New State Initiatives in Medicaid and DCF Financing & Contracting

Major Changes

  MH/ SA Integration Medicaid/ DCF “Braided” Funding  Provider Sponsored Networks  PSN/ Managed Care Partnerships  At risk contracting replaces fee for service  HMOs included Lucia Maxwell, FADAA Managed Care Consultant

Assumptions:

  State funding of the public BH system will be controlled, with predictable increases. “Managed” services result in increased client access and more appropriate (best practices) and cost effective care.

 Medicaid and DCF both fund services to essentially the same client population. Lucia Maxwell, FADAA Managed Care Consultant

First initiatives were in Medicaid

 MH pilots in area #6 (1997) and #1(2002)  Prepaid mental health plans and HMOs, both capitated (pre-paid, fixed amount, per member per month)  2004 Legislature extended pre-paid plans statewide, phase in 2004-2006  Substance abuse remains ffs until 2006 without further legislative direction.

Lucia Maxwell, FADAA Managed Care Consultant

Authority already in F.S. for DCF initiatives  SB 1258 (2001)  SB 2404 (2003)  HB 1843 (2004)  AHCA and DCF: joint planning, budgeting, procurements, contracting, and monitoring  DCF can establish fee for service, pre-paid capitation and pre-paid case rates by administrative rule Lucia Maxwell, FADAA Managed Care Consultant

DCF authorized to contract with:

 A single managing entity or a provider network in each area or region  “Managing entity” is defined as: 1. A network of existing providers with an ASO that can function independently 2. An ASO that is independent of local provider agencies, or 3. An entity of state or local government.

 NO competitive bidding is required if DCF contracts with the Medicaid managing entity (by 2006.) Lucia Maxwell, FADAA Managed Care Consultant

DCF may contract with a Managing Entity for:

 Data management  Data reporting  Clinical program management  Administrative functions NO changes in local match: amt, sources, ratio Lucia Maxwell, FADAA Managed Care Consultant

New DCF Concept Paper

 Proposes that DCF contract for MH and SA services with the Managing Entity selected by AHCA Medicaid to provide services to Medipass enrollees.  ME model is a Provider Network in partnership with a Managed Care Organization (ValueOptions) Lucia Maxwell, FADAA Managed Care Consultant

Impact on Substance Abuse

 Because Medicaid substance abuse remains ffs for now, Medicaid ME are mental health providers only.  Down the road, SA providers in some areas may have limited authority in MH partnerships already formed.  Public substance abuse client services are less suited to the Medicaid insurance model than MH clients (stable population, defined needs and costs) Lucia Maxwell, FADAA Managed Care Consultant

Additional concerns

 5% administrative fee will go to an MCO partnership rather than to develop the Provider Network infrastructure, as it would if DCF contracted directly with Networks.

 This model could require defined client eligibility and the need for providers to implement eligibility assessment systems.

Lucia Maxwell, FADAA Managed Care Consultant

New reimbursement models

 Unit cost contracting will be phased out.

 Risk models will be used.

 Reimbursement may be case rate, capitation, or a hybrid (global budget with a minimum # of clients served)  Likely pre-paid. Lucia Maxwell, FADAA Managed Care Consultant

Exemptions:

 DJJ or DCF residential program approved as Medicaid overlay provider  Community Based Care agencies will purchase capitated Medicaid BH services for HomeSafeNet children beginning July, 2004 (remain ffs until then.) Lucia Maxwell, FADAA Managed Care Consultant

Schedule for Medipass Prepaid Mental Health Plan RFPs     November, 2004 – Areas #5, #7 March, 2005 – Areas #2, #3, #4 August, 2005 – Area #11 Early 2006 – Areas #8, #9, #10  Contracts signed in all areas by July, 2006 Lucia Maxwell, FADAA Managed Care Consultant

Seeking to Maximize Medicaid Substance Abuse

 RWJ project: increased benefits (new Medicaid codes), and an expanded provider network  New SA codes in revised Medicaid Handbook  DCF granting exceptions to enroll new providers  AHCA Statewide trainings scheduled: Tally Sept. 9th-10 th , Ft. Lauderdale Sept. 14 th 15 th , Orlando September 30 th – October 1 st Lucia Maxwell, FADAA Managed Care Consultant

Medicaid SA capitation rate: actuarial analysis + State policy?

 Advocacy Center released recommendations for increased Medicaid services for substance abuse recipients  Mercer Report summarized costs and benefits of other State programs (Ga.)  DCF General Revenue and local funds could be certified as match to draw down addl. federal Medicaid dollars. Lucia Maxwell, FADAA Managed Care Consultant

Evaluation of System Changes:  SA/MH Corporation will establish criteria and baseline data to measure impact of system changes, for reports to Legislature (sunsets October, 2006 if not reauthorized)  By December 31 st , FMHI evaluation of pilots: recommendations and a timetable, milestones, and date certain for implementation of successful strategies statewide.

Lucia Maxwell, FADAA Managed Care Consultant

What could impact these changes

:

 Possible injunctions and court suits  Limitations of AHCA and DCF staff time and resources  DCF could reverse policy based on Medicaid contracting decisions statewide  Florida Medicaid reform  Changes in State Administration: Governor’s office, DCF, AHCA Lucia Maxwell, FADAA Managed Care Consultant