MM Curator summary
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[MM Curator Summary]: In addition to the 520 questions asked by MCO bidders and a few providers, the state also clarified unicorns will be invited to join the party (Medicaid “Accountable Care Organizations.” Silly rabbit, there is no accountability in Medicaid. Everyone knows that!)
Health care providers have an extra week to make the state an offer to provide managed care plans, health care networks and accountable care organizations through the statewide Medicaid Managed Care Program that serves nearly 4.5 million Floridians.
The Agency for Health Care Administration (AHCA) released a lengthy addendum to its invitation to negotiate (ITN), bumping the deadline for vendors to reply to Sept. 22.
While the vendors have an additional week to prepare their ITN responses, the anticipated date for the state to electronically post the names of the winning vendors remains the same: Dec. 11. Additionally, the state still intends to negotiate with as many as 10 health plans between October and November.
One change to the underlying ITN included in the addendum is adding accountable care organizations (ACOs) to the list of health plans with whom the state plans to ink Medicaid contracts.
ACOs are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high-quality care. To date, they have operated in the Medicare market.
The addendum also alters the ITN to prohibit managed care plans from using flat-rate payment arrangements in their agreements with subcontractors and providers. The addendum notes that the prohibition doesn’t preclude managed care plans from using value-based purchasing arrangements (VBPA).
The addendum adds language to the ITN requiring managed care plans to ensure contracted subcontractors “utilize value-based purchasing arrangements to the fullest extent.”
VBPAs link payments to performance in hopes of holding health care providers accountable for both the cost and quality of care they provide.
AHCA disclosed in its answers that while there is no pre-determined budget for the Statewide Medicaid Managed Care Program, the state estimates the contracts to be worth between $120 billion and $150 billion over the six-year span.
For more than a decade, Florida has required most, but not all Medicaid managed care beneficiaries, from the cradle to the grave, to enroll in a managed care plan to deliver health care. The Legislature last year agreed to make changes to the law, primarily administrative, including merging the number of Medicaid regions from 11 to nine.
Florida’s existing managed care contracts expire Dec. 31, 2024, and the ITN sets an ambitious timeline to ensure new contracts are negotiated, signed and executed by then. This is the third time the state has put its Medicaid Managed Care program up for competitive bid.
Sunshine State Health Plan, AmeriHealth Caritas Florida, Humana Healthy Horizons of Florida, United Healthcare of Florida and Community Care Plan, a provider-sponsored network run by a Broward County hospital district, all submitted questions to the state to be answered.
Questions were also submitted by some less-recognized names.
For instance, the Alliance of Florida PPECs asked AHCA to clarify whether children enrolled in prescribed pediatric extended care centers (PPECs) will be placed in Medicaid managed care plans.
Currently these children are not required by law to enroll in managed care plans, but the ITN said AHCA intended to enroll non-mandatory populations into the managed care plans.
“Yes,” AHCA replied to the question, adding the people will be given “the ability to opt out of managed care at any time.”
PPECs serve medically complex children eligible from birth through age 20 with continual medical care, but they do not provide residential care.
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