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July 12, 2018

THE AGENCY REQUIREMENTS ON THE HEALTH PLANS AND HOW THEY AFFECT NURSING FACILITY PROVIDERS

Medicaid New Five-Year Contract Begins January 1, 2019


As you are aware, the new Statewide Medicaid Managed Care(SMMC) program contract becomes effective 1/1/19. Beginning, December 1, 2018, there will be a staggered rollout of the program throughout the state over a three-month period. It is apparent that the added requirements placed in the contract to the health plans are there to enact the goals of the Agency. These requirements and goals are real, measurable and will affect providers.

Two of the Agency goals are reducing antipsychotics and implementing value based contracting. These goals are clearly written into the new contract and were part of the rebidding process requiring the health plans to implement. These requirements include possible fines if not implemented and monitored.

Why this is potentially problematic to the nursing facility is how this requirement is implemented. For example, a new requirement of re-credentialing will include reviewing the nursing facility providers quality star ratings and antipsychotic percentage. The below is directly from the new contract between the Agency and the health plans:

Within the new contract, there is an eighteen-page section explaining the sanctions/liquidated damages and fines that will be applied if the requirements of the contract are not met. There are 100 specific items to be sanctioned or fined by the Agency ranging from $500 per day to $25,000 per occurrence based on the severity of the offense. These damages will not be passed through to the provider but, the health plans will be diligent in their requirements to ensure they are not fined. Below is a fine for not meeting credentialing requirements:



Value based purchasing is another goal of the Agency to implement through the SMMC contract. Value based purchasing was a repeated theme throughout the rebidding process and is linked to various goals of the Agency. The Agency is requiring the health plans to implement value based purchasing contracts within their provider network. There are specific contract volume requirements for each year of the five (5) year contract. Most of these will be physician based contracts but, there are specific measures such as, potentially preventable admissions(PPA) and readmission(PPR) and potentially preventable emergency department visits (PPV) that will affect nursing facility providers.

In the coming weeks we will explore the other new requirements of the contract and how these requirements will potentially affect providers.

If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909.



AHCA PROVIDES UPDATES ON SMMC PROGRAM AND ANNOUNCES REGIONAL ROLLOUT OF CONTRACT

The Agency provided updates on the SMMC program to the Medicaid Medical Care Advisory Committee on July 10, 2018. Some of the highlights included a summary of the past five-year experience and what is changing in the new five-year contract. Page 9 of the attached slide-deck illustrates the Agency’s new SMMC Program Goals. This slide-deck reveals the Agency’s intentions and goals for the upcoming five years of the SMMC program.

The roll-out of the new SMMC program contract begins December 1, 2018 and is staggered over a three-month period. Below is a chart showing this roll-out schedule:


AHCA HAS SETTLED WITH THE PROTESTING
HEALTH PLANS

The Agency has announced the health plans who received the final protest settlements. Molina as a Comprehensive plan was awarded regions 8 and 11. Whereas, Prestige Healthchoice as a MMA plan was awarded regions 9 and 11. Below is an updated grid listing the health plan awardees:


RIPPED FROM THE HEADLINES

Managed Long-Term Services and Supports: Status of State Adoption and Areas of Program Evolution, chapter 3, page 47 of the MACPAC report to Congress. HMA Contributes MLTSS Research to MACPAC Report.

Health plan updates

Staywell, WellCare’s Medicaid health plan has provided an updated Florida Medicaid Provider Resource Guide.This guide explains how to access their provider portal and all the capabilities within the portal. Read the Guide...

Copyright 2018 — Publication of FAHA H&S
Chair: Brian Robare
President/CEO: Steve Bahmer
Principal/Editor: Dana McHugh

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