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Florida Managed Care Program Features, as of 2013Features1915 (b) Medicaid DiseaseManaged CareManagementProgram typeComprehensiveMCO any othertypeStatewide or region-specific?Medicaid ReformWaiverMedipassNursing Home Diversion Long-term Care Program Prepaid DentalProgramHealth PlansPrepaid MentalHealth PlansProgram of AllInclusive Care forthe Elderly (PACE)Other PHP Plans Comprehensive MCO PCCMany other typeMLTSS onlyMLTSS onlyBHO (PIHP and/orPAHP)PACEStatewideStatewideDuval, Baker, Clay,Nassau, BrowardStatewideStatewideBay, Brevard, Broward,StatewideCalhoun, Charlotte, Collier,DeSoto, Franklin,Gadsden, Glades, Gulf,Hendry, Holmes, IndianRiver, Jackson, Jefferson,Lee, Leon, Liberty,Madison, Martin, MiamiDade, Monroe,Okeechobee, Orange,Osceola, Palm Beach,Sarasota, Seminole, St.Lucie, Taylor, Wakulla,WashingtonStatewideStatewideFederal operating authority1915(b) waiver1915(b) waiver1115 demonstration1915(b) waiver 1915(a)/1915(c)1915(b)/1915(c)1915(b) waiver1915(b) waiverPACEProgram start /20137/1/20046/30/20001/1/2003Waiver expiration date (if /20146/30/20161/31/20149/30/2014.If the program ended in 2013, indicate .the end datePopulations enrolled.Low-income ryMandatoryMandatory.Aged, Blind or Disabled Children orAdultsNon-Disabled Children (excludingchildren in foster care or receivingadoption Mandatory.MandatoryMandatoryMandatory.Individuals receiving Limited Benefits.Mandatory.Low-income adults not otherwiseeligible and covered prior to 2014under a waiver or other authority.Full DualsVoluntary.Voluntary.VoluntaryPartial Duals.Children with Special Health CareNeedsNative American/Alaskan emptFoster Care and Adoption AssistanceChildrenEnrollment choice periodVoluntaryVoluntaryVoluntaryVoluntary30 days30 days30 daysEnrollment broker name (ifapplicable)Automated Health .Systems, Inc.Automated HealthSystems, ous30 days30 daysPre-assignedN/AAutomatedHealthSystems, Inc.Automated HealthSystems, Inc.Automated Health .Systems, Inc.105MandatoryDental.
Florida Managed Care Program Features, as of 2013Features1915 (b) Medicaid DiseaseManaged CareManagementMedicaid ReformWaiverMedipassNursing Home Diversion Long-term Care Program Prepaid DentalProgramHealth PlansPrepaid MentalHealth PlansProgram of AllInclusive Care forthe Elderly (PACE)Notes on enrollment choice period90 day changeperiod afterselection.90 day change periodafter selection.90 day changeperiod afterselection.90 day changeperiod afterselection.Benefits coveredInpatient hospital physical healthX.X.Inpatient hospital behavioral health(MH and/or SUD)Outpatient hospital physical healthX.X.XXXXXX.X.X.X.PhysicianX.X.XXNurse practitionerX.X.XXX.X.XOutpatient hospital behavioral health(MH and/or SUD)Partial hospitalization.Rural health clinics and FQHCsClinic services.X.XXLab and x-rayX.X.XPrescription drugs and prostheticdevicesEPSDTX.X.XX.X.Case management.Health home.XXX.XX.XFamily planningX.X.XDental services (medical/surgical)X.X.X.XDental (preventative or corrective)X.X.X.XX.XHome health agency services.Personal care (state plan option).HCBS waiver services.Private duty nursing.ICF-IDD.Nursing facility services.XHospice care.XNon-Emergency MedicalTransportationX.X.X.106.XX.XX.X.X.XX.X.X.X
Florida Managed Care Program Features, as of 2013Features1915 (b) Medicaid DiseaseManaged CareManagementMedicaid ReformWaiverOther (e.g., nurse midwife services,freestanding birth centers, podiatry,etc.)Chiropractic,DiseaseCommunity Mental ManagementHealth, DiseaseManagement,Durable MedicalEquipment,Hearing,Immunization,Mental HealthTargeted CaseManagement,OccupationalTherapy, PhysicalTherapy,RespiratoryTherapy, SpeechTherapy, VisionHEDIS data required?YesCAHPS data required?Accreditation required?MedipassNursing Home Diversion Long-term Care Program Prepaid DentalProgramHealth PlansPrepaid MentalHealth PlansProgram of AllInclusive Care forthe Elderly (PACE)Chiropractic,.Community MentalHealth, DiseaseManagement, DurableMedical Equipment,Hearing, Immunization,Mental Health TargetedCase Management,Occupational Therapy,Physical Therapy,Respiratory Therapy,Speech Therapy, VisionCopayments andcoinsurance for allMedicare services up to theamount Medicaid wouldhave paid under fee forserviceHome Health Prosthetic.Devices, Intermittent andSkilled Nursing Services.The Agency negotiatedexpanded benefits abovethe Medicaid state planservice package. Theseexpanded benefits vary byplan and include expandedadult dental services,expanded outpatienthospital visits, physicianhome visits, and manyother expanded benefitsthat can be viewed throughthe following link:http://ahca.myflorida.com/Medicaid/statewide mc/pdf/mma/Expanded esNoYesYesYesNoNoYesNoNoNoAccrediting organizationNCQA, JCAHO,AAAHC, URACNCQANCQA, AAAHC, URAC .NCQA, AAAHC, nationally .recognized accreditingorganizations.EQRO contractor name (if applicable)Health ServicesAdvisory GroupNo.Health Services AdvisoryGroupYesNoHealth ServicesAdvisory GroupNo.NoHealth Services AdvisoryGroupNo.NoHealth ServicesAdvisory GroupNo.Yes.Yes.Yes.No.Quality assurance and improvementPerformance incentives?Payment bonuses/differentials toreward MCOsPreferential auto-enrollment to rewardMCOsPublic reports comparing MCOperformance on key metricsWithholds tied to performance metrics107No
Florida Managed Care Program Features, as of 2013Features1915 (b) Medicaid DiseaseManaged CareManagementMedicaid ReformWaiverMedipassNursing Home Diversion Long-term Care Program Prepaid DentalProgramHealth PlansPrepaid MentalHealth PlansProgram of AllInclusive Care forthe Elderly (PACE)American Eldercare;Amerigroup; YourCareBrevard (BrevardAlzheimer's FoundationInc.); Buena Vista; ProjectIndependence at Home;Hope Choices; Humana;Little Havana Activities andNutrition Centers of Miami;Neighborly Care Network;Simply Healthcare Plan;Sunshine; UnitedHealthcare Plan; UnitedHome Care Service;Universal Healthcare Plan;Urban Jacksonville;WorldNet Services;Community Living;Chapters Health NursingHome Diversion Plan;Molina Healthcare;HealthEaseLakeview Center,Inc; MagellanBehavioral Health ofFL; Public HealthTrust of DadeCounty; NorthFlorida BehavioralHealth Par;Community BasedCare Partnership;Florida HealthPartners, IncFlorida PACE Center;Hope Select Care;Chapters HealthSenior Independence,Inc.; SuncoastNeighborly Care, Inc.Participating plans and regions servedPlans in ProgramAmerigroup; Buena AIDS HealthcareVista; CareFlorida; FoundationClear HealthAlliance; FloridaTrue Health;Freedom;Healthease;Healthy PalmBeaches; Humana;Medica; MolinaHealthcare;Positive; PreferredMedical Plan;Simply HealthcarePlan; Staywell;Sunshine; UnitedHealthcare Plan;Vista Healthplan ofS. FL; Prestige;Integral; SalubrisLLC; Better Health,LLC; Care AccessPSN, LLC; FirstCoast Advantage,LLC; South FloridaCommunity CareNetwork; WeCareHealth Plans, IncPositive; Florida MHS Multiple primary(Magellan); Freedom; care providersHumana; Medica;Molina Healthcare;CareFlorida; SimplyHealthcare Plan; ClearHealth Alliance;StayWell; Sunshine;United Healthcare Plan;Better Health, LLC;Children's MedicalServices; South FloridaCommunity CareNetwork; First CoastAdvantage, LLC108American Eldercare, Inc.; DentaQuest;Amerigroup Florida, Inc.;Managed Care ofCoventry Healthcare ofNorth AmericaFlorida, Inc.; HumanaMedical Plan, Inc.; MolinaHealthcare of Florida, Inc.;Sunshine Health Plan, Inc.;United Healthcare ofFlorida, Inc.
Florida Managed Care Program Features, as of 2013Features1915 (b) Medicaid DiseaseManaged CareManagementMedicaid ReformWaiverMedipass.The Provider Service.Networks (PSNs) arereimbursed on a fee-forservice basis for allFlorida state plancovered services.Under Reform, the feefor-service PSN mustcover transportation,which is done on acapitated basis. TheChildren's MedicalServices Network(CMS) is classified as aProvider ServiceNetwork and a specialtyplan under MedicaidReform. This plan wasdeveloped to servechildren with specialhealth care needs asdefined by Floridastatutes on a voluntarybasis. AIDS HealthcareFoundation of Florida(AHF MCO), d/b/aPositive Health Care, isa specialty plan (HMO)for beneficiaries livingwith HIV/AIDS.Nursing Home Diversion Long-term Care Program Prepaid DentalProgramHealth PlansPrepaid MentalHealth PlansProgram of AllInclusive Care forthe Elderly (PACE)This program is open toindividuals age 65 andolder who are full dualeligibles and meet nursingfacility level of care plusadditional frailty criteria.The Nursing HomeDiversion waiver providescase management andMedicare crossoverpayments for acute careand long-term careservices to eligibleparticipants. All participantsselect a case manager andtheir Nursing HomeDiversion provider. NursingHome Diversion serviceproviders are managedcare organizations that areapproved for each county.Nursing Home Diversionproviders are fully capitatedand are responsible forMedicare co-payments anddeductibles for coveredservices to all individualsenrolled in this program.Recipients enrolled .in the Medipassprimary care casemanagementprogram aremandatorily enrolledin a Prepaid MentalHealth Plan. Thereis one PMHP ineach of Medicaid's11 regions.NotesProgram notesThe DiseaseManagementPAHP isspecifically forpersons withHIV/AIDS. t isper member permonth.Beneficiariesenrolled inProject AIDSCare waiver arevoluntary. ThisincludesMedicare dualeligibles, apopulationotherwiseineligible formandatoryinclusion inDiseaseManagement.End of Worksheet109Limited enrollment beganin August 2013, but theprogram was not statewideuntil March 2014. In orderto enroll in the Long-termCare program, abeneficiary must meetNursing Facility level ofcare.All eligible childrenunder 21 years ofage are mandatoryfor the prepaiddental healthplans.
Florida, Inc. DentaQuest; Managed Care of North America: Lakeview Center, Inc; Magellan Behavioral Health of FL; Public Health Trust of Dade County; North Florida Behavioral Health Par; Community Based Care Partnership; Florida Health Partners, Inc
