Transcript Document

2004 Legislative Action
Re- Medicaid Contracting :
What Does it Mean for Substance Abuse
and for Provider Networks?
Medicaid HMOs & Medipass
• Behavioral health will be added to HMO contracts.
• Language affects FY2005 appropriation.
• For Medipass clients, AHCA will contract with “a single managed
care plan” in each area, selected by competitive bid (two plans if
over 150,000 recipients)
• HMO/ Medipass contracting may be coordinated by area, and
likely will not begin until fall at the earliest.
• Florida Medicaid recipients are enrolled 50% in Medipass and
50% in HMOs, but proportions vary widely by district
(see enrollees/ billings analysis by area.)
AHCA will contract for Managed
MH/SA Services to Medipass enrollees
• Contracts in place statewide by July, 2006.
• Capitated, pre-paid plans competitvely bid.
• Contractors must comply with Dept. of Insurance
licensing and cash reserve requirements.
• Could be partnerships between networks and
behavioral managed care organizations (area #6
model.)
Special child welfare provisions
• Active HomeSafeNet cases exempt for one
year, all services remain fee for service.
• CBCs may form own specialty pre-paid
plan during the year .
• Plan must achieve same savings as other
managed care plans.
Overlay services still exempt
Children exempted from all managed care
plans if enrolled in:
• SIPP, or
• DJJ or DCF residential program approved
as Medicaid overlay provider
Medicaid substance abuse
cap delayed?
• FADAA language placed in Statute 2 years ago
was not amended.
• "The agency (AHCA) may reimburse for
(Medicaid) substance abuse treatment services on
a fee-for-service basis until the agency finds that
adequate funds are available for capitated, prepaid
arrangements.“
• FADAA has scheduled meeting with AHCA to
clarify.
Provider networks
• MH/SA providers should jointly negotiate
and contract with HMOs through networks,
if possible.
• If providers seek to increase market share
through negotiations for HMO and
Medipass contracts, insurance companies
can use the process to leverage additional
discounts on service reimbursement.
More info on
Medipass & HMO Enrollment
in your area:
• http://www.fdhc.state.fl.us/MC
HQ/Managed_Health_Care/M
HMO/med_data.shtml