Florida Medicaid Reform

Provider Information - Year 2 (July 1, 2007 - June 30, 2008)
Broward, Duval, Baker, Clay, and Nassau Counties

Letter of Intent

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.

Medicaid Reform Training for Beneficiaries

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. http://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/federal_authorities/federal_waivers/Archive/Archive/index.shtml

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 Field 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.

Florida Medicaid Reform Health Plan Application

The revised Application for Medicaid Reform Fee-For-Service Provider Service Networks (PSNs), Prepaid PSNs, Health Maintenance Organizations (HMOs) and other authorized Health Plans and the Reform Health Plan Contracts is now available. This multi-purpose Health Plan Application is designed to capture detailed information that will facilitate a contract between the Agency and any PSN, HMO or other authorized Health Plans that meet the requirements to become a Medicaid Reform Health Plan.

Medicaid Reform Health Plan Application, December 2006 [PDF 237KB]

Model Contracts

Florida Medicaid Reform Health Plan Expansion Application

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.

Medicaid Reform Health Plan Expansion Application, January 2007 [PDF 393KB]

Model Contracts

Medicaid Reform PSN Conversion to Capitation Application

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.

Medicaid Reform PSN Conversion to Capitation Application, November 2007 [PDF 793KB]

Disclosure of Ownership and Control Interest Statement (CMS-1513)

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.

Disclosure of Ownership and Control Interest Statement (CMS-1513) [PDF 550KB]

Florida Medicaid Reform Data Book

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 spreadsheet. If you would like to obtain a copy, please submit your request to John Churchill at John.Churchill@ahca.myflorida.com. Be sure to include your name, organization name, address, and phone number.

Florida Medicaid Reform Plan Evaluation Tool

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 John.Churchill@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 Christina.Lopez@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 [MS Excel 1.26MB]

Instructions for Evaluation Tool [PDF 127KB]

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

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

Revised Reform Capitation Rates

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. 

Florida Medicaid September 2007 - August 2008 FINAL Reform Capitation Rates [PDF 18KB]

January 2008 Revised Reform Capitation Rates (effective January 1, 2008 through August 31, 2008) [PDF 40KB]

Florida Medicaid September 2008 - August 2009 Reform Capitation Rates [PDF 67KB]

Provider Relations Contact Information for Reform Health Plans

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.

Provider Relations Contact Information for Reform Applicants, June 2007 [PDF 13KB]