A Whole New Ball Game: Implementation of SB 2404, the Managed Care Timetable

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

2. 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, 2003

3. Managed Care contracts • Sets a date certain to implement policy of ACHA and DCF contracting with same managing entities statewide: by July 1st 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, 2003

4. 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, 2003

5. 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, 2003

6. 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, 2003

7. 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, 2003

8. 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 (2003-2004) 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, 2003

9. Timetable:Calendar Year 2004/ 2005 • Medicaid RFPs: Area #9 and #10 in February, 2004Area #3 and #5 in June, 2004Area #7 and #2 in October, 2004Area #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, 2003

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

11. 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, 2003

12. 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, 2003

13. 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 Lucia Maxwell - August, 2003