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
DCF can establish fee for service, pre-paid capitation
and pre-paid case rates by administrative rule
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
Protection of community based care: must be network
members, services excluded from contracts
Exclusion of BHOS, SIPP waiver, foster group care
(Fam. Saf. child caring facilities) from MC contracts
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.)
Whether AHCA will seek waiver of requirement for competing
plans in each area? (networks ensure provider choice instead)
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
New Medicaid codes (state revenue neutral)
Approval for new data reporting systems in pilots
Substance abuse managing entity in #4 and #12
“Traditional” contractors must be offered network contracts (not
necessarily Board vote or client referrals)
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:
Data management
Data reporting
Clinical program management
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?)
ITN released for District #8 ASO contract
($ 5m to develop capacity of provider network.)
Decisions about DCF conversion to fee for service reimbursement
(“on the way” to capitation or case rates)
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
New (HIPAA) Medicaid codes and fees due October, 2003
Additional Medicaid service codes may be added (2003-2004)
Requires approval by Legislative Budget Commission,
insuring budget neutral (local match or offsetting GR)
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)
enriched benefit financed by GR
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
DCF and AHCA use same HIPAA reimbursement codes
(DCF grantees contract for units, but report HIPAA codes)
Sub abuse capped in current pilots in District #1 and Area #6 ?
Federal approval of Medicaid waiver request
Lucia Maxwell - August, 2003
Timetable: 2006
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Medicaid capitation contracts statewide by July
Report and re-authorization of MHSA corporation
(sunsets October, 2006)
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
Possible injunctions and court suits
Limitations of AHCA and DCF staff time and resources
DCF may contract with same managing entities
selected by Medicaid competitive bid, or NOT
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
Eligibility groups will change
No more increase in federal Medicaid match
Results of actuarial study and new Medicaid codes are
last chance to increase sub abuse Medicaid revenue.
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
MCO, ASO, BHMO, PSO or provider sponsored
organization, PSN or provider sponsored network
provider choice, call center, cash reserves,
credentialing, utilization review, provider profiling,
utilization management
Lucia Maxwell - August, 2003