Florida’s Agency for Health Care Administration Medicaid Reform Technical Advisory Panel Report: March 19, 2012

Mar 19, 2012


Florida’s Agency for Health Care Administration (“AHCA”) Medicaid Reform Technical Advisory Panel met today, March 19, 2012.  To view the meeting materials, click here.

An update of the 1115 Medicaid Reform Demonstration Waiver extension was provided by AHCA Division of Medicaid Deputy Secretary Justin Senior, who indicated that the Medicaid Reform Demonstration Waiver has been extended until June 30, 2014.  Although the waiver extension was granted, the federal government has requested information relating to projects benefiting low income patients from hospitals seeking Low Income Pool reimbursement.

Mr. Senior also provided an update on the amendment to the 1115 Medicaid Reform Demonstration Waiver (“Waiver”), which will expand the managed care program statewide.  There are no official deadlines currently in place for the amendment to the Waiver, and Mr. Senior described the negotiations as amicable and professional. 

Panel members asked AHCA staff members who were present several questions relating to the federal government’s requirements on the Medical Loss Ratio (“MLR”).  The staff members responded that an MLR of 85/15 will be mandated on an annual basis and AHCA will collect data on a quarterly basis beginning in June 2012. 

Several health plans participating on the panel today inquired what the penalty for non-compliance with the MLR would be, to which staff members replied that AHCA has no authority to penalize plans, but that the Waiver allows for the federal government to implement unspecified penalties. They went on to explain that all enforcement authority under the Waiver will belong to the federal government.  Additional questions were raised regarding the lack of methodology for determining the MLR of Provider Service Networks (“PSN”) and whether the concept of the MLR exists in current PSN relationships.

AHCA and Center for Medicaid Services leadership will meet in April to discuss timelines for negotiations relating to the expansion of Medicaid Managed Care Program statewide.  All required submissions have been made in a timely manner to the federal government, which has requested a transition plan, including the order in which regions will transition, to be submitted by AHCA. 

The Long-Term Care Databook was released several weeks ahead of schedule on March 16, 2012.  This may allow the Long-Term Care Invitation to Negotiate (“ITN”) to be released by mid-June 2012, also several weeks ahead of schedule.

The Medical Assistance Program Databook may be released slightly ahead of the October 1, 2012 deadline, which may allow for the Medical Assistance Program ITN to be released in mid-December 2012-slightly ahead of the January 1, 2013 deadline.

The Panel was provided with an update on AHCA’s 2012-2013 budget, highlighted by the following significant reductions

  • Home health visits for non-pregnant adults reduced from 4 to 3;
  • 5.46 percent reduction in hospital inpatient rates;
  • Limitation of 6 emergency room visits for adults;
  • Limit for non-pregnant adults of 2 visits per month to general physician, with no limitation on visits to specialists; and
  • 1.25 percent reduction for nursing home reimbursement.

An update also was provided on the rate development process for contract year 2012-2013.  On January 6, 2012 inpatient and outpatient encounter data was requested from plans.  AHCA has met with its actuaries, as well as with representatives of some plans.  It was related that an additional six months of data was requested in order to allow the plans to fully incorporate 2011 financial data.  AHCA will hold face-to-face meetings with plans to allow its staff and actuaries to understand difficulties plans are encountering in conforming to the agency’s templates

An update on Choice Counseling and Enhanced Benefits was provided, during which it was stated that all call centers were in compliance with contractual terms and a little over $5 million of $6.4 million in enhanced benefits have been expended.