Lucia Maxwell - August, A Whole New Ball Game: Implementation of SB 2404, the Managed Care Timetable

Lucia Maxwell - August, Highlights of SB 2404 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, Managed Care contracts Sets a date certain to implement policy of ACHA and DCF contracting with same managing entities statewide: by July 1 st 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, Current policy issues 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, Additional provisions 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, 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) - Local match: no change in ratio, amount, sources - Can contract directly with a provider network - Contractors coordinate with Medicaid pre-paid plans (if not same entity)

Lucia Maxwell - August, Next developments 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, Timetable: Calendar Year 2003 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 ( ) 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, Timetable: Calendar Year 2004/ 2005 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, Timetable: 2006 Medicaid capitation contracts statewide by July Report and re-authorization of MHSA corporation (sunsets October, 2006) By December 31 st, FMHI evaluation of pilots: recommendations and a timetable, milestones, and date certain for implementation of successful strategies statewide.

Lucia Maxwell - August, What will govern timetable? 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, State funds and Medicaid: need to coordinate eligibility and target populations 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, Important new vocabulary words 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