Federal Authorities

Managed Medical Assistance

March 2018 – Request to Amend Florida’s 1115 MMA Waiver – Prepaid Dental Health Program (Project Number 11-W-002064) and Public Input

The Agency for Health Care Administration (Agency) is seeking federal authority to amend Florida Medicaid’s 1115 MMA Waiver (Project Number 11-W-00206/4) to operate a Statewide Medicaid prepaid dental health program (PDHP). The State intends to operate the PDHP as an “Additional Program” under Section XIII of the Special Terms and Conditions in order to provide Florida Medicaid State Plan dental services to recipients through dental managed care organizations (dental plans). The PDHP is expected be implemented by January 1, 2019.

The PDHP does not reduce, or otherwise impede access to, Florida Medicaid dental services for any impacted recipient.  The State is not requesting any substantive changes to the 1115 MMA Waiver outside those specified in this amendment request. The State anticipates the PDHP will operate in accordance with the existing CMS-approved Special Terms and Conditions to the extent applicable. Any areas of divergence are specified in the amendment request.

Waiver History (2006-2017)

The following is a historical description of the federal and state authority granted since authorization of the waiver (Project Number 11-W-00206/4) was obtained in 2005.

Three-Year Extension Period (2011-2014): On December 15, 2011, the Agency received approval from CMS to extend Florida’s 1115 Medicaid Reform Waiver for the period July 1, 2011 through June 30, 2014.

A Waiver Amendment (2014):  On June 14, 2013, the Agency received CMS approval to amend the waiver to terminate the Medicaid Reform program, implement the MMA program, and rename the waiver, “Managed Medical Assistance”. The Reform program was terminated on August 1, 2014 with the implementation of the MMA program.

Three-Year Waiver Extension (2014-2017): On November 27, 2013, the Agency submitted an extension request to extend authority for the 1115 MMA Waiver for an additional three years (July 31, 2014 - June 30, 2017). The Agency received approval for the three-year extension from CMS on July 31, 2014. The effective dates of the current waiver period are July 31, 2014 through June 30, 2017.

1. Allow recipients under the age of 21 years who are receiving Prescribed Pediatric Extended Care services and recipients residing in group home facilities licensed under section 393.067, F.S., to voluntarily enroll in an MMA plan.
2. Enroll newly Medicaid eligible recipients into a managed care plan immediately after their eligibility determination, and to make changes to the auto-assignment criteria.
3. Extend the LIP program through the remainder of the demonstration period ending June 30, 2017.

1. Allow the Agency flexibility to contract with one to three vendors under the hemophilia program.
2. Include payments for nursing facility services in the MMA capitation rates for MMA enrollees under the age of 18 years.
3. Allow flexibility for specialty plans to conduct Performance Improvement Projects on topics that have more specific impacts to their enrollees, with Agency approval.

The Agency received temporary extensions to operate the MMA program from July 1, 2017 through August 4, 2017.

Five-Year Extension (2017-2022):  On August 3, 2017, the Agency received approval to extend authority for the 1115 MMA Waiver for the period of August 3, 2017 through June 30, 2022.

• Transition the federal authority to serve individuals enrolled in the MEDS-AD section 1115 demonstration to MMA; and
• Establish financial and non-financial eligibility criteria for individuals diagnosed with Acquired Immune Deficiency Syndrome (AIDS) to obtain and maintain coverage for Medicaid benefits without the need for enrollment in the 1915(c) Project AIDS Care (PAC) waiver.

Public Notice and Public Comment March 9, 2018 – April 7, 2018

The Agency will provide for a 30-day public notice and comment period prior to the submission of the waiver amendment to Federal CMS. The Agency will consider all public comments received regarding the development of the waiver amendment.

• Public Notice Document [615KB PDF]

Public Meetings/Workshops

The dates, times and locations of the public workshops to be held are as follows:

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least seven days before the workshop/meeting by contacting Kimberly Quinn at (850) 412-4284 or by email at Kimberly.Quinn@ahca.myflorida.com.

Submit Comments

The 30-day public comment period begins March 9, 2018 through April 7, 2018.

Written comments on the waiver amendment can be submitted via mail or email with the subject “1115 MMA Amendment – PDHP” during the public comment period.

Mail:
Agency for Health Care Administration
2727 Mahan Drive, Building 3
Tallahassee, FL 32308

Email:
FLMedicaidWaivers@ahca.myflorida.com

Amendment Submission

To view the amendment submission, including a summary of comments, please click the following link:

Florida's 1115 MMA Amendment Request [1MB PDF]