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Florida Managed Care Program Features, as of 2014 (1 of 2)FeaturesProgram typeManaged Medical AssistanceProgramComprehensive MCOStatewide or region-specific?StatewideFederal operating authority1115(a) (Medicaid demonstration rogram start dateWaiver expiration date (ifapplicable)If the program ended in 2014,indicate the end datePopulations enrolledProgram of All-Inclusive Carefor the ElderlyMLTSS only (PIHP and/or PAHP) Program of All-inclusive Carefor the Elderly (PACE)StatewideStatewide1915 (b) Medicaid ManagedCareComprehensive MCODisease ManagementStatewideOther Prepaid Health Plan(PHP) (limited e Adults not eligibleMandatoryunder ACA Section VIIIAged, Blind or Disabled Children Mandatoryor AdultsNon-Disabled Children (excluding Mandatorychildren in foster care orreceiving adoption iduals receiving Limited.BenefitsLow-income adults eligible under .ACA Section VIIIFull y.Partial Duals.Children with Special Health Care MandatoryNeedsNative American/Alaskan Natives oster Care and AdoptionAssistance ChildrenEnrollment choice periodMandatoryMandatoryExemptVoluntaryVoluntary30 days30 daysN/A30 days30 daysEnrollment broker name (ifapplicable)Notes on enrollment choiceperiodBenefits coveredAutomated Health SystemsAutomated Health SystemsAutomated Health Systems.Continuous while slots areavailableAutomated Health Systems,Inc.Inpatient hospital physical health.Long-term Care Program.X.X135X.

Florida Managed Care Program Features, as of 2014 (1 of 2)FeaturesInpatient hospital behavioralhealth (MH and/or SUD)Outpatient hospital physicalhealthOutpatient hospital behavioralhealth (MH and/or SUD)Partial hospitalizationManaged Medical AssistanceProgramXLong-term Care Program.Program of All-Inclusive Care 1915 (b) Medicaid Managedfor the ElderlyCareXXDisease Management.X.XX.X.XX.X.X.PhysicianX.XX.Nurse practitionerX.XX.Rural health clinics and FQHCsX.XX.Clinic servicesX.X.Lab and x-rayX.XX.Prescription drugs and prostheticdevicesX.XX.EPSDTX.X.Case managementXXX.Health home (SSA 1945).Family planningX.XX.Dental services(medical/surgical)Dental (preventative orcorrective)Home health agency servicesX.XX.X.XX.X.XX.Personal care (state plan option)XX.HCBS waiver services.XX.Private duty nursingX.ICF-IDD.Nursing facility services.XX.Hospice careXXX.Non-Emergency MedicalTransportationXXXX.136

Florida Managed Care Program Features, as of 2014 (1 of 2)FeaturesOther (e.g., nurse midwifeservices, freestanding birthcenters, podiatry, etc.)Quality assurance andimprovementHEDIS data required?Managed Medical AssistanceProgramMidwife, Birth Center, Podiatry.The Agency negotiated expandedbenefits above the Medicaid stateplan service package. Theseexpanded benefits vary by planand include expanded adultdental services, expandedoutpatient hospital visits,physician home visits, and manyother expanded benefits that canbe viewed through the tatewide mc/pdf/mma/Expanded Benefits.pdf.Long-term Care ProgramProgram of All-Inclusive Carefor the ElderlyHome Health Prosthetic Devices, All other FL Medicaid coveredIntermittent and Skilled Nursing services and other services asServices. The Agency negotiated determined by theexpanded benefits above themultidisciplinary teamMedicaid state plan servicepackage. These expandedbenefits vary by plan and includeexpanded adult dental services,expanded outpatient hospitalvisits, physician home visits, andmany other expanded benefitsthat can be viewed through thefollowing link:http://ahca.myflorida.com/Medicaid/statewide mc/pdf/mma/Expanded Benefits.pdf.1915 (b) Medicaid ManagedDisease ManagementCareChiropractic, CommunityDisease ManagementMental Health, DiseaseManagement, Durable MedicalEquipment, Hearing,Immunization, Mental HealthTargeted Case Management,Occupational Therapy, PhysicalTherapy, Respiratory Therapy,Speech Therapy, Vision.Yes.YesNoYesNoCAHPS data required?YesNoNoYesNoAccreditation required?YesYesNoYesYesAccrediting organizationNCQA, AAAHC, Nationallyrecognized accreditingorganizationsHealth Services Advisory GroupNCQA, AAAHC, Nationallyrecognized accreditingorganizationsHealth Services Advisory Group.NCQA, JCAHO, AAAHC,URACNCQA.Health Services Advisory Group.EQRO contractor name (ifapplicable)Performance incentives?Payment bonuses/differentials toreward plansPreferential auto-enrollment toreward plansPublic reports comparing MCOperformance on key metricsWithholds tied to performancemetricsMCOs/PHPsrequired/encouraged to payproviders for value/qualityoutcomes using shared-risk orshared-savings methods.XX.XX.XX.X.137

Florida Managed Care Program Features, as of 2014 (1 of 2)FeaturesManaged Medical AssistanceProgramLong-term Care ProgramProgram of All-Inclusive Care 1915 (b) Medicaid Managedfor the ElderlyCareDisease ManagementProvider Value-BasedPurchasingState pays provider-basedentities (such as ACOs orPCMHs) directly for value/qualityoutcomes using shared-risk orshared-savings methods.Participating plans and regions .servedPlans in ProgramAmerigroup Florida, Inc.; BetterHealth; Coventry Health Care;First Coast Advantage, LLC;Humana Medical Plan; IntegralQuality Care; Molina Healthcareof Florida; Preferred MedicalPlan; Prestige Health Choice;South Florida Community CareNetwork (SFCCN); SimplyHealthcare Plans, Inc.; StaywellHealth Plan of Florida; SunshineState Health Plan, Inc.; UnitedHealthcare of Florida; AHF /Positive Healthcare; MagellanComplete Care, LLC; SimplyDBA Clear Health Alliance;Sunshine Health Plan ChildWelfare; Children's MedicalServices Network (CMSN)Notes.American Eldercare, Inc.;Amerigroup Florida, Inc.;Coventry Healthcare of Florida,Inc.; Humana Medical Plan, Inc.;Molina Healthcare of Florida,Inc.; Sunshine Health Plan, Inc.;United Healthcare of Florida, Inc.Suncoast Neighborly Care, Inc.;Palm Beach PACE; FloridaPACE Center; Hope SelectCareAIDS Healthcare FoundationAmerigroup; Buena Vista;CareFlorida; Clear HealthAlliance; Florida HealthcarePlus; Florida True Health;Freedom; Healthease; HealthyPalm Beaches; Humana;Medica; Molina Healthcare;Positive; Preferred MedicalPlan; Simply Healthcare Plan;Staywell; Sunshine; UnitedHealthcare Plan; VistaHealthplan of South Florida;Prestige; First CoastAdvantage, LLC.; South FloridaCommunity Care Network.138.

Florida Managed Care Program Features, as of 2014 (1 of 2)FeaturesProgram notesManaged Medical AssistanceProgramPregnant women are mandatorilyenrolled. Low-income adults whoare non-disabled are not covered.Presumptively eligible pregnantwomen are excluded. Full dualrecipients are mandatorilyenrolled if they receive fee-forservice Medicare or are enrolledin a Medicare Advantage planthat is not fully liable. Full dualsenrolled in a fully liable MedicareAdvantage plan or in a MedicareAdvantage Special Needs planare excluded.Long-term Care ProgramProgram of All-Inclusive Care 1915 (b) Medicaid Managedfor the ElderlyCareIn order to enroll in the Long-term .Because this program ended inCare program, a beneficiary must2014, all Medicaid beneficariesmeet Nursing Facility level ofwere transitioned to the SMMCcare.program.End of worksheet139Disease ManagementAs of August 1, 2014, therewere zero enrollees in thisprogram as Medicaid recipientswere transitioned to the SMMCprogram.

Florida Managed Care Program Features, as of 2014 (2 of 2)FeaturesMedicaid Reform WaiverMedipassProgram typeComprehensive MCOStatewide or region-specific?Primary Care CaseManagement (PCCM)StatewideDuval, Baker, Clay, Nassau andBroward County1115(a) (Medicaid demonstration Behavioral Health Organization(BHO) only (PIHP and/or 20149/30/2014Federal operating authorityProgram start dateWaiver expiration date (ifapplicable)If the program ended in 2014,indicate the end datePopulations enrolled.Nursing Home DiversionPrepaid Dental Health PlansProgramMLTSS only (PIHP and/or PAHP) Dental only (PAHP)Prepaid Mental Health Plans.Low-income Adults not eligibleMandatoryunder ACA Section VIIIAged, Blind or Disabled Children Mandatoryor AdultsNon-Disabled Children (excluding Mandatorychildren in foster care orreceiving adoption atoryMandatory.MandatoryMandatoryIndividuals receiving Limited.BenefitsLow-income adults eligible under .ACA Section VIIIFull DualsVoluntary.VoluntaryMandatory.Partial Duals.Mandatory.Children with Special Health Care MandatoryNeedsNative American/Alaskan Natives ryVoluntaryMandatoryFoster Care and AdoptionAssistance ChildrenEnrollment choice periodVoluntaryVoluntaryExemptVoluntaryMandatory30 daysN/AOther30 daysPre-assignedEnrollment broker name (ifapplicable)Notes on enrollment choiceperiodBenefits coveredAutomated Health Systems, Inc. Automated Health Systems,Inc.Automated Health Systems, Inc. .Continuous.Inpatient hospital physical health.X.140.

Florida Managed Care Program Features, as of 2014 (2 of 2)FeaturesMedicaid Reform WaiverMedipassInpatient hospital behavioralhealth (MH and/or SUD)Outpatient hospital physicalhealthOutpatient hospital behavioralhealth (MH and/or SUD)Partial hospitalizationX.X.XPhysicianNurse practitionerNursing Home DiversionProgram.Prepaid Dental Health PlansPrepaid Mental Health Plans.X.X.X.X.Rural health clinics and FQHCsX.Clinic services.Lab and x-rayX.Prescription drugs and prostheticdevicesX.EPSDTX.Case management.XX.XHealth home (SSA 1945).Family planningX.Dental services(medical/surgical)Dental (preventative orcorrective)Home health agency servicesX.X.X.X.X.Personal care (state plan option).HCBS waiver services.X.Private duty nursing.ICF-IDD.Nursing facility services.X.Hospice care.X.Non-Emergency MedicalTransportationX.141

Florida Managed Care Program Features, as of 2014 (2 of 2)FeaturesMedicaid Reform WaiverMedipassOther (e.g., nurse midwifeservices, freestanding birthcenters, podiatry, etc.)Chiropractic, Community MentalHealth, Durable MedicalEquipment, Hearing,Immunization, Mental HealthTargeted Case Management,Occupational Therapy, PhysicalTherapy, Respiratory Therapy,Speech Therapy, Vision.Quality assurance andimprovementHEDIS data required?.YesNursing Home DiversionPrepaid Dental Health PlansProgramCopayments and coinsurance for .all Medicare services up to theamount Medicaid would havepaid under fee for servicePrepaid Mental Health Plans.No.Community Mental HealthServicesNoYesYesCAHPS data required?YesNoNoNoYesAccreditation required?YesNoNoNoNoNCQA, AAAHC, URAC.Health Services Advisory Group.Health Services Advisory Group.Health Services Advisory GroupAccrediting organizationEQRO contractor name (ifapplicable)Performance incentives?Payment bonuses/differentials toreward plansPreferential auto-enrollment toreward plansPublic reports comparing MCOperformance on key metricsWithholds tied to performancemetricsMCOs/PHPsrequired/encouraged to payproviders for value/qualityoutcomes using shared-risk orshared-savings methodsProvider Value-BasedPurchasingState pays provider-basedentities (such as ACOs orPCMHs) directly for value/qualityoutcomes using shared-risk orshared-savings methodsParticipating plans and regionsserved.142.