2004 Legislative Action

1

• 2004 Legislative Action
• Re- Medicaid Contracting
• What Does it Mean for Substance Abuse
• and for Provider Networks?

2
Medicaid HMOs Medipass

• Behavioral health will be added to HMO
  contracts.
• Language affects FY2005 appropriation.
• For Medipass clients, AHCA will contract with a
  single managed care plan in each area, selected
  by competitive bid (two plans if over 150,000
  recipients)
• HMO/ Medipass contracting may be coordinated by
  area, and likely will not begin until fall at the
  earliest.
• Florida Medicaid recipients are enrolled 50 in
  Medipass and 50 in HMOs, but proportions vary
  widely by district (see enrollees/ billings
  analysis by area.)

3
AHCA will contract for Managed MH/SA Services to
Medipass enrollees

• Contracts in place statewide by July, 2006.
• Capitated, pre-paid plans competitvely bid.
• Contractors must comply with Dept. of Insurance
  licensing and cash reserve requirements.
• Could be partnerships between networks and
  behavioral managed care organizations (area 6
  model.)

4
Special child welfare provisions

• Active HomeSafeNet cases exempt for one year, all
  services remain fee for service.
• CBCs may form own specialty pre-paid plan during
  the year .
• Plan must achieve same savings as other managed
  care plans.

5
Overlay services still exempt

• Children exempted from all managed care plans if
  enrolled in
• SIPP, or
• DJJ or DCF residential program approved as
  Medicaid overlay provider

6
Medicaid substance abuse cap delayed?

• FADAA language placed in Statute 2 years ago was
  not amended.
• "The agency (AHCA) may reimburse for (Medicaid)
  substance abuse treatment services on a
  fee-for-service basis until the agency finds that
  adequate funds are available for capitated,
  prepaid arrangements.
• FADAA has scheduled meeting with AHCA to clarify.

7
Provider networks

• MH/SA providers should jointly negotiate and
  contract with HMOs through networks, if possible.
• If providers seek to increase market share
  through negotiations for HMO and Medipass
  contracts, insurance companies can use the
  process to leverage additional discounts on
  service reimbursement.

8
More info on Medipass HMO Enrollmentin your
area

• http//www.fdhc.state.fl.us/MCHQ/Managed_Health_Ca
  re/MHMO/med_data.shtml