Provider Town Hall Presentation

1. Provider Town Hall Presentation Managed Medical Assistance (MMA) & Child Welfare (CW) 2014

2. Agenda • Sunshine Health &Managed Medical Assistance (MMA)Overview • Child Welfare (CW) Program Overview • Continuity of Care for Transitioning Members • Cenpatico Behavioral Health • Contracting • Covered Services & Expanded Benefits • Q & A

3. Sunshine Health & Managed Medical Assistance (MMA) Overview Mark Barrett VP, Network Development & Contracting MMA & CW 2014

4. Sunshine Health Overview • Sunshine Health is a wholly-owned subsidiary of Centene Corporation and has provided Medicaid Managed Care services in Florida since 2009. • Products: Medicaid; Long Term Care; HealthyKids; Medicare SNP; and Health Insurance Exchange • Number of Florida employees: 1,200+ • Number of Florida physicians: 18,500+

5. Centene Overview“Better Health Outcomes, Lower Cost” Medicaid (19 States) Exchanges (9 States) Correctional (3 States) MA D-SNP (6 States) History and Scope of Centene • Established in 1984 in Milwaukee, WI • Headquartered in St. Louis, MO • Fortune 500 company (#303) • Employs approximately 8,700 individuals • Serves government sponsored healthcare programs in 21 states • Provider network includes over 190,000 physicians and 1,900 hospitals ~2.6M Members

6. Bringing Medicaid LeadershipExperience to New Markets 1995 2006 1984 1999 2006 2004 2007 2009 2012 2009 2011 2012 2011 2010 Partnering with 19 State Medicaid Agencies* Starting Q4 2014* 2013 2013 2013 2012 * Fidelis SecureCare is subject to certain acquisition closing conditions including regulatory approvals

7. Specialty Company Resources and Expertise Total Solution Integration physical health, behavioral health, pharmacy services, and ancillary services Behavioral Health & Specialty Therapies Life, Health & Wellness Provider of In-Home Services Case Management Software Pharmacy & Specialty Pharmacy Benefits Integrated Approach HCBS for I/DD Populations Vision Benefits Telehealth Services Centurion is a correctional healthcare joint venture between Centene and MHM Services Inc. Currently has contracts in MA, MN, and TN.

8. Managed Medical Assistance (MMA) • Sunshine Health was selected to provide managed care services for Medicaid recipients in Regions 3 through 11 for a five year period. • 2014 Rollout of MMA • Regions 2, 3, 4 - May 1 • Regions 5, 6, 8 - June 1 • Regions 10, 11 - July 1 • Regions 1, 7, 9 - August 1

9. Managed Medical Assistance (MMA) & Managed Care The goals of Florida MMA are to provide: • Coordinated health care across different health care settings • A choice of the best managed care plans to meet recipients’ needs • The ability for health care plans to offer different, or more, services • The opportunity for recipients to become more involved in their health care

10. Medicaid Managed Care There are two different components that make up the Statewide Medicaid Managed Care (SMMC) program: • Long Term Care (LTC) • Managed Medical Assistance (MMA) Medicaid recipients who qualify and become enrolled in the Florida LTC managed care program will receive LTC services through a LTC managed care plan. Medicaid recipients who qualify and become enrolled in the Florida MMA program will receive all health care services other than LTC through a managed care plan.

11. AHCA’s List of Statewide Comprehensive Plans

12. Child Welfare (CW) Overview Cathy Sharp Manager, Provider Partnership MMA & CW 2014

13. Child Welfare (CW) Through a competitive bid process, the Agency for Health Care Administration (AHCA) selected Sunshine Health as the only specialty managed care plan to provide managed care services for children in the CW system for a five year period. • 2014 Rollout of CW • Regions 2, 3, 4 - May 1 • Regions 5, 6, 8 - June 1 • Regions 10, 11 - July 1 • Regions 1, 7, 9 - August 1

14. Child Welfare (CW) Sunshine Health is the sole specialty plan in Florida for the child welfare population, serving approximately 30,000 children statewide. CW includes three primary partners: • Sunshine Health • Cenpatico Behavioral Health • Community Based Care Integrated Health (CBC-IH)

15. Community Based Care (CBC) Sunshine Health is contracted with Community Based Care – Integrated Health (CBC-IH) to provide support and care coordination for all Sunshine Health CW Members statewide. Sunshine Health’s contract with CBC-IH is an innovative partnership designed to ensure that all behavioral or physical health care related services are coordinated with the CBC agencies. Our staff provide care and utilization management through an integrated team of professionals focused on meeting the overall needs of each child.

16. Child Welfare (CW) • CBC-IH is assisting Sunshine Health in gathering information for the new CW members’ Health Risk Screenings (HRS). The HRS includes questions regarding physical health, behavioral health, dental, and pharmacy authorizations or appointments during the 90 day CW continuity of care period. • CBC-IH will identify a PCP for each child in the Sunshine HealthCW Plan, and at go-live, it is anticipated that Sunshine Health will have the designated PCP on its provider list. This will greatly reduce the need for auto-assignment and ensure uninterrupted transition of care.

17. Continuity of Care Cathy Sharp Manager, Provider Partnership MMA & CW 2014

18. New Members • Sunshine Health ensures continuous care for new members receiving an active course of treatment through their previous health plan or Medicaid Fee-For-Service (FFS), provided the services were prior authorized before enrollment with Sunshine Health. • These services include: • Prior existing orders • Provider appointments (dental appointments, surgeries, etc.) • Prescriptions (including those at non participating pharmacies) • Behavioral health services

19. Continuity of Care Period • Sunshine Health provides continuity of care for all new members for the following time periods following the enrollment date or until the member’s new PCP or behavioral health provider reviews the member’s treatment plan: • MMA members up to 60 calendar days • CW members up to 90 calendar days • Sunshine Health ensures new members who are pregnant and have initiated a course of prenatal care, regardless of the trimester, continuity of care with their current OB/GYN until the completion of postpartum care • Sunshine Health also ensures, in conjunction with Medicaid eligibility, continuity of care for active orthodontia until the completion of care and reimbursement to providers, regardless of provider network

20. Authorization & Payment • In the event a new enrollee is receiving a prior authorized treatment with an out-of-network provider, Sunshine Health will: • Continue to pay for the course of treatment through the continuity of care timeframes, regardless of whether the services are provided by participating or non-participating providers • Adjudicate claims submitted by out-of-network providers between the date of service and the date of the clean claim submission, unless that period exceeds 365 days

21. Pharmacy Management • Sunshine Health adopted AHCA’s Preferred Drug List (PDL) formulary for the first year of MMA and CW. • Sunshine Health’s Pharmacy Benefit Manager (PBM), US Script, will continue to manage the pharmacy network and process PA or step edit requests • Sunshine Health’s specialty drug company, Acaria will continue to process requests for specialty drugs • Age, gender, and quantity limits along with the drugs that require a PA will mirror those on AHCA’s PDL. This information can be accessed through a link on Sunshine Health’s website to the AHCA website • PA forms and criteria can be accessed through US Script or Sunshine Health’s website • Any changes made by AHCA will be adopted to the PDL by Sunshine Health

22. Case Management Support • A Sunshine Health case manager is assigned to all members needing continuity of care services. • Case managers and other team members will follow these members and facilitate the care coordination process by: • Contacting the member/caregiver to obtain information on the member’s providers, dates of appointments, and provided services • Providing additional clinical information to utilization management • Helping the member make appointments with their Sunshine Health PCP or behavioral health provider • Helping the member transition to a participating provider, if needed

23. Contact Us We encourage providers who have new Sunshine Health patients transitioning from Medicaid FFS or another heath plan with approved authorizations, or in ongoing treatment plans, to contact Sunshine Health’s Utilization Management staff as soon as possible by calling: 1-866-796-0530

24. Cenpatico Behavioral Health Kristie Cavins Provider Relations Cenpatico Behavioral Health MMA & CW 2014

25. Service Area and Provider Types Cenpatico contracts with an extensive provider network that contracts with the following: • Community Mental Health Centers (CMHCs) • Independent Practitioners (MDs, PhDs, LPC, LCSW, and LMFTs) • Institutes for Mental Disorders (IMD) • General Hospitals offering psychiatric and/or substance use services • Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Primary Care Clinics (PCCs) • Statewide Inpatient Psychiatric Programs (SIPP)

26. Provider Participation Responsibilities Cenpatico emphasizes its commitment to quality of care for Sunshine Healthmembers by ensuring our providers adhere to the following: • Provide members with a professional level of care and efficiency that is consistent with community standards • Prepare and maintain complete medical records and other required documents for all member care • Participate in quality improvement activities, utilization review activities, orientations, continuing education, and other medical management components • Abide by ethical principles of their profession Cenpatico will communicate with providers to inform them of their participation responsibilities, credentialing and application status, and network requirements.

27. Provider Training Program Cenpatico will offer a series of trainings for providers specific to behavioral management services for members including: • Motivation interviewing • Trauma informed care • Privacy/HIPAA • Behavioral health screening tools • Integration of Care • IMPACT – depression model – PCP focused A schedule of upcoming training events will be available at: SunshineHealth.com

28. Network Participation Agreements Cenpatico wants to extend an agreement to your organization if you are not already contracted with us. For those existing network providers, an amendment to your existing contract to incorporate the expanded behavioral health outpatient benefits and applicable modifiers for MMA and CW may be necessary. For additional information, contact Dawn Kinkead at: dkinkead@cenpatico.comor727-434-4139

29. Contracting Bridget Jones Contract Negotiator MMA & CW 2014

30. Sunshine Health Network Snapshot

31. Participating Hospitals in Region 5

32. Participating Hospitals in Region 6 *Letter of Intent Completed & Agreement Pending

33. Contracting Overview • Contractual agreements must be in compliance with the terms of the Managed Care Plan’s AHCA contract. • 55 required contract checklist provisions • Template agreements must be approved by AHCA • Providers must be eligible for participation in the Medicaid Program • Fully completed application, including updated CAQH credentials, will expedite the credentialing process • Who do I contact about an agreement? • Contracting Representatives are on site today

34. Covered Services, Expanded Benefits & Program Incentives Cathy Sharp Manager, Provider Partnership MMA & CW 2014

35. MMA Covered Services • Laboratory & imaging services • Medical equipment & prostheses • Mental Health services • Nursing care • Optical services • Optometrist services • Physical, occupational, respiratory, and speech therapy • Podiatric services • Physician services, including physician assistant services • Prescription drugs • Renal analysis services • Respiratory equipment & supplies • Substance abuse treatment • Transportation to access covered services • Advanced registered nurse practitioner services • Ambulatory surgical treatment center services • Chiropractic services • Dental services • Early periodic screening & treatment services • Emergency services • Family planning services • Healthy start services • Hearing services • Home health agencies services • Hospice services • Hospital inpatient services • Hospital outpatient services

36. Sunshine Health Expanded Benefits (Limitations and Authorizations may apply)

37. Sunshine Health Expanded Benefits (Limitations and Authorizations may apply)

38. Sunshine Health Expanded Benefits (Limitations and Authorizations may apply)

39. Sunshine Health Expanded Benefits(Some limitations and authorizations may apply)

40. Sunshine Health Program Incentives

41. Questions