AHCA: Medicaid Reform Provider Information

A request for submission of Letter of Intent was issued by the Agency November 8, 2006 regarding Health Plan participation in Medicaid Reform Expansion in Baker, Clay and Nassau Counties. The Letter of Intent is non-binding. The following link is a list of Letters of Intent submitted by Health Plans to participate in the Medicaid Reform expansion. Other information contained in this link to the list of Health Plans includes Plan type (PSN or HMO), and Population and Counties to be served.

Beginning in July 2007, there will be changes to Florida Medicaid in Baker, Clay, and Nassau Counties. These changes are needed to better meet the health care needs of Florida Medicaid beneficiaries. These changes are called “Medicaid Reform”. In Baker, Clay, and Nassau, beginning in April 2007, the local Medicaid office will be offering training meetings on these changes. If you would like to attend one of these meetings, please click on the link below and you will be guided to a site where you can sign up.

Anyone needing further information, or special accommodations under the Americans with Disabilities Act of 1990 (for example, Braille or large print documents, sign language interpreter services, or closed-captioning) should contact the Medicaid Area Office at 1 (904) 353-2100 or toll free at 1 (800) 273-5880. Special accommodation requests under the Americans with Disabilities Act should be made at least seven business days prior to the public meetings. If TTY service is needed, Medicaid beneficiaries can call 1 (800) 955-8771 for assistance.

Health plans that already serve Medicaid enrollees through a Reform plan may now apply to expand services to other Reform counties. The counties are Clay, Baker, Nassau, Duval and Broward. Plans that seek to expand to Clay, Baker or Nassau must serve all three counties.

The expansion application requires updates on any information that has changed since execution of the Reform plan contract the plan's original Reform application as well as new information for the expansion counties.

Pursuant to s. 409.91211(3)(e), F.S., Reform Fee-for-Service (FFS) PSNs shall convert to capitation by no later than the beginning of the fourth year of operation. This will require the current Reform FFS PSNs to meet capitated health plan contract requirements and enter into capitated health plan contracts with the Agency no later than by August 31, 2009. FFS PSNs may opt to convert to capitation earlier provided they meet all capitated health plan requirements. Before the Agency will enter into a capitated health plan contract with an existing Reform FFS PSN, the PSN must submit a completed Medicaid Reform FFS PSN Conversion Application and successfully pass all phases of the conversion application review process.

A completed Disclosure of Ownership and Control Interest Statement (CMS 1513), is required for all Florida Medicaid Reform health plan applicants. To obtain a copy of the form, please click on the link below.

The Data Book provides historic fee-for-service data and summary statistics for each of the four Medicaid Reform target populations: TANF; SSI; HIV/AIDS and Children with Chronic Conditions. In addition, claims and service distribution tables are provided for each target population, with the exception of 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 as a Microsoft Excel spreadsheet. If you would like to obtain a copy, please submit your request to Jason Campbell at campbejt@ahca.myflorida.com. Be sure to include your name, organization name, address, and phone number.

The Agency for Health Care Administration has released an updated version of the Plan Evaluation Tool (PET). The PET is currently available as an Excel spreadsheet and has been updated for the 9/1/2007 – 8/31/2008 contract period based on the most current data available. All Medicaid health plans in Broward and Duval – as well as any new plans in Baker, Clay and Nassau counties – are required to fill out the new PET and submit their new benefit grids, including any requested expanded benefits, to the Agency for the 2007-2008 contract year. Please be advised that due to the updated data, your approved 2006-2007 benefit grid may no longer pass under the new version of the PET. To ensure that your grid will be acceptable for the 2007-2008 contract period, please verify your benefits package using the new PET. The entire Excel spreadsheet with your draft benefits must be submitted to the Agency no later than 5:00 PM on June 11, 2007. You must submit your final benefits to the Agency through the PET no later than 5:00 PM on June 15, 2007.

In order to expedite the review process, please email your plan’s revised draft benefit grid and any supporting documentation for each expanded benefit to John Churchill at churchij@ahca.myflorida.com by 5:00 PM on Monday, June 11, 2007. You must submit your final draft benefit grid and supporting documentation for each expanded benefit to John Churchill by 5:00 p.m. on Friday, June 15, 2007. Also, please copy Christina Lopez lopezc@ahca.myflorida.com on each submission. Benefits grids received after June 15, 2007 may cause a delay in your plan’s Medicaid Reform contract execution, as well as a delay in including the benefit details in the Choice Counseling materials.

Thank you for your prompt attention to this matter. If you have any questions or concerns about this process, please do not hesitate to email John Churchill or call him at (850) 410-1858.

For more information on the PET, refer to the corresponding letter for HMO and PSN.

State of Florida Medicaid Reform Program - Evaluation Tool [1.26MB Microsoft Excel]

Instructions for Evaluation Tool [127KB PDF]

Provider Service Network (PSN) Notification Letter [479KB PDF]

Health Maintenance Organization (HMO) Notification Letter [480KB PDF]

The Revised Reform Rates for Broward (Area 10), and Duval, Baker, Clay and Nassau (Area 4) are found below. As rates are calculated by Area, the Area 4 rates cover all counties in Area 4, and therefore the counties of Duval, Baker, Clay, and Nassau have the same rates. These rates are effective January 1, 2008 through August 31, 2008.

The following link is a list of Medicaid Reform Health Plans 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.

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