This chart book is the sixth in a series that explores utilization and expenditures for Medicaid‐funded LTSS in Maryland for fiscal years (FYs) 2012 through 2016. The focus of this chart book is on Medicaid nursing facility services, with one chapter that illustrates Maryland’s efforts at providing home and community‐based services (HCBS) to an increasing number of Medicaid recipients who may otherwise be served in nursing facilities.
Pursuant to SB 481 (Chapter 464 of the Acts of 2002), the Maryland Department of Health (the Department) created an annual process to set the fee-for-service (FFS) reimbursement rates for Maryland Medicaid and the Maryland Children’s Health Program (MCHP) in a manner that ensures provider participation. The law directs the Department to submit an annual report to the Governor and various House and Senate committees addressing the progress of the rate-setting process; a comparison of Maryland Medicaid’s reimbursement rates with those of other states; the schedule for adjusting Maryland’s reimbursement rates; and the estimated costs of implementing the above schedule and proposed changes to the FFS reimbursement rates. This is the Department’s annual report dated June 2019.
Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). On June 3, Senior Director of Analytics and Research and Chief Data Scientist Ian Stockwell, PhD, presented this poster, which summarizes the work he led to identify factors found in clinical and functional assessment tools that increase the risk of a future nursing home (NH) admission and apply those risk-scoring coefficients to individuals on Maryland’s Home and Community-Based Services (HCBS) waiting list.
Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). Senior Policy Analyst Charles Betley, MA, presented this poster at both the State Health Policy Interest Group Meeting on June 1 and the ARM on June 3. This poster summarizes the work Betley led to analyze Mississippi Medicaid claims data and quantify the financial impact of tobacco use on Mississippi’s Medicaid program.
Hilltop staff presented at the 2019 AcademyHealth Annual Research Meeting (ARM). Director of Health Reform Studies Laura Spicer, MA, and Senior Policy Analyst Alexis Smirnow, MPH, gave this podium presentation about the potential of implementing Small Business Health Options Program (SHOP) in Maryland at the State Health Policy Interest Group Meeting on June 1.
As part of its participation in the Maryland Primary Care Program (MDPCP), The Hilltop Institute is developing a risk model that will score primary care patients attributed to MDPCP-participating practices according to risk of avoidable hospitalization and/or emergency department (ED) utilization. These patient-level risk scores will ultimately be vended to participating medical practices on a monthly basis in order to facilitate care management through the improved allocation of scarce care coordination resources.
As a first step in this process, Hilltop conducted a comprehensive literature review. The goal of the review was to find peer-reviewed academic journal articles that identify risk factors for potentially avoidable hospitalization, thus providing a basis for risk factor extraction and risk model feature creation. Identified risk factors will be coded using CCLF and other publicly available data sources and included in the final risk model as potential predictors of avoidable hospitalization or ED use. The literature review provides the foundation for the MDPCP risk model and is a crucial step in the modeling process.
This report is an update to the 2016 Health Home Evaluation Report and the 2015 Joint Chairmen’s Report on Patient Outcomes for Participants in Health Homes. Its purpose is to describe the outcomes of participants in the Maryland Health Home program. Maryland’s Health Home program targets Medicaid participants with a serious and persistent mental illness (SPMI) and/or an opioid substance use disorder (SUD) and risk of additional chronic conditions due to tobacco, alcohol, or other non-opioid substance use; as well as children with serious emotional disturbances (SED).
This report describes the services The Hilltop Institute provided to the Maryland Department of Health (the Department) under the Master Agreement between Hilltop and the Department. The report covers fiscal year (FY) 2018 (July 1, 2017, through June 30, 2018). Hilltop’s interdisciplinary staff provided a wide range of services, including: Medicaid program development and policy analysis; HealthChoice program support, evaluation, and financial analysis; long-term services and supports program development, policy analysis, and financial analytics; and data management and web-accessible database development.
This chart book, prepared for the Maryland Department of Health, compares the FY 2019 Medicaid reimbursement rates of Maryland and its surrounding states with Maryland’s Medicare fee schedule for CY 2018 for the Baltimore region. The surrounding states included in this study are Washington, DC; Delaware; Pennsylvania; Virginia; and West Virginia. Physician fees comprise three components: physician’s work, practice expense, and malpractice insurance expense.
This report presents to the Center for Mississippi Health Policy the results of a model for estimating tobacco-related costs for Mississippi Medicaid participants using administrative claims data for calendar years (CYs) 2016 and 2017. Tobacco-related costs were estimated to be $388 million in 2016 and $396 million in 2017. This report describes the various methods that were used to develop these cost estimates.