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Statewide Medicaid Managed Care

AHCA Announces the Award of New Contracts for the Statewide Medicaid Managed Care Program

Posted on April 24, 2018

The Agency for Health Care Administration (Agency) today announced its intent to award contracts to nine health plans as a result of the re-procurement of the Statewide Medicaid Managed Care (SMMC) program. Florida law mandates that SMMC health plans be re-procured every 5 years; this was the first re-procurement. Through a regular, established competitive procurement process, the Agency negotiated and selected health plans to provide Managed Medical Assistance (MMA) and Long-term Care (LTC) services to the more than 3 million Floridians enrolled in the SMMC program.

The Agency’s negotiation team, made up of experts in the field of Medicaid and managed care, have negotiated the broadest benefit package ever available to Florida Medicaid recipients. This includes a wide array of added benefits available to health plan enrollees at no additional cost to the State of Florida. The enhanced benefit package negotiated is the most abundant ever available to Florida Medicaid recipients and includes, for the first time, a variety of extra benefits focused on substance abuse treatment and mental health, including intensive outpatient treatment, group and individual therapy, enhanced pain management services to provide alternatives to the use of opioids, and additional medication assisted treatment options. Health plans have agreed to continue to offer adults preventative benefits such as adult dental preventative and treatment services. In all, more than 55 additional benefits will be offered.

Further benefits for participating providers were also achieved, including additional enhanced payments to pediatric providers under the Medicaid Physician Incentive Program (MPIP).

In the Invitations to Negotiate for this procurement, released in July of 2017, the Agency laid out three primarily quality related goals for the program, including reducing potentially preventable inpatient and outpatient hospital events (e.g., hospitalizations and trips to the emergency department); improving birth outcomes; and increasing the percentage of enrollees receiving long-term care services in the community instead of a nursing facility. The Agency has negotiated commitments from each of the awarded plans to aggressively pursue these goals, including plan specific reductions in the percentage of potentially preventable healthcare events and adverse birth outcomes and continued rate incentives for transition to community based services for LTC recipients even after statutory benchmarks for transition are met.

In addition, there are several enhancements which will aid in combatting the opioid epidemic, including alternative pain management, greater access to medication assisted treatment options, and additional tools to reduce the incidence of babies with neonatal abstinence syndrome (NAS).  Access to providers will be enhanced through coverage parity via telemedicine for all covered services.

For the first time in the history of the Florida Medicaid program, those diagnosed with HIV/AIDS or a serious mental illness will have the option to enroll in a specialty plan specifically designed to serve those diagnoses, in every region and every county of the state. A specialty plan focused on serving children in Florida’s child welfare system will also be available statewide.

In addition, the awards will bring two new provider-based health plans, known as Provider Service Networks, or PSNs, into the Florida Medicaid program to serve recipients receiving MMA and LTC services.

Upon posting the intended awards, the Agency will remain in a blackout period for the next 72 hours. Florida law provides an opportunity for respondents who did not receive an award the option to challenge the result.

All information regarding the Agency’s solicitations is posted via the Vendor Bid System can be found by clicking here.

The solicitation numbers for Statewide Medicaid Managed Care are AHCA ITN 001-17/18 – Region 1 through AHCA ITN 011-17/18 – Region 11.

Filed Under: Featured Tagged With: Agency for Health Care Administration, State of Florida, Statewide Medicaid Managed Care

AHCA Releases Statewide Medicaid Managed Care Re-Procurement Data Book

Posted on April 4, 2017

The Agency for Health Care Administration (Agency) announced today the release of the Statewide Medicaid Managed Care (SMMC) data book in preparation for the program’s competitive re-procurement. The data book provides relevant background information that prospective plans will find useful in the development of their response to the Invitation to Negotiate (ITN), which the Agency will release in the summer of 2017. 

Agency Secretary Justin M. Senior said, “Releasing the data book is an important step in the re-procurement process of the SMMC program. We hope this will provide prospective plans with valuable information as they prepare their responses to the ITN. The Agency looks forward to working with the plans to provide the best possible health care for Medicaid recipients as we move through the first re-procurement of the program.”

The Agency is hosting a public meeting to address questions about the Statewide Medicaid Managed Care data book released on March 30, 2017. The public meeting will be held on Wednesday, April 12, 2017, 8:30am – 11:30am Eastern Time at the Agency for Health Care Administration, 2727 Mahan Drive, Bldg. 3, Conference Room A, Tallahassee, Fla.   32308. A conference number will be available for those unable to attend in person.

Dial In Number: 1-(877)-218-8845
Conference Code: 497-971-21# 

Anyone interested in the data book can download it from the SMMC re-procurement website. For additional information about the public meeting and the SMMC program, click here. 

Filed Under: Featured Tagged With: Agency for Health Care Administration, AHCA, Re-Procurement Data Book, Statewide Medicaid Managed Care

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