Provider Information

Year One - Broward and Duval Counties

Table of Contents
Click on the links in the table below and you will be directed to the corresponding information.

Click here for information from previous workshops.

The Agency conducted two workshops in October to obtain input from Medicaid Reform health plans and other stakeholders on the proposed performance measures the Medicaid Reform plans will be required to collect and report. The Agency will provide the results of the plan performance measures, along with other plan performance information, to Medicaid Reform recipients in the form of Choice Counseling materials so that recipients can choose a Reform plan that best meets their individual needs.

10/6/06 Performance Measures Workshop

The first workshop was held on October 6, 2006, from 1:00 p.m. until 4:00 p.m. Medicaid Reform plans, Medicaid Reform plan applicants, Health Care Advocacy Organizations and others attended the workshop in person or by conference call. The goal of the workshop was to present the proposed performance measures, the timeline for collecting the measures, and obtain input from stakeholders especially from Reform plans. To view the October 6, 2006, workshop presentation materials please click on the link below. During the workshop, the Agency encouraged participants and all interested parties to submit their written comments to the attention of Linda Macdonald at the address below by October 12, 2006. All written comments that were received by October 12, 2006, are posted on this page. To view the stakeholder comments, please click on the link below.  The Agency will review the comments and as appropriate revise the timeline and the performance measures to be reported by the Medicaid Reform plans.

10/26/06 Performance Measures Workshop

The second workshop was held at the Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room C and D, in Tallahassee on October 26, 2006, from 1:00 p.m. until 3:30 p.m. At this workshop, the Agency reviewed the comments received, discussed changes made to the timeline and/or the proposed performance measures, and present the final performance measures.

October 26, 2006 Medicaid Reform Performance Measures Workshop Presentations [100KB PDF]

Medicaid Reform Performance Measures 10/26/06 [47KB PDF]

Pfizer Health Solutions Reporting Overview 10/26/06 [471KB PDF]

The following link is a list of Medicaid Reform Health Plan Applications received by the Agency. The Agency is currently reviewing all of the Applications and intends to have contracts executed by July 1, 2006.

Medicaid Reform Applicants, May 26, 2006 [217KB PDF]

The following link is a list of Medicaid Reform Health Plan Applicants and the telephone numbers for each of their Provider Relations offices. These telephone numbers may be used by health care providers who are interested in speaking to Health Plan staff regarding participation in Reform Health Plan networks.

Provider Relations Contact Information for Reform Applicants, June 9, 2006 [18KB PDF]

Florida Medicaid September 2006 through August 2007 Reform Rates [33KB PDF]

The following links will take you to the Broward County Benefit Comparison Chart and the Duval County Benefit Comparison Chart. Each provides inform. The mailing of the Benefit Comparison Charts with an enrollment form and other instructions to mandatory Reform beneficiaries began July 24, 2006, and will be provided to voluntary Reform beneficiaries by request. Questions from beneficiaries in the Reform areas are being directed to a Choice Counselor. Questions from beneficiaries in the Reform areas are being directed to a Choice Counselor at 1-866-454-3959. Click here to view the comparison charts.

Choice Counseling Transition of Reform Population [18KB PDF]

This document provides historic fee-for-service data for all four Medicaid Reform target populations: TANF; SSI; HIV/AIDS and Children with Chronic Conditions. Summary statistics are provided for all four populations. In addition, claims and service distribution tables are provided for each population except Children with Chronic Conditions.

Prospective plans will find this information essential in the development of their proposed benefit package(s). This Medicaid Reform Data Book is available in CD format, upon request. Please submit your request to Jason Campbell at campbejt@ahca.myflorida.com. Please include your name, organization name, address, phone number and the number of CD[s] you are requesting. There is a limit of 2 CDs per organization.

Florida’s version of the Medicaid Rx risk-adjustment model is now available. This model will be used during the initial stages of Medicaid Reform to risk adjust capitation rates paid to health care plans participating in Reform areas. The Medicaid Rx model was created by a team from the University of California San Diego to use historical pharmacy utilization data as a predictor of future health care costs. By combining this model with a health plan’s historical pharmacy utilization, Florida and the health plan can determine its members’ predicted future physical, mental, and pharmacy health care costs with a greater degree of accuracy than with the current age- and gender-based methodology. To run the Medicaid Rx model, you will need a PC or mainframe computer with a copy of SAS and sufficient disk capacity to store your working files and results.

To obtain a copy of the Medicaid Rx Model, please submit your request to Jason Campbell at campbejt@ahca.myflorida.com, along with your contact information — name and title, organization, address, telephone number, fax number, and e-mail address.

Please mail your comments or suggestions to:

Medicaid Reform
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308

Email your comments and suggestions on Medicaid reform to
medicaidreform@ahca.myflorida.com