Introductions

1. Prepaid Mental Health PlanCommunity Stakeholder MeetingAHCA Areas 3 and 4December 16, 2004 – Jacksonville, FLDecember 17, 2004 – Ocala, FL

2. Introductions • Deborah McNamara • Prepaid Mental Health Plan Coordinator • (850) 414-0633; mcnamard@fdhc.state.fl.us • Trecia Perry • Prepaid Mental Health Plan Contract Manager • (813) 871-7600 x133; perryt@fdhc.state.fl.us • Jorja Daniels • Prepaid Mental Health Plan Area Coordinator • (813) 871-7600 x132; danielsj@fdhc.state.fl.us

3. Purpose of the Stakeholder Meeting • Present an overview of the Prepaid Mental Health Plan • Answer questions • Elicit feedback and recommendations

4. HB 1843 and Mental Health Services • Prepaid Mental Health Plans will be implemented statewide by July 1, 2006. • Health Maintenance Organizations will provide community mental health services to their members statewide. • Children in the HomeSafeNet database will receive services through a specialty prepaid network beginning July 1, 2005.

5. What Does This Mean? • One Prepaid Mental Health Plan in each AHCA area will provide mental health care for people enrolled in the MediPass program. • Members of Medicaid HMOs will be excluded from participating in the Prepaid Mental Health Plan. • Children in the HomeSafeNet database will be excluded from participating in the Prepaid Mental Health Plan. A new prepaid plan will be developed operated by the Community-Based Care Organizations beginning July 1, 2005.

6. Planned Implementation Schedule

7. What is a Prepaid Mental Health Plan? • A Prepaid Mental Health Plan is a managed care organization that contracts with AHCA to provide mental health services to its members though a capitated payment system. • AHCA pays a per member, per month (PMPM) fee to the plan based on the age and eligibility category of each member.

8. Who will be our Prepaid Mental Health Plan provider? The Prepaid Mental Health Plan contractor must: • Have experience in providing community mental health services. • Be licensed with the Department of Insurance under Chapter 624, 636, or 641. • Be accredited through an organization such as the Joint Commission on Accreditation of Health Care Organizations, the Commission on Accreditation of Rehabilitation Facilities, the National Committee for Quality Assurance, or the Utilization Review Accreditation Commission.

9. RFP Process • A Request for Proposal is released by AHCA. • Interested parties submit a Notice of Intent to Submit a Proposal to AHCA. • AHCA will hold a Bidder’s Conference to give interested parties an opportunity to ask informal questions about the requirements. • All formal questions must be submitted to AHCA in writing. A written response will be prepared and will become an addendum to the RFP. • Interested parties submit proposals to AHCA. • No less than three reviewers will evaluate and score each proposal. • The entity whose proposal receives the highest score will be awarded the contract.

10. Who is eligible to be in the Prepaid Mental Health Plan? Any Medicaid recipient who elects to enroll in MediPass for the provision of their physical health care services will be assigned to the Prepaid Mental Health Plan for the provision of their mental health services, unless they are ineligible.

11. Who is NOT eligible to be in the Prepaid Mental Health Plan? • Recipients who have both Medicaid and Medicare. • Persons living in an institutional setting, such as a nursing home, state mental health treatment facility, or prison. • Medicaid-eligible recipients receiving services through Hospice. • Recipients in the Medically Needy Program. • Newly enrolled recipients who have not yet chosen a health plan. • SOBRA eligible pregnant women and presumptively eligible pregnant women. • Individuals with private major medical coverage. • Members of a Medicaid HMO. • Children enrolled in the HomeSafeNet database. • Recipients receiving FACT services.

12. Services

13. Quality Services • Services must be: • Recovery-oriented • Individualized • Evidence-Based • Services cannot be: • More restrictive than those offered in the fee-for-service plan

14. Services Covered by the Prepaid Mental Health Plan • Inpatient Psychiatric Hospital Services • 45 days for adult recipients • 365 days for children • Outpatient Psychiatric Hospital Services • Psychiatric Physician Services • Community Mental Health Services • Mental Health Targeted Case Management

15. Community Mental Health Services • Individualized Treatment Plan Development and Modification • Evaluation and Assessment Services • Medical and Psychiatric Services • Mental Health Counseling/Therapy • Psychosocial Rehabilitative Services • Clubhouse • Therapeutic Behavioral On-Site Services • Self-Help/Peer Services • Crisis Intervention Mental Health Services and Post-Stabilization Care Services

16. Additional Service Requirements • Monitoring of recipients in: • State Mental Health Treatment Facilities • Jails and Juvenile Detention Facilities • Residential Treatment Facilities • Provision of services to residents in Assisted Living Facilities with a Limited Mental Health License

17. Optional Services • The Prepaid Mental Health Plan provider has flexibility to offer additional services that it deems beneficial. • Optional Services listed as part of the bidder’s original proposal become mandatory services once the contract is executed. • Examples may include: • Respite Care • Support Groups • Prevention Services

18. Services NOT Covered • Specialized Therapeutic Foster Care • Therapeutic Group Care Services • Behavioral Health Overlay Service (BHOS) • Statewide Inpatient Psychiatric Program (SIPP) • Residential treatment programs, long-term care • Transportation • Medical/Surgical Interventions • Medications • Florida Assertive Community Treatment Services (FACT) • Comprehensive Behavioral Health Assessments • Qualified Evaluator Services • Substance Abuse Services

19. Downward Substitution of Care • Prepaid Mental Health Plan providers may offer alternative services to their members. • Examples of downward substitutions include psychologists and social workers in private practice. • Services provided as a downward substitution may not be more restrictive than the level of care available in the fee-for-service system.

20. Access Requirements • Direct service providers must be available to every member within: • 30 minutes typical travel time in urban areas • 60 minutes typical travel time in rural areas • Appointment times: • Immediate access for emergencies • Within 23-hours for urgent appointments (e.g., non-emergent allergic reactions to medication) • Within 7 days for routine appointments

21. Staffing Standards • Ratios of staff members to recipients for specific disciplines • Requirements for staff members trained in specific specialty areas (e.g., young children, domestic violence, etc.)

22. Community Coordination • The Prepaid Mental Health Plan provider must be an active participant in the mental health treatment community. • The plan is required to develop linkages to other vital community systems, such as the schools, the criminal justice system, and agencies serving the homeless.

23. Medicaid Managed Care Advisory Group • Each AHCA area will have a Medicaid Managed Care Advisory Group that meets quarterly. • Members include the Prepaid Mental Health Plan contractor, Medicaid HMOs, the Department of Children and Families, mental health care providers, and local advocacy groups. • Recipients of care are encouraged to become active participants.

24. Operational Issues

25. Transition Plan for New Members • The Prepaid Mental Health Plan is required to provide an transition plan for new enrollees. • For recipients who have been participating in treatment during the previous six months, the plan must continue to authorize services until the Individualized Treatment Plan is reviewed and a transition plan is developed.

26. Grievances and Fair Hearings • The Prepaid Mental Health Plan is required to have a grievance and appeal system in place that is approved by AHCA. • Members may access the Department of Children and Families Medicaid Fair Hearing process.

27. Quality Improvement • The Prepaid Mental Health Plan contractor must have a quality improvement program. • The quality improvement program will be reviewed by AHCA and by the External Quality Review Organization.

28. Reporting • The Prepaid Mental Health Plan contractor is required to submit reports to AHCA on a regular basis. • Examples of reports include: • The number of members assigned to each provider. • The results of annual member and stakeholder satisfaction surveys conducted by the plan. • Grievances and the actions taken by the plan to resolve the grievances. • Community outreach activities. • Service utilization. • Critical incidents. • Financial reports.

29. Monitoring • Conducted jointly between AHCA and the Department of Children and Families. • A minimum of two on-site monitoring visits annually. • Quarterly desk reviews. • Annual evaluations by the External Quality Review Organization.

30. How can the community ensure success? • Get to know your local AHCA staff. Each Prepaid Plan will have AHCA staff members assigned to provide oversight and answer questions. • Actively participate in your local Medicaid Managed Care Advisory Group.

31. Further Information • Area One Prepaid Mental Health Plan Request for Proposal: http://www.fdhc.state.fl.us/Medicaid/ITN_RFP/rfp_area_1.pdf • 1915b Waiver Information: http://www.cms.hhs.gov/medicaid/1915b/default.asp

32. Please Send Comments Deborah McNamara, LCSW Agency for Health Care Administration 2727 Mahan Drive, MS 20 Tallahassee, FL 32308