A Whole New Ball Game Implementation of SB

A Whole New Ball Game: Implementation of SB 2404, the Managed Care Timetable 1 Lucia Maxwell - August, 2003

Highlights of SB 2404 2 l Requires AHCA and DCF to accomplish joint planning, budgeting, procurements, contracting, and monitoring for behavioral health services l DCF can establish fee for service, pre-paid capitation and pre-paid case rates by administrative rule l 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 3 l Sets a date certain to implement policy of ACHA and DCF contracting with same managing entities statewide: by July 1 st 2006 l Protection of community based care: must be network members, services excluded from contracts l Exclusion of BHOS, SIPP waiver, foster group care (Fam. Saf. child caring facilities) from MC contracts l May be two Medicaid contracts if 150, 000 + enrollees (e. g. Dade County) Lucia Maxwell - August, 2003

Current policy issues 4 l Role of the HMOs l 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. ) l Whether AHCA will seek waiver of requirement for competing plans in each area? (networks ensure provider choice instead) l 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 5 l Local match certification program to draw down additional Medicaid – AHCA directed to initiate l New Medicaid codes (state revenue neutral) l Approval for new data reporting systems in pilots l Substance abuse managing entity in #4 and #12 l “Traditional” contractors must be offered network contracts (not necessarily Board vote or client referrals) l 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: l Data management l Data reporting l Clinical program management l 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) 6 Lucia Maxwell - August, 2003

Next developments 7 l MH networks formed in every district (include sub abuse agencies? ) l ITN released for District #8 ASO contract ($ 5 m to develop capacity of provider network. ) l Decisions about DCF conversion to fee for service reimbursement (“on the way” to capitation or case rates) l Decision about mental health clients transferred from HMOs to Medipass if HMOs are capped for behavioral Lucia Maxwell - August, 2003

Timetable: Calendar Year 2003 8 l Plan for statewide prepaid financing due October (Medicaid and DCF) – participation of cbc and sheriffs mandated l New (HIPAA) Medicaid codes and fees due October, 2003 l Additional Medicaid service codes may be added (2003 -2004) Requires approval by Legislative Budget Commission, insuring budget neutral (local match or offsetting GR) l 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) l enriched benefit financed by GR l 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 9 l 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 l DCF and AHCA use same HIPAA reimbursement codes (DCF grantees contract for units, but report HIPAA codes) l Sub abuse capped in current pilots in District #1 and Area #6 ? l Federal approval of Medicaid waiver request Lucia Maxwell - August, 2003

Timetable: 2006 10 l Medicaid capitation contracts statewide by July l Report and re-authorization of MHSA corporation (sunsets October, 2006) l 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, 2003

What will govern timetable? 11 l Decision about participation of HMOs l Possible injunctions and court suits l Limitations of AHCA and DCF staff time and resources l DCF may contract with same managing entities selected by Medicaid competitive bid, or NOT l 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 12 l If Congress approves Medicaid block grant, Florida will accept l Eligibility groups will change l No more increase in federal Medicaid match l Results of actuarial study and new Medicaid codes are last chance to increase sub abuse Medicaid revenue. l Challenge is to coordinate planning for State funding and Medicaid re- target populations and eligiblity. Lucia Maxwell - August, 2003

Important new vocabulary words 13 l Risk sharing, pre-paid, capitated (per capita), case rates (fixed sum), sub-cap l MCO, ASO, BHMO, PSO or provider sponsored organization, PSN or provider sponsored network l provider choice, call center, cash reserves, credentialing, utilization review, provider profiling, utilization management Lucia Maxwell - August, 2003