provider Totals
Humboldt
78
Ambulance, Air/Ground 2
Certified R.N. Practitioner 3
Critical Access Hosp/Inpatient 1
DME, Disposable, Prosthetics 3
ESRD Facility 1
Home/Comm Based Waiver-Mr 3
Hospital, Outpatient 1
IHS And Tribal Clinics 1
Mental Health, Outpatient 4
Nurse Anesthetist 1
Nursing Facility 1
Optometrist 4
Outpatient Surgery, Hosp Based 1
Pharmacy 4
Physician, M.D.,Osteopath 33
Special Clinics 4
Swing-Bed,Acute Hospital 1
Targeted Case Management 1
Therapy 9
Grand Total 78
Provider Type Provider Totals
Lander
31
Ambulance,Air/Ground 2
Certified R.N. Practitioner 5
Critical Access Hosp/Inpatient 1
Dentist 1
Hospital, Outpatient 1
Mental Health, Outpatient 7
Nursing Facility 1
Pharmacy 2
Physician, M.D.,Osteopath 5
Special Clinics 4
Swing-Bed,Acute Hospital 1
Targeted Case Management 1
Grand Total 31