Transcript Document

A Whole New Ball Game:
Implementation of SB 2404,
the Managed Care Timetable
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Lucia Maxwell - August, 2003
Highlights of SB 2404
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
Requires AHCA and DCF to accomplish joint planning,
budgeting, procurements, contracting, and monitoring
for behavioral health services
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DCF can establish fee for service, pre-paid capitation
and pre-paid case rates by administrative rule
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Authorizes DCF to contract with a single managing
entity or a provider network in an area or region
Lucia Maxwell - August, 2003
Managed Care contracts
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
Sets a date certain to implement policy of ACHA and
DCF contracting with same managing entities
statewide: by July 1st 2006
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Protection of community based care: must be network
members, services excluded from contracts
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Exclusion of BHOS, SIPP waiver, foster group care
(Fam. Saf. child caring facilities) from MC contracts
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May be two Medicaid contracts if 150,000 + enrollees
(e.g. Dade County)
Lucia Maxwell - August, 2003
Current policy issues
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
Role of the HMOs

Whether substance abuse will be left out of the Medicaid capitated
contracts for now?
(2001 billings would yield 70 cents pmpm - after cap and admn.)
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Whether AHCA will seek waiver of requirement for competing
plans in each area? (networks ensure provider choice instead)
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How cap rates will be set ?
Possibility of using data from other states to project costs of
“enriched” Medicaid benefit and using General Revenue to fund)
Lucia Maxwell - August, 2003
Additional provisions
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
Local match certification program to draw down additional
Medicaid – AHCA directed to initiate
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New Medicaid codes (state revenue neutral)
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Approval for new data reporting systems in pilots
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Substance abuse managing entity in #4 and #12
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“Traditional” contractors must be offered network contracts (not
necessarily Board vote or client referrals)
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Cap rate may be adjusted “to ensure that care available” (means
no entity would accept lower rate)
- Admn. decision - 10% retained (9% cap+1% bidders’ fee)
Lucia Maxwell - August, 2003
DCF managed care contracts
- May contract with managing entity for these functions:
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Data management
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Data reporting
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Clinical program management
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Administrative functions
(could mean State still contracts directly with providers for client services)
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Local match: no change in ratio, amount, sources
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Can contract directly with a provider network
- Contractors coordinate with Medicaid pre-paid plans
(if not same entity)
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Lucia Maxwell - August, 2003
Next developments
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
MH networks formed in every district
(include sub abuse agencies?)
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ITN released for District #8 ASO contract
($ 5m to develop capacity of provider network.)
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Decisions about DCF conversion to fee for service reimbursement
(“on the way” to capitation or case rates)
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Decision about mental health clients transferred from HMOs to
Medipass if HMOs are capped for behavioral
Lucia Maxwell - August, 2003
Timetable:
Calendar Year 2003
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
Plan for statewide prepaid financing due October
(Medicaid and DCF) – participation of cbc and sheriffs mandated
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New (HIPAA) Medicaid codes and fees due October, 2003
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Additional Medicaid service codes may be added (2003-2004)
Requires approval by Legislative Budget Commission,
insuring budget neutral (local match or offsetting GR)
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AHCA will submit Medicaid waiver: statewide contracting, cap sub
abuse, provider (not plan) choice, 10% is retained by the State
(9% cap+1% bidders’ fee)
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enriched benefit financed by GR
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AHCA plans to release Medicaid RFP for Areas #5 and #11 in
October (bidder must have Dept. of Insurance license)
Lucia Maxwell - August, 2003
Timetable:
Calendar Year 2004/ 2005
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Medicaid RFPs:
Area #9 and #10 in February, 2004
Area #3 and #5 in June, 2004
Area #7 and #2 in October, 2004
Area #8 in 2005
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DCF and AHCA use same HIPAA reimbursement codes
(DCF grantees contract for units, but report HIPAA codes)
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Sub abuse capped in current pilots in District #1 and Area #6 ?
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Federal approval of Medicaid waiver request
Lucia Maxwell - August, 2003
Timetable: 2006
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Medicaid capitation contracts statewide by July
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Report and re-authorization of MHSA corporation
(sunsets October, 2006)
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By December 31st, FMHI evaluation of pilots:
recommendations and a timetable, milestones, and
date certain for implementation of successful strategies
statewide.
Lucia Maxwell - August, 2003
What will govern timetable?
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Decision about participation of HMOs
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Possible injunctions and court suits
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Limitations of AHCA and DCF staff time and resources
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DCF may contract with same managing entities
selected by Medicaid competitive bid, or NOT
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DCF contracting will have own timetable for introducing
risk-sharing, and could reverse policy based on effects
of Medicaid contracting statewide.
Lucia Maxwell - August, 2003
State funds and Medicaid: need to coordinate
eligibility and target populations
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
If Congress approves Medicaid block grant,
Florida will accept
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Eligibility groups will change
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No more increase in federal Medicaid match
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Results of actuarial study and new Medicaid codes are
last chance to increase sub abuse Medicaid revenue.
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Challenge is to coordinate planning for State funding
and Medicaid re- target populations and eligiblity.
Lucia Maxwell - August, 2003
Important new vocabulary words
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Risk sharing, pre-paid, capitated (per capita), case
rates (fixed sum), sub-cap
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MCO, ASO, BHMO, PSO or provider sponsored
organization, PSN or provider sponsored network
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provider choice, call center, cash reserves,
credentialing, utilization review, provider profiling,
utilization management
Lucia Maxwell - August, 2003