Florida Medicaid Reform

Provider Information - Year 1 (July 1, 2006 - June 30, 2007)
Broward and Duval Counties

Medicaid Reform Performance Measures 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.

October 6, 2006 Medicaid Reform
Performance Measures Presentation
[PDF 126KB]

Attention: Linda Macdonald
Agency for Health Care Administration
Medicaid Bureau of Health Systems Development
2727 Mahan Drive, Building 3, MS 50
Tallahassee, Florida 32308

Email: Linda.Macdonald@ahca.myflorida.com

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 [PDF 100KB]

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

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


Medicaid Reform Applicants

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 [PDF 217KB]

Provider Relations Contact Information for Reform Applicants

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 [PDF 18KB]

Reform Rates

The Final Reform Rates for Broward (Area 10), and Duval, Baker, Clay and Nassau (Area 4) counties have been certified by the Agency's actuary and approved by the Centers for Medicare and Medicaid Services. 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."

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

Benefit Comparison Charts

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 at 1-866-454-3959.

Comparison Charts

Choice Counseling Transition of Reform Population

Choice Counseling Transition of Reform Population [PDF 18KB]

Florida Medicaid Reform Data Book

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 John Churchill at John.Churchill@_blank.myflorida.com. Please include your name, organization name, address, phone number and the number of CD[PDF s] you are requesting. There is a limit of 2 CDs per organization.

Florida Medicaid Reform: Medicaid Rx Model

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.

Florida Medicaid Rx Model Spreadsheet [17KB Microsoft Excel]

Florida Medicaid Reform Plan Evaluation Tool

Prospective Health Plan Applicants are required to submit customized benefits packages with their Health Plan Applications. These benefits packages will be tested for actuarial equivalency and benefit sufficiency. To assist health plans in designing customized benefit packages that will satisfy these tests, AHCA has provided the Florida Medicaid Reform Plan Evaluation Tool (PET) for health plans to test proposed benefit packages before submitting them to AHCA for approval.

Since the initial release of the PET, the 2006 Legislature (Conference Report on House Bill 5001, the 2006-2007 General Appropriations Act) has restored adult vision and adult hearing services to the standard Medicaid benefit. In addition, adult partial denture services have been added. The PET has been revised to include these restored and added services. On May 26, 2006, the revised PET was made available to the prospective health plans.

Prospective plans are required to submit their updated benefits packages for the September 1, 2006 through August 31, 2007 time period to the Agency no later than June 5, 2006 for inclusion in July 2006 Choice Counseling materials. Benefits packages received after June 5, 2006 may be incorporated in subsequent versions of Choice Counseling materials.

The PET and user instructions for Year One are no longer available for testing benefits packages.

Plans may submit the updated benefits packages in Microsoft format via email to John Churchill at John.Churchill@_blank.myflorida.com.

Medicaid Reform Health Plan Application Frequently Asked Questions

Since release of the application, the Agency has worked with prospective health plan applicants to provide clarification regarding the application and contracting process. We have received several questions regarding the release of different tools that will be made available to prospective health plan applicants. We are taking this opportunity to provide an update and clarification regarding the application process, provide some updated tools, and to provide all prospective health plans with responses to questions that the Agency has received to-date. We encourage you to visit this page regularly for new Frequently Asked Questions.

Medicaid Reform Health Plan Application Frequently Asked Questions, April 27, 2006 [PDF 39KB]



Medicaid Reform Health Plan Application, Frequently Asked Questions, April 5, 2006 [PDF 111KB]