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2004 Legislative Action Re- Medicaid Contracting : What Does it Mean for Substance Abuse and for Provider Networks?

2004 Legislative Action Re- Medicaid Contracting : What Does it Mean for Substance Abuse and for Provider Networks?. Medicaid HMOs & Medipass. Behavioral health will be added to HMO contracts. Language affects FY2005 appropriation.

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2004 Legislative Action Re- Medicaid Contracting : What Does it Mean for Substance Abuse and for Provider Networks?

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  1. 2004 Legislative Action Re- Medicaid Contracting : What Does it Mean for Substance Abuse and for Provider Networks?

  2. Medicaid HMOs & Medipass • Behavioral health will be added to HMO contracts. • Language affects FY2005 appropriation. • For Medipass clients, AHCA will contract with “a single managed care plan” in each area, selected by competitive bid (two plans if over 150,000 recipients) • HMO/ Medipass contracting may be coordinated by area, and likely will not begin until fall at the earliest. • Florida Medicaid recipients are enrolled 50% in Medipass and 50% in HMOs, but proportions vary widely by district (see enrollees/ billings analysis by area.)

  3. AHCA will contract for Managed MH/SA Services to Medipass enrollees • Contracts in place statewide by July, 2006. • Capitated, pre-paid plans competitvely bid. • Contractors must comply with Dept. of Insurance licensing and cash reserve requirements. • Could be partnerships between networks and behavioral managed care organizations (area #6 model.)

  4. Special child welfare provisions • Active HomeSafeNet cases exempt for one year, all services remain fee for service. • CBCs may form own specialty pre-paid plan during the year . • Plan must achieve same savings as other managed care plans.

  5. Overlay services still exempt Children exempted from all managed care plans if enrolled in: • SIPP, or • DJJ or DCF residential program approved as Medicaid overlay provider

  6. Medicaid substance abuse cap delayed? • FADAA language placed in Statute 2 years ago was not amended. • "The agency (AHCA) may reimburse for (Medicaid) substance abuse treatment services on a fee-for-service basis until the agency finds that adequate funds are available for capitated, prepaid arrangements.“ • FADAA has scheduled meeting with AHCA to clarify.

  7. Provider networks • MH/SA providers should jointly negotiate and contract with HMOs through networks, if possible. • If providers seek to increase market share through negotiations for HMO and Medipass contracts, insurance companies can use the process to leverage additional discounts on service reimbursement.

  8. More info on Medipass & HMO Enrollmentin your area: • http://www.fdhc.state.fl.us/MCHQ/Managed_Health_Care/MHMO/med_data.shtml

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