DRAFT 2012-2015 Health Plan Contract:
This is a preliminary draft of the 2012-15 Medicaid Health Plan Contract (strike-through/ track changes version). Please note that the changes from the last general amendment (telemedicine) are also included as track-changes. Most sections of this draft are final but some are still undergoing revision (particularly Attachment II, Section XIV, Sanctions, and Section XII, Reporting Requirements). Those sections are marked under review and the Agency will provide draft language once it is available. This document is scheduled to be reviewed with the health plans by conference call on June 1, 2012, at 10:30 a.m. Eastern Time. Written comments or revisions will be accepted to the draft contract language from the health plans until close of business on June 15, 2012.
DRAFT 2012-2015 Attachment I FFS (513 KB, PDF)
DRAFT 2012-2015 Attachment I Capitated (611 KB, PDF)
DRAFT 2012-2015 Attachment II (2.56 MB, PDF)
DRAFT 2012-2015 Exhibits (907 KB, PDF)
2009-2012 Medicaid Managed Care Contract
Please be advised that health plan expansion requests received after June 1, 2012, are not likely to be fully reviewed and approved prior to the release of the procurement documents for Statewide Medicaid Managed Care.
For the Miami-Dade and Statewide Prepaid Dental Contracts, please go to the PrePaid Dental Health Plans page at Prepaid Dental Health Plans Contracts and Templates.
May 1, 2011 Health Plan Contract
The draft health plan contract combines the May 1, 2010 Health Plan Contract and the Agency’s Fine-Tuning 2 General Amendment executed by health plans in April - May 2011 and the Non-Reform PSN Behavioral Health Amendment executed in January – April 2011. These consolidated contract documents are used for both Reform and non-Reform HMO and PSN contracts.
Attachment I Scope of Services Capitated Health Plans Clean Draft (465 KB, PDF) *5-1-2011
Attachment I Scope of Services Fee-For-Service Provider Service Networks Clean Draft (286 KB, PDF) *5-1-2011
Attachment II – Core Contract Provisions Clean Draft (1.37 MB) *5-1-2011 (reposted 12-27-11)
Attachment II - Exhibits Clean Draft (798 KB, PDF) *5-1-2011
Health Plan Report Guide
Health plan reporting specifications for all contract-required reports are provided in the 2009 – 2012 Report Guide. The 2009 – 2012 Report Guide and report templates are located below. The latest revised version of the guide is shown with its effective date, along with a Report Guide Revisions Transmittal, and a summary of changes made to the original document. Red-lined versions identifying changes are not posted but are available upon request. When the latest guide takes effect, the prior version will be moved to history. Plans may submit reports/report files using the information in the newest guide prior to its effective date where possible.
Report Guide (2.05 MB, PDF) Effective 07-01-2012
Report Guide Revisions Table (307 KB, PDF) Effective 07-01-2012
Report Guide Transmittal (45 KB, PDF) Effective 04-02-2012
Current:
Report Guide (1.72 MB, PDF) Effective 04-01-2012
Contract Required Forms, Templates and Instructions
Templates:
Audited Annual and Unaudited Quarterly Financial Reports (274 KB, XLS) 2012
Behavioral Health – Critical Incident Report - Individual (21 KB, XLS)
Behavioral Health – Critical Incident Report - Summary (59 KB, XLS)
Behavioral Health – Enrollee Satisfaction Survey Summary (24 KB, XLS)
Behavioral Health – Required Staff-Providers Report (60 KB, XLS)
Behavioral Health – Stakeholders’ Satisfaction Survey Summary (27 KB, XLS)
Benefit Maximum Report (30 KB, XLS)
Catastrophic Component Threshold Report (30 KB, XLS)
CHCUP (CMS-416) & FL 60% Screening (220 KB, XLS) (Federal Fiscal Year 2010-2011)
Claims Aging Report & Supplemental Filing Report Capitated Health Plans (2510 KB, XLS)
Claims Aging Filing Report Fee-For-Service PSNs (2065 KB, XLS)
Community Outreach Health Fairs Public Events Notification (142 KB, XLS)
Community Outreach Representative Report (43 KB, XLS)
Complaints, Grievances, and Appeals Report (516 KB, XLS)
Customized Benefit Notifications Report (37 KB, XLS)
Hernandez Settlement Agreement Log (217 KB, XLS)
Hernandez Settlement Agreement Survey (25 KB, XLS)
HIV-AIDS Algorithm Detail 03-06-09 (1491 KB, XLS)
Insolvency Protection Multiple Signatures Agreement Form (77 KB, PDF)
Medicaid Redetermination Notice Summary Report (40 KB, XLS)
Medical Loss Ratio Report - Draft (187KB, PDF) *New - Effective 7/1/12
MPI Annual Fraud and Abuse Activity Report 03-12-12 (903 KB, XLSX) *Updated 4-2-12
MPI Subcontract Checklist Jan2011 (56 KB, XLS)
Naming Convention for Navigator (36 KB, PDF)
Navigator Plan Files Questions & Answers 12-08-09 (95 KB, PDF)
Synopsis of the Navigator for Reform Choice Counseling (32 KB, PDF)
Newborn Enrollment Report (19 KB, XLS)
PCP Wait Times Report (1726 KB, XLS)
Performance Measures (52 KB, XLS)
Provider Network File Layout (350 KB, PDF) Effective 4/1/11
Provider Termination & New Provider Notification Report 12-15-09 (67 KB, XLS)
Rx Quarterly Submissions Proprietary Format Data Layout (45 KB, DOC)
Rx Quarterly Submissions NCPDP Format Data Layout (46 KB, DOC)
Rx Quarterly Submissions Data Certification (35 KB, DOC)
Forms:
Involuntary Disenrollment Request Form (74 KB, XLS) *Updated 5/24/11
Behavioral Health 80/20 Refund - contact the Bureau of Managed Health Care at 850-412-4300
Health Plan Redetermination Date Reminder (7 KB, PDF)
Redetermination Date File Usage Form (69 KB, PDF)
Provider Network Checklist (89 KB, DOC)
Medicaid Health Plan Provider Network Spreadsheet (94 KB, XLS)
Florida Health Plan Export File Formats (437 KB, PDF) *Contains the Provider Network Response File *Effective 7/1/12
Sample Letter of Delegation (41 KB, PDF)
Capitation Information:
Medicaid Reform Capitation Rates Effective Sep2011 (123 KB, PDF)
Medicaid Non-Reform Capitation Rates Effective Sep2011 (209 KB, PDF)
Medicaid Non-Reform Capitation Rates 2010-2011 Contract Year (105 KB, PDF) *Effective 9/1/2010
Medicaid Reform Capitation Rates 2010-2011 Contract Year (27 KB, PDF) *Effective 9/1/2010
Medicaid Non-Reform Capitation Rates - effective 11-01-2009 (102 KB, PDF)
Medicaid HMO Non-Reform Capitation Rates-2009-2010 Contract Year (61 KB, XLS)
Medicaid PSN Non-Reform Capitation Rates-2009-2010 Contract Year (29 KB, XLS)2012 Policy Transmittals:
12-01 HMO & 12-01 PSN Requesting an Expansion (167 KB, PDF) 1-24-2012
Health Plan Letters:
2011:
Ineligible Providers 5-10-11 (355 KB, PDF)
Provider Service Networks (PSNs)
MEDICAID REFORM CONTRACT INFORMATIONPrior Medicaid Managed Care Health Plan Information:
For historical and informational purposes the 2009-2012 Contract and associated files are being archived as updates/changes are made.
2009-2012 Medicaid Managed Care Contract, Report Guide, Templates and Forms - Archives
Prior HMO Contracts and Related Information - Archives
Prior Health Plan Policy Letters - Archives
Transmittal Archives:
2011 Policy Transmittals Archive
2010 Policy Transmittals Archive
2009 Policy Transmittals Archive
2008 Policy Transmittals Archive
2007 - no Policy Transmittals issued
2006 Policy Transmittals Archive
2005 Policy Transmittals Archive
2004 Policy Transmittals Archive
2003 Policy Transmittals Archive
2002 Policy Transmittals Archive (86.5 KB, PDF)
2001 Policy Transmittals Archive
2000 Policy Transmittals Archive
1999 Policy Transmittals Archive
