Transcript MEDICAID TRANSPORTATION

Florida’s Agency for Health
Care Administration
Secretary Andrew Agwunobi, M.D.
Mission
“The Agency for Health Care Administration
champions accessible, affordable, quality health
care for all Floridians.”
Division of Health Quality
Assurance
“…state licensure…federal certification…of health care
facilities…CON…complaints…”
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Long Term Care
– Licensure and Certification
– Nursing Home Gold Seal
– Quality of Long Term Care Facility Improvement Trust Fund
– Nursing Home Guide and Watch List
– Adverse Incidents and Nursing Home Reporting
– Background Screening
Certificate of Need Program
Plans and Construction Review
Managed Care
– Managed Care Subscriber Assistance
– Statewide Provider/Health Plan Claim Dispute Resolution
Division of Health Quality
Assurance
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Emergency Support Function (ESF8) with the Department of Health
– Emergency Status System
– 94% of Nursing Homes Enrolled
Field Operations
– Eight Field Offices: Inspections and Investigations
– Complaint Administration: Call Center and 5-day Abuse Reports
– Quality of Care Monitors
– Survey Integrity and Training
– Informal Dispute Resolution (IDR)
– MDS/OASIS Help Desk
Quality Indicator Survey Process
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Federal Quality Indicator Survey Process
– Florida: First Statewide Pilot
Improve Consistency/Accuracy of QOC/QOL Problem Identification
Using a More Structured Process
Comprehensive Review of Regulatory Care Areas within the Current
Survey Process
Enhanced Documentation by Organizing Survey Findings through
Automation
Focus Survey Resources on Facilities with Largest Number of Quality
Concerns
QIS Florida Roll-out Plan
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Tallahassee/Pensacola
Alachua/Miami
Orlando/Ft. Myers
Delray/Tampa-St. Pete
November 2007 Complete
January – July 2008
February – October 2008
July 2008 – November 2009
Government Performance Results
Act (GPRA)
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Congressional Directive:
– Initiate Program Performance Reform
– Series of Pilot Projects in Setting Program Goals
– Measuring Program Performance Against Goals
– Reporting Publicly on Progress
– Improve Federal Program Effectiveness and Public Accountability
– Promoting a New Focus on:
• Results
• Service Quality
• Customer Satisfaction
Nursing Home GPRA Focus
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Reduce Restraint Use
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Reduce Pressure Ulcers
– 2006 (4th Quarter)
• 8.6 Florida
• 5.8 Nation
– 2006 (4th Quarter)
• 9.7 Florida
• 8.4 Nation
– 2007 (1st Quarter)
• 8.3 Florida
• 5.5 Nation
– 2007 (1st Quarter)
• 9.6 Florida
• 8.6 Nation
Strategies for Improvement
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Register to Participate in the Advancing Excellence in
America’s Nursing Homes Campaign
– www.nhqualitycampaign.org
Consider Partnerships with other Health Care Providers
Southeast Region Workgroup
– Nursing Home Association Participation
– Hospital Association Participation
– State Agency Participation
Division of Medicaid
“Directs all Medicaid program planning and development activities”
$15.6 Billion Annual Medicaid Services Budget
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2.0 Million Eligibles
Bureau of Medicaid Program Analysis
– Nursing Home Reimbursement and Rate Setting
– Cost Reports and Audits
Bureau of Medicaid Contract Management
– Provider Enrollment & Fiscal Intermediary Management / Claims
Bureau of Medicaid Pharmacy Services
Medicaid Reimbursement
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Budget Reduction Session Impact
– Nursing Home Rate Reduction 3% Effective January 1, 2008
– Recurring Reduction: Based on Annualized Amount each Rate Semester
Crossover Payments
– Initial Implementation Issues Corrected
– Claims Reprocessed
– Recovery of Automatic Crossover Payments Pending
Fiscal Agent Transition to EDS
Division of Medicaid
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Bureau of Medicaid Services
– Handbook and Policy
– Waiver Programs
– Pre-Admission Screening and Resident Review (PASRR)
11 Area Offices
– Claim Reconciliation
– Beneficiary Assistance
Bureau of Medicaid Health Systems Development
– Medicaid Managed Care Policy and Disease Management
Bureau of Medicaid Quality Management
– Provider Satisfaction Surveys
Florida Senior Care
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Integrate All Medicaid Services, including Nursing Facility and Waiver
Services, in a Managed Care Plan
Medicaid Beneficiaries Age 60 and Older and Dually Eligible
(Medicaid and Medicare) Beneficiaries Age 21 and Older Can
Participate in Brevard, Osceola, Orange, Seminole, Miami-Dade, and
Monroe Counties
Enrollment is Voluntary in These Areas of the State
Enrollees Can Choose to Enroll or Disenroll at Any Time
Any Willing, Qualified Managed Care Plan May Enroll as a Provider
Individuals Living in Residential Facilities Can Stay in Their Facility
Even if the Facility Does Not Have a Contract with a Florida Senior
Care Managed Care Plan
Implementation is Expected in November 2008
Florida Center for Health Information
and Policy Analysis
“collection…analysis…dissemination… of health-related data”
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Health Information Infrastructure
– Fosters the Deployment of Electronic Medical Records and E-prescribing
Data Collection, Dissemination and Quality Assurance
Transparency in Health Care
– Consumer-Driven
Floridahealthfinder.Gov
– Search Tools to Compare Short-term Acute Care Hospitals, Ambulatory
(Outpatient) Surgery Centers, Health Plans, and Nursing Homes
– A.D.A.M. Health Encyclopedia with Thousands of Health Articles and
Illustrations
– Health Care Facility Finder
– Information About Insurance, Medications, Seniors, Medical Conditions,
and Resources for Medical Care
– Consumer Publications
– Information for Health Care Professionals and Much More
Nursing Home White Paper
“Long Term Care Review”
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Overview of Regulation, Quality, Ownership, Reimbursement
– Significant Regulatory Oversight Exists
– Ownership Disclosure is Limited
– Unable to Identifiable Correlation between Quality and
Ownership but More Extensive Analysis Is Warranted
Nursing Home White Paper
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Recommendations
– Revise Nursing Home Guide
– Increase Transparency of Information
– Examine “Proof” Standard for Nursing Home Sanctions
– Revise Change of Ownership Definition and Requirements
– Expand Disclosure of Ownership
– Commission Statistical Analysis to Evaluate Quality and
Ownership
– Review Regulation of Alternative Settings – Assisted
Living/Adult Family Homes
Long Term Care Issues
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Aging Demographics
– Certificate of Need Moratorium until 2011
MRSA Workgroup
– Department of Health Partnership
State Budget Pressure