Nursing
Home
Transition
to
Managed
Care
Nursing
Home
Transition
Workgroup
Proposed Nursing Home Transition Plan
•
For
both
duals
and
non
‐
duals:
–
Persons
permanently
placed
in
a
nursing
home
before
the
transition
date
(see
“Transition
Timeline”
slide)
will
remain
in
FFS
(fee
‐
for
‐
service)
for
the
duration
of
their
stay.
–
Persons
not
permanently
placed
before
the
transition
date
will:
•
If
already
in
a
managed
care
plan,
they
will
remain
in
that
plan
upon
permanent
placement.
•
If
in
FFS
as
of
the
transition
date,
they
will
remain
in
FFS
until
eligibility
for
permanent
placement
is
determined
–
then
they
will
be
mandated
into
managed
care
(MLTC
for
duals,
MMC
for
non
‐
duals).
•
If
new
to
Medicaid,
they
will
be
required
to
enroll
in
a
plan
FIDA
Roll
‐
Out
•
October
2014
– Adults
in
the
FIDA
region
may
voluntarily
enroll
in
FIDA.
•
January
2015
– Adults
in
the
FIDA
region
will
be
passively
enrolled
in
FIDA
but
may
opt
out
back
to
MLTC
(or
back
to
FFS
if
they
were
enrolled
in
FFS
as
the
time
of
passive
Nursing Home Transition Timeline
Begin Date
Affected
Region
Adults /
Kids
Jan 2014
FIDA Region
Adults
Apr 2014
Rest of State
Adults
Oct 2014
(FIDA voluntary
roll-out)
FIDA Region
Adults
Jan 2015
(FIDA
passive enrollment)
FIDA Region
Adults
Apr 2015
Entire State
Kids
FIDA - Fully Integrated Duals Advantage Plan FIDA Region - NYC, Westchester, Nassau, Suffolk Adults - Age 21 or older
Estimated
Adult
Nursing
Home
Population
Transitioning
to
Managed
Care
(or
Remaining
in
MC
upon
Permanent
Placement)
During
First
12
Months
of
Transition
(duals
and non
‐
duals)
Statewide
FIDA Region Rest of State
Total Nursing Home Population (inc. "New")
82,601
51,735
30,866
Total "New" Population Moving Into
Managed Care
(during first 12 months of transition)20,576
12,364
8,212
Total Nursing Home Population Remaining
Outside Managed Care
(after first 12 months)62,025
39,371
22,654
Percent Transitioning in First 12 Months
25%
24%
27%
Note 1: "New" is defined as receiving permanent placement status on or after January 1, 2014 in the FIDA region or April 1, 2014 in the Rest of the State.
Note 2: This data is an estimate for the first 12 months of the adult transition and is based on Nov 1, 2010 to Oct 31, 2011 historical data. 18 to 20 year olds are included in this data, but should not be. Additionally, the figures for the "New" population are estimated to be about 10% low due to the manner in which the data was run (due to time constraints).
Estimated
Adult
Nursing
Home
Population
Transitioning
to
Managed
Care
(or
Remaining
in
MC
upon
Permanent
Placement)
During
First
12
Months
of
Transition
(duals
vs. non
‐
duals)
Statewide
Duals
Non-Duals
Total Nursing Home Population (inc. "New")
82,601
74,849
7,752
Total "New" Population Moving Into
Managed Care
(during first 12 months of transition)20,576
18,894
1,682
Total Nursing Home Population Remaining
Outside Managed Care
(after first 12 months)62,025
55,955
6,070
Percent Transitioning in First 12 Months
25%
25%
22%
Note 1: "New" is defined as receiving permanent placement status on or after January 1, 2014 in the FIDA region or April 1, 2014 in the Rest of the State.
Note 2: This data is an estimate for the first 12 months of the adult transition and is based on Nov 1, 2010 to Oct 31, 2011 historical data. 18 to 20 year olds are included in this data, but should not be. Additionally, the figures for the "New" population are estimated to be about 10% low due to the manner in which the data was run (due to time constraints).
Estimated
Spend
for
Adult
NH
Population
Transitioning
to
Managed
Care
(or
Remaining
in
MC
upon
Permanent
Placement)
During
First
12
Months
of
Transition
(duals
and non
‐
duals)
Statewide
FIDA Region
Rest of State
Total Spend on Population
$
5,969,605,431
$
4,378,668,339
$
1,590,937,092
Nursing Home Spend on Population
$
5,259,123,850
$
3,780,194,064
$
1,478,929,786
Total Spend on "New" Population Moving
Into Managed Care
$
953,293,967
$
707,659,158
$
245,634,809
Nursing Home Spend on "New" Population
Moving Into Managed Care
$
622,230,207
$
426,746,274
$
195,483,933
Total Spend on Population Remaining
Outside Managed Care
$
5,016,311,464
$
3,671,009,181
$
1,345,302,283
Nursing Home Spend on Population
Remaining Outside Managed Care
$
4,636,893,643
$
3,353,447,790
$
1,283,445,853
"New" Nursing Home Spend as Percent of Total
12%
11%
13%
Note: This payment data is not annualized and should not be. It is the actual estimated impact for year one of the transition and assumes people move into (or stay in) managed care throughout the year and not all at once.
Estimated
Spend
for
Adult
NH
Population
Transitioning
to
Managed
Care
(or
Remaining
in
MC
upon
Permanent
Placement)
During
First
12
Months
of
Transition
(duals
vs. non
‐
duals)
Statewide
Duals
Non-Duals
Total Spend on Population
$
5,969,605,431
$
4,949,339,369
$
1,020,266,061
Nursing Home Spend on Population
$
5,259,123,850
$
4,545,122,715
$
714,001,135
Total Spend on "New" Population Moving
Into Managed Care
$
953,293,967
$
746,734,090
$
206,559,877
Nursing Home Spend on "New" Population
Moving Into Managed Care
$
622,230,207
$
538,186,315
$
84,043,892
Total Spend on Population Remaining
Outside Managed Care
$
5,016,311,464
$
4,202,605,279
$
813,706,184
Nursing Home Spend on Population
Remaining Outside Managed Care
$
4,636,893,643
$
4,006,936,400
$
629,957,243
"New" Nursing Home Spend as Percent of Total
12%
12%
12%
Note: This payment data is not annualized and should not be. It is the actual estimated impact for year one of the transition and assumes people move into (or stay in) managed care throughout the year and not all at once.
