REPORT FROM DIVISION OF AGING SERVICES DIRECTOR LAURA OTTERBOURG … · 2018. 2. 28. · FFS Nursing Facility (NF) 8,540 MLTSS HCBS 22,367 MLTSS Assisted Living 3,094 11,744 41,860

R E P O R T F R O M D I V I S I O N O F A G I N G S E R V I C E S

D I R E C T O R L A U R A O T T E R B O U R G

FEBRUARY 22, 2018

MLTSS Steering C0mmittee Meeting

2 Advisory, Consultative, Deliberative

Long Term Care (LTC) and Managed Long Term Services & Supports (MLTSS)


Total Long Term Care Recipients* 54,573

FFS Nursing Facility (NF) 8,540

MLTSS HCBS 22,367

MLTSS Assisted Living 3,094

11,744

41,860

Fee For Service (FFS/Managed Care Exemption)

Managed Long Term Support & Services (MLTSS)

Long Term Care Recipients Summary – January 2018

Source: NJ DMAHS Shared Data Warehouse Regular MMX Eligibility Summary Universe, accessed 2/6/2018. Notes: Information shown includes any person who was considered LTC at any point in a given month and includes individuals with Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499, Special Program Codes 03, 05, 06, 17, 32, 60-67, Category of Service Code 07, or MC Plan Codes 220-223 (PACE). * ‘FFS NF – Other is derived based on the prior month’s population with a completion factor (CF) included to estimate the impact of nursing facility claims not yet received. Historically, 63.56% of long term care nursing facility fee-for-service claims are received one month after the end of a given service month. ** Includes Medically Needy (PSC 170,180,270,280,340-370,570&580) recipients residing in nursing facilities and individuals in all other program status codes residing in nursing facilities that are not within special program codes 60-67 or capitation codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499.

FFS NF – Other** 2,949

MLTSS NF 16,112

MLTSS SCNF (Upper & Lower) 287

969 PACE

FFS Skilled Nursing Facility (SCNF) 255


MLTSS Rebalancing

Source: Monthly Eligibility Universe (MMX) in Shared Data Warehouse (SDW), accessed on 2/6/2018.

Notes: All recipients with PACE plan codes (220-229) are categorized as PACE regardless of SPC, Capitation Code, or COS. Home & Community Based Services (HCBS) Population is defined as recipients with a special program code (SPC) of 60 (HCBS) or 62 (HCBS – Assisted Living) OR Capitation Code 79399,89399 (MLTSS HCBS) with no fee-for-service nursing facility claims in the measured month. Nursing Facility (NF) Population is defined as recipients with a SPC 61,63,64,65,66,67 OR CAP Code 78199,88199,78399,88399,78499,88499 OR a SPC 60,62 with a COS code 07 OR a Cap Code 79399,89399 with a COS code 07 OR a COS 07 without a SPC 60-67 (Medically Needy &/or Rehab). COS 07 count w/out a SPC 6x or one of the specified cap codes uses count for the prior month and applies a completion factor (CF) due to claims lag (majority are medically needy recipients).

27.5% 29.9% 32.6% 35.8% 39.1% 41.9% 44.8% 46.7%

2.0% 2.0%

2.0% 2.0%

1.9% 1.9%

1.8% 1.8%

70.5% 68.1% 65.4% 62.2% 58.9% 56.3% 53.4% 51.6%

0%

20%

40%

60%

80%

100%

Jul-14 Jan-15 Jul-15 Jan-16 Jul-16 Jan-17 Jul-17 Jan-18

6 Month Intervals

HCBS% PACE % NF%


Long Term Care Population by County

Source: DMAHS Shared Data Warehouse Monthly Eligibility Universe, accessed 2/6/18.

Notes: Information shown includes any person who was considered LTC at any point in a given month, based on CAP Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499, Special Program Codes 60-67, Category of Service Code 07, or MC Plan Codes 220-223 (PACE). * Uses count for the prior month due to claims lag in identifying medically needy (PSC 170,180,270,280,340-370,570&580) and other non-exempt fee-for-service nursing facility recipients.

COUNTY NJ

FamilyCare LTC

ATLANTIC 4.1% 3.5%

BERGEN 6.6% 9.5%

BURLINGTON 3.6% 4.0%

CAMDEN 8.2% 7.5%

CAPE MAY 1.1% 1.5%

CUMBERLAND 2.8% 2.6%

ESSEX 13.5% 8.9%

GLOUCESTER 2.7% 2.6%

HUDSON 10.3% 9.3%

HUNTERDON 0.6% 0.7%

MERCER 4.1% 4.3%

MIDDLESEX 7.7% 7.5%

MONMOUTH 4.7% 6.6%

MORRIS 2.5% 3.9%

OCEAN 7.5% 7.3%

PASSAIC 8.9% 7.5%

SALEM 0.9% 1.0%

SOMERSET 1.9% 2.7%

SUSSEX 0.9% 1.3%

UNION 6.6% 6.3%

WARREN 0.9% 1.2%

881

2,626

911

1,948

352 607

1,869

793

3,151

120

932

2,021

1,435

847

1,430

2,231

199 517

165

1,488

237

963

2,377

1,169

1,751

447

553

2,784

586

1,630

228

1,053

1,936

1,958

1,209

2,425

1,714

310

911

512

1,803

401

5

26

212

1

229

2

10

116

280

3

91

3

1

0

1,000

2,000

3,000

4,000

5,000

6,000

December 2017

HCBS & AL NF Pace


6

Long Term Care Recipients per County, by Age Grouping

Source: NJ DMAHS Shared Data Warehouse Regular MMX Eligibility Summary Universe, accessed 2/6/2018. Notes: Information shown includes any person who was considered LTC at any point in a given month and includes individuals with Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499, Special Program Codes 03, 05, 06, 17, 32 (prior to 7/1/14) or SPC 60-67 (post 7/1/14), Category of Service Code 07, or MC Plan Codes 220-223 (PACE). County distinction is based on recipient’s county of residence in the given month.

25%

12%

26% 26% 26% 27% 26% 23%

19% 17%

26% 18% 17% 17% 20% 20% 23%

12%

25% 19%

9%

42%

47%

37% 43%

43% 43% 45% 43%

50%

35%

40%

45% 41% 45% 40%

47% 49%

40%

44%

45%

44%

30%

40% 33%

26% 29% 29% 27% 30% 30%

45%

31% 34% 39% 36% 38%

30% 25%

46%

28% 33%

46%

0%

20%

40%

60%

80%

100%

County Long Term Care Population, by Age Grouping December 2017

0-34 35-64 65-84 85+


7

Rebalancing Long Term Care, by County

Source: NJ DMAHS Shared Data Warehouse Regular MMX Eligibility Summary Universe, accessed 2/6/2018. Notes: Information shown includes any person who was considered LTC at any point in a given month and includes individuals with Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499, Special Program Codes 03, 05, 06, 17, 32 (prior to 7/1/14) or SPC 60-67 (post 7/1/14), Category of Service Code 07, or MC Plan Codes 220-223 (PACE). County distinction is based on recipient’s county of residence in the given month.

48% 53%

44%

53%

44%

53%

40%

58%

66%

34%

47% 51%

42% 41% 37%

57%

39% 36%

24%

45%

17%

52% 47%

56%

47%

56%

47%

60%

42%

34%

66%

53% 49%

58% 59% 63%

43%

61% 64%

76%

55%

83%

0%

20%

40%

60%

80%

100%

HCBS/AL NF/SCNF


8

MLTSS Recipients per County, by Plan

Source: NJ DMAHS Shared Data Warehouse Regular MMX Eligibility Summary Universe, accessed 2/1/2018. Notes: Information shown includes any person who was considered MLTSS at any point in a given month and includes individuals with Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 & 88499 AND Special Program Codes 60-64. County distinction is based on recipient’s county of residence in the given month.

906 1,174

986

1,823

378

729

1,064

615

1,314

188

906 1,164 1,261

490

1,562

789

202 450

171

648

289

300

624

359

635

118

110

849

390

707

224

569

736

367

411

430

192

103

602

108

257

650

215

395

545

147

687

185

492

494

294

884

914

159

344

1,402

660

1,128

202

746 101

374

955

194

702

273

158

305

332

192 192

107

226

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

January 2018

Horizon United Amerigroup WellCare Aetna FFS


MLTSS Setting by Plan


Notes: Includes all recipients in Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499, 88499 at any point in the given month and categorizes them by plan.

28.4%

49.0% 56.1%

45.9%

72.8%

4.3%

9.2%

7.8%

11.3%

2.2%

67.3%

41.8% 36.1%

42.8%

25.0%

0%

20%

40%

60%

80%

100%

Aetna Amerigroup Horizon United WellCare

January 2018

MLTSS HCBS MLTSS AL MLTSS NF/SCNF


HCBS Population’s LTC Services Utilization, by SFY

Source: NJ DMAHS Share Data Warehouse MLTSS Services Dictionary, accessed on 1/22/2018. Notes: Dollars represent encounters paid through the date that the SDW was accessed. Subcapitations are not included in this data. Other Includes: Adult Family Care, Caregiver Training, Chore Services, Community Transition Services, Medication Dispensing Device (Monitoring), Medication Dispensing Device (Setup), Residential Modifications, TBI Behavioral Management, Non-Medical Transportation, and Vehicle Modifications.

Monthly Average Number of HCBS Recipients

SFY15 SFY16 SFY17

HCBS/AL 12,459 16,236 20,955

$99.8

$60.1

$28.1

$11.7 $20.3

$154.3

$62.5

$30.7 $28.3 $27.4

$221.3

$62.8

$37.1

$53.6

$32.3

$0

$50

$100

$150

$200

$250

PCA/Home-Based SupportCare

Assisted Living NF/SCNF Services Medical Day Services Private Duty Nursing

Mill

ion

s

HCBS Population: Top 5 LTC Services Utilized SFY15, SFY16 & SFY17

SFY15 SFY16 SFY17


MLTSS Population’s LTC Services Utilization, SFY17

Source: NJ DMAHS Share Data Warehouse MLTSS Services Dictionary, accessed on 1/22/2018. Notes: Claims represent encounters paid through the date that the SDW was accessed. Subcapitations are not included in this data. Data not shown for services whose claims represent 5% or less of total claims. LTC Services not shown include: Adult Family Care, Assisted Living Program, Caregiver Training, Chore Services, Cognitive Therapy (Group/Indiv.), Community Transition Services, Home-Delivered Meals, Medication Dispensing Device (Monitoring), Medication Dispensing Device (Setup), Occupational Therapy (Group/Indiv.), PERS Monitoring, PERS Setup, Physical Therapy (Group/Indiv.), Residential Modifications, Respite (Daily/Hourly), Social Adult Day Care, Speech/Language/Hearing Therapy (Group/Indiv.), Structured Day Program, Supported Day Services, TBI Behavioral Management, and Vehicle Modifications.

Long Term Care Service Type Utilization Dollars

NF/SCNF Services $1,710,764,634

PCA/Home-Based Support Care $222,260,602

Assisted Living $63,650,092

Medical Day Services $53,696,264

Private Duty Nursing $32,490,894

Community Residential Services $13,228,420

TBI Habilitative Therapies $9,936,089

Home-Delivered Meals $8,285,563

Structured Day Program $3,895,072

PERS Set-up & Monitoring $2,586,195

Respite $2,089,713

Residential Modifications $1,108,144

Other $626,108

Social Adult Day Care $521,124

Supported Day Services $10,292

Grand Total $2,125,149,206


Overall MLTSS Migration (All Settings)

Source: NJ DMAHS Shared Data Warehouse MLTSS Summary Table, accessed 2/8/2018.

Notes: Base numbers include any person who was considered MLTSS at any point in a given month, based on cap codes 79399, 89399, 78199, 88199, 78399, 88399, 78499 and 88499. ABD defined as PSC 1xx, 2xx, or 5xx or cap codes 77399, 79599, 87399 or 89599. ‘New to MLTSS – Other’ consists of 'New to NJ FamilyCare' and 'Migrated into MLTSS from FFS NF'

1,295

1,606

1,667

1,458

1,347

1,227

744

288

-803

-611

-631

-435

-388

-239

-191

-134

-127

-212

-168

-128

-123

-97

-75

-56

-1000 -500 0 500 1000 1500 2000

Dec-17

Jun-17

Dec-16

Jun-16

Dec-15

Jun-15

Dec-14

Aug-14

Migrated into MLTSS from ABD No Longer Enrolled in NJ FamilyCareMigrated into MLTSS from Non-ABD Eligibility Category Left MLTSSNew to MLTSS- Other

Migrating Into MLTSS Migrating Out of MLTSS


A Look at the June 30, 2014 Waiver Population Today


Notes: Includes all recipients who were in a waiver SPC (03, 05, 06, 17 or 32) on 6/30/14. Where they are now is based on capitation code or PSC. Those without a current capitation code or PSC are determined to be “No Longer Enrolled”. Of the total number no longer enrolled, 93.8% (3,102) have a date of death in the system (current through 7-11-16).

MLTSS HCBS 5,252 43.6%

MLTSS NF 1,069 8.9%

Other (Non-MLTSS NJ FamilyCare)

308 2.6%

No Longer Enrolled

5,409 44.9%

All Waivers (6/30/14 = 12,040)


MLTSS Population, by Age Group January 2018


Notes: Includes all recipients in Capitation Codes 79399, 89399, 78199, 88199, 78399, 88399, 78499, 88499 at any point in the given month and categorizes them by age.

0-21 78

0.5%

22-64 2,980 18.2%

65-84 6,808 41.5%

85+ 6,533 39.8%

MLTSS NF/SCNF

0 - 21 440

1.7%

22 - 64 6,594 25.9%

65 - 84 11,775 46.2%

85+ 6,652 26.1%

MLTSS HCBS/AL


Home Delivered Meals

Source: NJ DMAHS Share Data Warehouse MLTSS Services Dictionary, accessed on 2/9/2018. Notes: Claims represent encounters paid through the date that the SDW was accessed. Recipient counts are unique for each month shown. Home Delivered Meals use procedure code S5170_null and S5170_SE. All recipients included in counts were in one of the 8 MLTSS cap codes during the service month on the claim.

1,399 1,402 1,548

1,874

2,336

3,101

3,474

4,113

4,559

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

5,000

7/1

/20

14

8/1

/20

14

9/1

/20

14

10

/1/2

01

4

11

/1/2

01

4

12

/1/2

01

4

1/1

/20

15

2/1

/20

15

3/1

/20

15

4/1

/20

15

5/1

/20

15

6/1

/20

15

7/1

/20

15

8/1

/20

15

9/1

/20

15

10

/1/2

01

5

11

/1/2

01

5

12

/1/2

01

5

1/1

/20

16

2/1

/20

16

3/1

/20

16

4/1

/20

16

5/1

/20

16

6/1

/20

16

7/1

/20

16

8/1

/20

16

9/1

/20

16

10

/1/2

01

6

11

/1/2

01

6

12

/1/2

01

6

1/1

/20

17

2/1

/20

17

3/1

/20

17

4/1

/20

17

5/1

/20

17

6/1

/20

17

7/1

/20

17

8/1

/20

17

9/1

/20

17

Home Delivered Meals MLTSS Recipients

Questions?

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REPORT FROM DIVISION OF AGING SERVICES DIRECTOR LAURA OTTERBOURG … · 2018. 2. 28. · FFS Nursing Facility (NF) 8,540 MLTSS HCBS 22,367 MLTSS Assisted Living 3,094 11,744 41,860