Medical Care Advisory Committee. Justin M. Senior Deputy Secretary for Medicaid Agency for Health Care Administration January 28, 2014
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1 Medical Care Advisory Committee Justin M. Senior Deputy Secretary for Medicaid Agency for Health Care Administration January 28, 2014
2 2014 Legislative Session The 2014 Regular Legislative Session convenes on March 4, The Agency will monitor legislation for any potential impact on the SMMC program. 2
3 Statewide Medicaid Managed Care Update 3
4 Why are changes being made to Florida s Medicaid program? Because of the Statewide Medicaid Managed Care (SMMC) program, the Agency is changing how a majority of individuals receive most health care services from Florida Medicaid. Statewide Medicaid Managed Care program Long-term Care program (implementation Aug March 2014) Managed Medical Assistance program (implementation May 2014 August 2014) 4
5 Long-term Care Program 5
6 Long-term Care Program Roll Out Schedule Region Date Enrolled in LTC Plans 1 March 1, November 1, March 1, March 1, February 1, February 1, August 1, September 1, September 1, November 1, December 1,
7 Enrollment by Region Long-term Care Program Enrollment by Region As of January 1, 2014 Region 2 3,736 Region 7 8,337 Region 8 5,040 Region 9 7,213 Region 10 5,778 Region 11 18,347 Total: 48,451 7
8 Roll-Out Update Roll-Out is Going Very Smoothly: Recipients are not having to move. No services are being missed. Complaint hub process created to provide expedited resolution of any provider or recipient issues. No Major Problems, minor issues identified and addressed: Recipient addresses Plan transition from capitated provider service network (PSN) to a fee-for-service PSN. Changes for institutional providers 8
9 Long-term Care Program Continued Outreach The Agency has been and continues to be aggressive with our recipient and provider outreach: Outbound calls to recipients Total of 9,800 calls Webinars on various subjects Total of 36 webinars Reaching approximately 5,200 individuals Provider Calls held regionally Over 1,505 providers have participated Agency content was among the top 1% of most viewed on SlideShare in 2013 That s nearly the population of Oxford, UK! 9
10 Managed Medical Assistance Program 10
11 Managed Medical Assistance Program Plan Selection The Agency selected 14 companies to serve as standard, nonspecialty MMA plans. Five companies were selected to provide specialty plans that will serve populations with a distinct diagnosis or chronic condition, tailored to meet the specific needs of the specialty population. 11
12 Plans Selected for Managed Medical Assistance Program Participation (Standard Plans) Note: Formal protest pending in Region 11 for MMA Standard Plans MMA Plans Region Amerigroup Better Health Coventry First Coast Advantage Humana Integral Molina Preferred Prestige SFCCN Simply Sunshine State United Healthcare Staywell 1 X X 2 X X 3 X X X X 4 X X X X 5 X X X X 6 X X X X X X X 7 X X X X X X 8 X X X X 9 X X X X 10 X X X X 11 X X X X X X X X X X 12
13 Plans Selected for Managed Medical Assistance Program Participation (Specialty Plans) MMA Specialty Plans Clear Health Alliance Freedom Health, Inc. Magellan Complete Care Positive Healthcare Florida Sunshine State Health Plan, Inc. Region HIV/AIDS Cardiovascular Disease; Chronic Obstructive Pulmonary Disease; Congestive Heart Failure; & Diabetes (Dual Eligibles) Serious Mental Illness HIV/AIDS Child Welfare 1 X X 2 X X X 3 X X X 4 X X 5 X X X X 6 X X X X 7 X X X X 8 X X X 9 X X X X 10 X X X X X 11 X X X X X 13
14 Managed Medical Assistance Program Roll Out Schedule Roll Out Schedule Regions Enrollment Date 2, 3 and 4 May 1, , 6 and 8 June 1, and 11 July 1, , 7 and 9 August 1,
15 Recipient Notification and Enrollment Dates Region Pre-Welcome Letter Welcome Letter Reminder Letter Last Day to Choose a Plan Before Initial Enrollment Date Enrolled in MMA Plans 1 4/1/2014 5/26/2014 6/23/2014 7/17/2014 8/1/ /2/2014 2/17/2014 3/24/2014 4/17/2013 5/1/ /2/2014 2/17/2014 3/24/2014 4/17/2013 5/1/ /2/2014 2/17/2014 3/24/2014 4/17/2013 5/1/ /3/2014 3/24/2014 4/21/2014 5/22/2014 6/1/ /3/2014 3/24/2014 4/21/2014 5/22/2014 6/1/ /1/2014 5/26/2014 6/23/2014 7/17/2014 8/1/ /3/2014 3/24/2014 4/21/2014 5/22/2014 6/1/ /1/2014 5/26/2014 6/23/2014 7/17/2014 8/1/ /3/2014 4/21/2014 5/26/2014 6/19/2014 7/1/ /3/2014 4/21/2014 5/26/2014 6/19/2014 7/1/
16 Status of Waiver Renewal On November 27, 2013, the Agency submitted a 3-year waiver extension request to the Centers for Medicare and Medicaid Services (CMS). Part of that request includes a proposal to redesign the ongoing Low Income Pool as a System Access and Transformation Incentive Fund (Incentive Fund) funded at $4.5 billion annually. Medicaid leadership traveled to Baltimore to discuss with CMS the extension request and redesign of the Low Income Pool. We look forward to continuing to work with federal CMS for approval of the extension and Low Income Pool redesign. 16
17 For More Information Updates about the Statewide Medicaid Managed Care program are posted at: Upcoming events and FAQs can be found on the News and Events tab Sign up to receive program updates by clicking the red Sign Up for Program Updates box Questions about the program can be ed to: 17
18 You can find more information on the SMMC program at: Youtube.com/AHCAFlorida Facebook.com/AHCAFlorida Twitter.com/AHCA_FL 18
19 Medical Care Advisory Committee Update 19
20 Medical Care Advisory Committee The Medical Care Advisory Committee (MCAC) was established in accordance with 42 C.F.R The committee serves to advise the Agency for Health Care Administration, Division of Medicaid about health and medical care services. The MCAC has the opportunity to assist in policy development and program administration, and provides recommendations and suggestions to the Agency on the state s comprehensive quality strategy for the Florida Medicaid program, as described in Special Terms and Conditions (STCs) #43 and #118 of the 1115 Managed Medical Assistance (MMA) Waiver. 20
21 Medical Care Advisory Committee The STCs require that the Medical Care Advisory Committee include representation of at least four beneficiaries at all times. In addition, the STCs require the state to establish smaller advisory committees that will meet on a regular basis (at least quarterly) to focus on the specific subpopulations. 21
22 Subpopulation Committees Subpopulations: managed long-term services and supports beneficiaries with HIV/AIDS children, including safeguards and performance measures related to foster children the provision of dental care to all children, and behavioral health/substance use disorder services These subpopulations will be impacted by SMMC: specialty Plans end of prepaid dental health plans, and prepaid mental health plans 22
23 Goals of the Subpopulation Committees Focus on the transition of these populations to the Statewide Medicaid Managed Care program. Present recommendations and suggestions to the state on the state s comprehensive strategy, as set forth in STC 118. Provide input to the state on the consumer report cards, set forth in STC
24 Proposed Subcommittee Structure AHCA staff will serve as team lead for each of the subcommittees, facilitating meetings and taking minutes. MCAC members will be assigned to each subcommittee and will report back to the MCAC on subcommittee discussions, recommendations and concerns. Subcommittee meetings are required quarterly, but may be needed more often. Committee members will serve without compensation, but will be reimbursed for allowable travel expenses in accordance with the statutory provisions of the State of Florida. 24
25 Subpopulation Committee Breakout Session We will now break into subpopulation workgroups. You are all invited to participate. 25
26 Questions? 26
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