Trying to transform Medicaid into a statewide managed-care program, Florida health officials face dozens of questions from the federal government about how the plan would work.
The federal Centers for Medicare & Medicaid Services sent a list of questions in January, more than five months after Florida submitted proposals to shift hundreds of thousands of beneficiaries into HMOs and other managed-care plans.
The list of questions centers on a proposal to move the bulk of Medicaid beneficiaries, such as low-income women and children, into managed care. At the same time, the state Agency for Health Care Administration is negotiating with federal officials on a related proposal to use managed-care plans for seniors who need long-term care.
Questions touched on a wide range of issues, including safeguards that the state will put in place as it contracts with HMOs.
“The State must ensure that plans maintain a network of providers in sufficient number, mix, and geographic distribution to meet the needs of Medicaid beneficiaries,” one part of the list said.
“What are the standards that will be used by the state to ensure access to Medicaid services and to which managed care plans will be held accountable? How have these standards been vetted? Describe the ongoing oversight and review that will be in place to ensure plans maintain a sufficient network.”
Also, the questions deal with hot-button industry issues such as negotiations between managed-care plans and hospitals and a requirement — known as a medical loss ratio — that plans spend a minimum amount of money they receive on patient care.
“How will the agency evaluate and determine that a plan’s pharmacy network can assure reasonable access to services?” federal officials asked in another part of the list. “What are the requirements/parameters surrounding the use of mail order pharmacies?”
Florida lawmakers last year approved the controversial shift to managed care, arguing it would help hold down costs and lead to better-coordinated services for beneficiaries. The changes, however, depend on federal approval.
AHCA met an August deadline for submitting two proposals to federal officials — one dealing with long-term care, the other for the broader Medicaid population. The proposals would be phased in, with long-term care beneficiaries the first to start enrolling in 2013.
Agency officials said Tuesday that AHCA expects to release what is known as an “invitation to negotiate” for the long-term care portion by July 1. That is an important initial step in the process of determining which health plans will get contracts.
Justin Senior, deputy secretary for Medicaid, told members of the state’s Medical Care Advisory Committee that AHCA can take that step before it has received approval from the federal government. He described the negotiations on the long-term care portion as being “off the clock,” which means the federal government doesn’t currently have a deadline for making a decision about whether to approve the proposal.
Meanwhile, Senior said agency officials are working on responses to the list of questions federal officials sent in January about the broader Medicaid population. He said he expects a face-to-face meeting with federal officials in April.
The list includes 42 questions, some with multiple parts. The questions deal with myriad issues, ranging from how the state will review the financial stability of managed-care plans to how long it will take to enroll all beneficiaries.
It even delves into issues such as a requirement that managed-care plans establish programs to reward beneficiaries for such things as quitting smoking.
“How will individuals access the smoking cessation, weight loss and substance abuse programs?” federal officials asked. “Will these be voluntary programs for which satisfactory completion will earn enhanced benefits credits?”
By Jim Saunders
