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HCR 2 Medicaid Enrollment and Claims Data SFY 21 Q3

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HCR 2 Medicaid Enrollment and Claims Data SFY 21 Q3 DocuSign Envelope ID: 26EE54AC-6D71-49AC-8281-26482C0D06D1 John Bel Edwards Dr. Courtney N. Phillips GOVERNOR SECRETARY SECRETARY State of Louisiana Louisiana Department of Health Bureau of Health Services Financing May 26, 2021 The Honorable John Bel Edwards, Governor State of Louisiana P.O. Box 94004 Baton Rouge, LA 70804 The Honorable Patrick “Page” Cortez, President Louisiana State Senate P.O. Box 94183, Capitol Station Baton Rouge, LA 70804-9183 The Honorable Clay Schexnayder, Speaker Louisiana State House of Representatives P.O. Box 94062, Capitol Station Baton Rouge, LA 70804-9062 Re: HCR 2 Quarterly Report – Medicaid Expansion Enrollment and Claims Data In response to House Concurrent Resolution 2 (HCR 2) of the 2020 First Extraordinary Session, the Louisiana Department of Health (LDH) submits the enclosed report. This report can be viewed on LDH’s website at https://ldh.la.gov/index.cfm/newsroom/detail/5892. The resolution requires LDH to publish on a quarterly basis a report containing data directly related to payment for health care services through the implementation of a health coverage expansion of the Louisiana medical assistance program. The report includes the following: (a) Total Medicaid Expansion enrollment on a monthly basis from July 2020 through March 2021. (b) The average monthly Expansion premium paid to managed care organizations providing benefits and services to eligible Medicaid enrollees and the portion of the premium related to hospital payments for the January 1, 2021 rates. (c) The aggregate Medicaid Expansion claims payment by provider type for July 2020 through March 2021. (d) The total amount of inpatient and outpatient Medicaid Expansion claims paid to hospitals delineated by individual hospital for July 2020 through March 2021 separated into two attachments by inpatient and outpatient. Bienville Building ▪ 628 N. Fourth St. ▪ P.O. Box 629 ▪ Baton Rouge, Louisiana 70821-0629 Phone: (225) 342-9500 ▪ Fax: (225) 342-5568 ▪ www.dhh.la.gov An Equal Opportunity Employer DocuSign Envelope ID: 26EE54AC-6D71-49AC-8281-26482C0D06D1 The Honorable John Bel Edwards The Honorable Patrick “Page” Cortez The Honorable Clay Schexnayder HCR 2 Quarterly Report - Medicaid Expansion Enrollment and Claims Data May 26, 2021 Page 2 Please feel free to contact me at (225) 342-6726 with any questions or comments that you may have regarding the enclosed Medicaid Expansion Enrollment and Claims Data report. Sincerely, Pam Diez Deputy Undersecretary Enclosure cc: The Honorable Fred H. Mills, Senator The Honorable Mack “Bodi” White, Senator The Honorable Larry Bagley, Representative The Honorable Jerome “Zee” Zeringue, Representative Mr. David R. Poynter, Legislative Research Library DocuSign Envelope ID: 26EE54AC-6D71-49AC-8281-26482C0D06D1 (A) Total Medicaid Expansion enrollment on a monthly basis. Month Enrollees July 2020 538,114 August 2020 550,576 September 2020 562,374 October 2020 572,485 November 2020 586,031 December 2020 599,463 January 2021 607,757 February 2021 617,709 March 2021 626,415 Source: LAMEDS, Enrollment Trends Report http://www.ldh.la.gov/index.cfm/page/1275. Data is extracted on or near the 1st day following the end of each month. Monthly data is not updated in subsequent months to reflect retro eligibility determinations made after the end of each month. HCR2_SFY2021_Q3 Business Analytics 1 of 45 DocuSign Envelope ID: 26EE54AC-6D71-49AC-8281-26482C0D06D1 (B) Average Per Member Per Month and Portion of the Per Member Per Month Associated with Hospitals Expansion Rate Estimate -- Rate Floor Expansion Adult (Rate Floor) Hospital Portion of Expansion Rate Full Rate $627.48 $278.95 • Hospital records are identified by CLQ_Claim_Type 01 and 03. • The PMPM above does not include claims related to maternity kick payments. • The PMPM above is the aggregate rate for regular Expansion and High Needs rate cells (which do not include SBH/NEMT-only). HCR2_SFY2021_Q3 Mercer Report 2 of 45 DocuSign Envelope ID: 26EE54AC-6D71-49AC-8281-26482C0D06D1 (C) The aggregate M edicaid claims payment by provider type (for Expansion only). NOTE: 1) Data are based on service provider types. 2) Data extracted by DOP and on 04/16/2021. 3) Error Providers are made up of those providers that are enrolled in the Managed Care Program but not enrolled in the Fee For Service Program (FFS). 4) Methodology change effective 7/1/19 removing PMPM payments to MCOs and MCNA (Provider Types 05 & AY) to eliminate duplication of total dollars reported. 5) Provider Types 60, 64 & 69 include $1,990,366 in payments for Non-Inpatient/Non-Outpatient claim types. Provider Type Description for Provider Type Total (= FFS + Encounters) Provider Jul-2020 Aug-2020 Sep-2020 Oct-2020 Nov-2020 Dec-2020 Jan-2021 Feb-2021 Mar-2021 SFY Sum Type Total $ 237,341,064 $ 241,206,458 $ 259,063,219 $ 278,923,000 $ 245,379,331 $ 275,703,012 $ 244,511,545 $ 251,381,990 $ 289,188,712 $ 2,322,698,331 Total 03 CHILDREN'S CHOICE (WVR)(IN-ST) 1,105 1,014 5,955 5,128 6,032 10,169 8,658 9,726 17,945 65,732 03 04 PEDI DAY HLTH CARE (IN-ST) 3,188 107 2,063 63 16 2,491 7,927 04 06 NOW PROFESSIONAL SERVICES 11,958 13,189 11,922 18,797 32,402 51,718 36,548 32,323 44,923 253,780 06 07 CASE MGMT-INFT & TODD (IN-ST) 42,258 92,125 39,079 64,298 59,937 89,323 233,206 265,910 321,113 1,207,248 07 08 OAAS CASE MGMT (IN-ST) 2,026 1,847 1,719 720 243 6,556 08 09 HOSPICE SERVICES (IN-ST) 276,126 168,021 310,222 250,641 268,096 306,675 219,136 324,892 242,381 2,366,190 09 12 MULTI-SYSTEMIC THER (IN-ST) 2,217 1,481 1,552 1,846 1,188 1,054 756 2,112 2,016 14,221 12 13 PREVOC REHAB (WVR) (IN-ST) 0 505 303 85 0 3,407 7,641 6,541 11,386 29,869 13 14 PERS EMERG RESP SYS (WVR) 188 188 14 16 PERS EMERG RESP SYS (WVR) 4,545 4,687 5,822 7,493 4,608 7,193 8,045 8,561 9,292 60,247 16 18 COMM MENTAL HLTH CTR/PART HOSP 332,834 70,851 42,707 34,895 96,769 50,923 113,685 82,806 8,810 834,279 18 19 DR OF OSTEOPATH MED (IND & GP) 784,962 989,173 837,427 995,227 871,856 927,777 821,589 824,099 1,004,838 8,056,949 19 20 PHYSICIAN (IND & GP) 27,316,344 32,035,973 27,578,281 33,507,181 29,229,057 32,962,318 28,412,226 29,389,387 33,657,037 274,087,803 20 23 INDEPENDENT LAB 4,238,799 5,235,496 4,168,864 5,940,197 5,329,534 6,023,826 6,526,345 6,762,212 5,202,080 49,427,353 23 24 PERSONAL CARE SERVICES (IN-ST) 279,199 302,489 355,741 300,114 317,613 409,327 368,302 332,751 419,185 3,084,721 24 25 MOBILE XRAY/RADIATION THRPY CT 15,420 18,384 13,884 13,687 22,163 33,687 14,596 20,625 58,419 210,865 25 26 PHARMACY 78,849,077 71,711,828 80,362,856 78,479,531 77,042,641 83,777,751 77,107,509 82,915,720 99,496,333 729,743,247 26 27 DENTIST (IND & GP) 2,475,940 2,093,767 2,049,740 2,943,557 2,356,252 2,542,155 2,298,726 1,949,846 2,312,630 21,022,613 27 28 OPTOMETRIST (IND & GP) 1,259,697 1,172,658 1,166,543 1,329,136 1,129,833 1,263,540 1,282,736 1,368,065 1,474,593 11,446,800 28 29 EARLYSTEPS (IND & GP) (IN-ST) 5 6 13 24 29 30 CHIROPRACTOR (IND & GP) 37,617 38,951 29,902 34,987 33,640 50,414 37,191 44,041 50,312 357,054 30 31 PSYCHOLOGIST (LIC/MED) (IN-ST) 136,369 133,160 99,190 136,557 105,526 113,859 92,893 100,944 162,692 1,081,190 31 32 PODIATRIST (IND & GP) 175,537 233,730 224,948 241,939 236,063 238,965 209,751 253,446 295,814 2,110,192 32 33 PRESCRIBING ONLY PROVIDER 162,309 118,524 83,891 76,768 89,402 95,506 85,322 127,066 116,484 955,272 33 34 AUDIOLOGIST (IN-ST) 14,448 13,675 14,421 27,922 23,325 16,932 18,471 12,255 25,095 166,543 34 35 PHYSICAL THERAPIST (IN-ST) 431,633 526,527 493,294 550,335 584,992 605,786 507,193 546,646 691,845 4,938,250 35 37 OCCUPATIONAL THERAPIST (IN-ST) 41,381 48,400 40,045 55,105 47,765 42,029 36,272 33,734 46,036 390,768 37 38 SCHOOL BSED HEALTH CTR (IN-ST) 363 88 200 108 344 351 45 30 565 2,094 38 39 SPEECH/LANGUAGE THERAP (IN-ST) 10,590 7,038 8,119 7,933 6,709 9,193 4,290 3,908 4,213 61,993 39 40 DME 2,444,483 2,414,503 2,386,561 2,430,956 2,546,482 2,882,422 2,576,144 2,589,942 2,951,315 23,222,809 40 41 REGISTERED DIETICIAN (IN-ST) 5,885 7,578 5,902 7,188 5,940 5,166 2,494 715 2,879 43,747 41 42 NON-EMER MED TRANSPORT (IN-ST) 911,253 827,812 716,978 781,477 723,434 991,069 1,290,467 814,575 798,998 7,856,063 42 43 CASE MGT - NHV/FTM (IN-ST) 2,774 6,028 5,441 2,326 1,586 18,155 43 44 HOME HEALTH AGENCY (IN-ST) 681,083 973,444 854,144 1,180,596 702,447 813,224 826,020 755,284 871,631 7,657,874 44 45 CASE MGMT - CONTRACTOR (IN-ST) 1,459 1,761 1,992 641 2,059 1,967 2,245 743 575 13,442 45 47 CASE MGMT - CMI 18,065 14,532 10,933 12,782 9,076 17,718 9,301 11,116 12,999 116,522 47 51 AMBULANCE TRANSPORTATION 2,726,546 2,866,569 2,818,230 5,147,400 3,032,909 3,145,211 2,742,197 2,767,238 2,889,238 28,135,539 51 54 AMBULATORY SURGI CTR (IN-ST) 110,259 132,839 109,220 145,010 135,092 124,778 96,020 126,946 146,930 1,127,094 54 55 EMERG ACCESS HOSPITAL (IN-ST) 7,395 10,780 10,117 25,797 9,440 4,916 1,853 19,613 16,628 106,538 55 56 PRESCRIBER ONLY FOR MCO 3,998 3,813 4,637 5,856 3,116 3,471 2,806 3,157 1,733 32,585 56 57 OPH REGISTERED NURSE (IN-ST) 7,968 14,428 17,052 13,962 15,545 2,557 3,818 5,207 6,476 87,014 57 59 NEURO REHAB HOSPITAL (IN-ST) 114,853 30,361 207,712 350,127 119,391 117,904 183,782 127,395 281,927 1,533,454 59 60 HOSPITAL 80,406,033 84,096,335 99,641,476 108,720,081 83,403,379 97,831,856 82,005,186 84,385,919 95,381,243 815,871,508 60 HCR2_SFY2021_Q3 Business Analytics 3 of 45 DocuSign Envelope ID: 26EE54AC-6D71-49AC-8281-26482C0D06D1 Provider Type Description for Provider Type Total (= FFS + Encounters) Provider Jul-2020 Aug-2020 Sep-2020 Oct-2020 Nov-2020
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