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

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A Whole New Ball GameImplementation of SB 2404,
the Managed Care Timetable
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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

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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)

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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)

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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 cap1
  bidders fee)

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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)

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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

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TimetableCalendar 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 cap1
  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)

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TimetableCalendar 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

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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.

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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.

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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.

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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