Transcript Managed care models in Florida are based on the Medicaid

DCF System Redesign:
Contracting with
Community Managing Entities
Lucia Maxwell, FADAA
DCF plans “system conversion”
within two years

A managing entity will be selected by competitive bid
for each district or region.

DCF will contract for SA and MH services with the
Managing Entity rather than directly with providers.

The role of district office staff will change to that of
“Purchaser.”

Parts of the DCF data system may be outsourced.

NO changes in local match: amt, sources, ratio
Lucia Maxwell, FADAA
What are DCF’s goals for the redesign?








Recovery oriented services, individualized
treatment
Customer driven services
Systems of care, not “silo-ed” agencies
Assure best practices
Quality improvement
More flexible funding
Reliable data system
Preserve local $ contributions
Lucia Maxwell, FADAA
Implicit Assumptions

District offices do not have the resources to take on
the level of care management desired.
 In a community/ provider driven system, providers
must take responsibility to build systems of care.
 Goal is cost efficiency, not cost reductions.
 DCF will need a reliable data system to monitor
outcomes.
 Managing Entity administration will be financed with a
percentage of services dollars.
Lucia Maxwell, FADAA
What will be the new role of district
office staff?





Negotiating and monitoring a single contract for a
services system.
Setting CQI measurable system goals for the
Managing Entity to achieve (increase women’s
services, decrease waiting lists, improve workforce
development activities, increase detox capacity.)
Enhanced focus on community planning.
Increased communication with stakeholders
Monitor ME mechanisms to ensure that services
design and service delivery are consumer driven.
Lucia Maxwell, FADAA
DCF Community Managing Entity
Administrative Services
Organization:
Provider Sponsored
Network:
Staff to carry out:
Contracting
Monitoring
Finance
Information Systems
Quality Improvement
Technical assistance
Outreach to stakeholders
Lucia Maxwell, FADAA
Service agencies
governed by
community boards,
which together
represent a continuum
of care, form a
corporation and select
governance.
Models may vary across the state
Florida Statutes includes these options:

Local government as the ME contractor
 DCF contracts with an independent ASO,
which forms a provider network.
Lucia Maxwell, FADAA
DCF managed care model

Not a Medicaid model: e.g. insurance plan,
eligible beneficiaries, contracts with for-profit
Managed Care Organizations licensed by the
Department of Insurance

Seeking to retain community based service
system working in partnership with the State.

Differences: more local determination, less
restrictive eligibility, significant local funding,
possible shared risk, insurance licensure and
reserves not required.
Lucia Maxwell, FADAA
Elements Important to Success

Clear State commitment

Time to build administrative capacity

Follow through on redefinition of DCF
role, re-training for district staff

Compromise on Managing Entity goals
and required capacities, which will be
funded from service dollars
Lucia Maxwell, FADAA
FADAA Supports





Local determination of ME structure within State
guidelines (allow separate SA networks initially.)
ME should be a non profit, 501 © (3)
Providers accountable as owners - ME must provide
evidence that services are driven by client and
community needs and preferences.
ME contracts oriented to outcomes, not process:
service capacity meets defined community need,
appropriate placements, reduced waiting lists, client
retention, more clients served.
Braid Medicaid/ DCF funding through MEs.
Lucia Maxwell, FADAA
DCF Managing Entities and
Medicaid Reform

Prepaid MH Plans and the CBC Specialty Network
are not included in the Medicaid reform waiver.

DCF Managing Entities could contract directly with
Health Maintenance Organizations and Provider
Service Networks to serve Medicaid recipients.

MEs assume Medicaid role early: Local governments
authorize MEs to coordinate new Medicaid services
funded by local match: detox, intervention, aftercare.
These services will never be added to managed care
contracts.
Lucia Maxwell, FADAA