Florida s Agency for Health Care Administration

1. Florida�s Agency for Health Care Administration Secretary Andrew Agwunobi, M.D. Welcome to Medicaid�s training of the coverage and limitations of the Independent Laboratory Services program. My name is __________ and I am a ________ with ________. (You could talk a little about your work experience.) We are so glad that you could be with us today, going over the policies and principles of the program. This understanding will save you time, effort and money. In addition to the training you receive today, other support is available through: the provider handbook you received at enrollment, Consultec telephone customer service and area representatives access to local AHCA staff as well as having this information available on through FL Medicaid�s web site www.fdhc.state.fl.us/Medicaid. We will review some of our most frequently asked questions at the end of the presentation, but feel free to ask questions as we go along. Let�s get started. Welcome to Medicaid�s training of the coverage and limitations of the Independent Laboratory Services program. My name is __________ and I am a ________ with ________. (You could talk a little about your work experience.) We are so glad that you could be with us today, going over the policies and principles of the program. This understanding will save you time, effort and money. In addition to the training you receive today, other support is available through: the provider handbook you received at enrollment, Consultec telephone customer service and area representatives access to local AHCA staff as well as having this information available on through FL Medicaid�s web site www.fdhc.state.fl.us/Medicaid. We will review some of our most frequently asked questions at the end of the presentation, but feel free to ask questions as we go along. Let�s get started.

2. Mission �The Agency for Health Care Administration champions accessible, affordable, quality health care for all Floridians.�

3. Division of Health Quality Assurance��state licensure�federal certification�of health care facilities�CON�complaints�� Long Term Care Licensure and Certification Nursing Home Gold Seal Quality of Long Term Care Facility Improvement Trust Fund Nursing Home Guide and Watch List Adverse Incidents and Nursing Home Reporting Background Screening Certificate of Need Program Plans and Construction Review Managed Care Managed Care Subscriber Assistance Statewide Provider/Health Plan Claim Dispute Resolution

4. Division of Health Quality Assurance Emergency Support Function (ESF8) with the Department of Health Emergency Status System 94% of Nursing Homes Enrolled Field Operations Eight Field Offices: Inspections and Investigations Complaint Administration: Call Center and 5-day Abuse Reports Quality of Care Monitors Survey Integrity and Training Informal Dispute Resolution (IDR) MDS/OASIS Help Desk

5. Quality Indicator Survey Process Federal Quality Indicator Survey Process Florida: First Statewide Pilot Improve Consistency/Accuracy of QOC/QOL Problem Identification Using a More Structured Process Comprehensive Review of Regulatory Care Areas within the Current Survey Process Enhanced Documentation by Organizing Survey Findings through Automation Focus Survey Resources on Facilities with Largest Number of Quality Concerns

6. QIS Florida Roll-out Plan Tallahassee/Pensacola November 2007 Complete Alachua/Miami January � July 2008 Orlando/Ft. Myers February � October 2008 Delray/Tampa-St. Pete July 2008 � November 2009

7. Government Performance Results Act (GPRA) Congressional Directive: Initiate Program Performance Reform Series of Pilot Projects in Setting Program Goals Measuring Program Performance Against Goals Reporting Publicly on Progress Improve Federal Program Effectiveness and Public Accountability Promoting a New Focus on: Results Service Quality Customer Satisfaction

8. Nursing Home GPRA Focus Reduce Restraint Use 2006 (4th Quarter) 8.6 Florida 5.8 Nation 2007 (1st Quarter) 8.3 Florida 5.5 Nation Reduce Pressure Ulcers 2006 (4th Quarter) 9.7 Florida 8.4 Nation 2007 (1st Quarter) 9.6 Florida 8.6 Nation

9. Strategies for Improvement Register to Participate in the Advancing Excellence in America�s Nursing Homes Campaign www.nhqualitycampaign.org Consider Partnerships with other Health Care Providers Southeast Region Workgroup Nursing Home Association Participation Hospital Association Participation State Agency Participation

10. Division of Medicaid�Directs all Medicaid program planning and development activities� $15.6 Billion Annual Medicaid Services Budget 2.0 Million Eligibles Bureau of Medicaid Program Analysis Nursing Home Reimbursement and Rate Setting Cost Reports and Audits Bureau of Medicaid Contract Management Provider Enrollment & Fiscal Intermediary Management / Claims Bureau of Medicaid Pharmacy Services

11. Medicaid Reimbursement Budget Reduction Session Impact Nursing Home Rate Reduction 3% Effective January 1, 2008 Recurring Reduction: Based on Annualized Amount each Rate Semester Crossover Payments Initial Implementation Issues Corrected Claims Reprocessed Recovery of Automatic Crossover Payments Pending Fiscal Agent Transition to EDS

12. Division of Medicaid Bureau of Medicaid Services Handbook and Policy Waiver Programs Pre-Admission Screening and Resident Review (PASRR) 11 Area Offices Claim Reconciliation Beneficiary Assistance Bureau of Medicaid Health Systems Development Medicaid Managed Care Policy and Disease Management Bureau of Medicaid Quality Management Provider Satisfaction Surveys

13. Florida Senior Care Integrate All Medicaid Services, including Nursing Facility and Waiver Services, in a Managed Care Plan Medicaid Beneficiaries Age 60 and Older and Dually Eligible (Medicaid and Medicare) Beneficiaries Age 21 and Older Can Participate in Brevard, Osceola, Orange, Seminole, Miami-Dade, and Monroe Counties Enrollment is Voluntary in These Areas of the State Enrollees Can Choose to Enroll or Disenroll at Any Time Any Willing, Qualified Managed Care Plan May Enroll as a Provider Individuals Living in Residential Facilities Can Stay in Their Facility Even if the Facility Does Not Have a Contract with a Florida Senior Care Managed Care Plan Implementation is Expected in November 2008

14. Florida Center for Health Information and Policy Analysis�collection�analysis�dissemination� of health-related data� Health Information Infrastructure Fosters the Deployment of Electronic Medical Records and E-prescribing Data Collection, Dissemination and Quality Assurance Transparency in Health Care Consumer-Driven Floridahealthfinder.Gov Search Tools to Compare Short-term Acute Care Hospitals, Ambulatory (Outpatient) Surgery Centers, Health Plans, and Nursing Homes A.D.A.M. Health Encyclopedia with Thousands of Health Articles and Illustrations Health Care Facility Finder Information About Insurance, Medications, Seniors, Medical Conditions, and Resources for Medical Care Consumer Publications Information for Health Care Professionals and Much More

17. Nursing Home White Paper�Long Term Care Review� Overview of Regulation, Quality, Ownership, Reimbursement Significant Regulatory Oversight Exists Ownership Disclosure is Limited Unable to Identifiable Correlation between Quality and Ownership but More Extensive Analysis Is Warranted

18. Nursing Home White Paper Recommendations Revise Nursing Home Guide Increase Transparency of Information Examine �Proof� Standard for Nursing Home Sanctions Revise Change of Ownership Definition and Requirements Expand Disclosure of Ownership Commission Statistical Analysis to Evaluate Quality and Ownership Review Regulation of Alternative Settings � Assisted Living/Adult Family Homes

19. Long Term Care Issues Aging Demographics Certificate of Need Moratorium until 2011 MRSA Workgroup Department of Health Partnership State Budget Pressure