AGENCY FOR HEALTH CARE ADMINISTRATION
Proposed Amendment to Florida’s 1115 Managed Medical Assistance Waiver
The Agency for Health Care Administration (Agency) is seeking public input on a proposed amendment to Florida’s 1115 Managed Medical Assistance (MMA) Waiver.
SUMMARY DESCRIPTION OF PROPOSED AMENDMENT:
The Agency plans to submit an amendment to Florida’s 1115 MMA Waiver to the Centers for Medicare and Medicaid Services (Federal CMS). The proposed amendment will allow for Medicaid-eligible children receiving Prescribed Pediatric Extended Care (PPEC) services to become eligible to voluntarily enroll in Florida’s MMA program, a component of the Statewide Medicaid Managed Care (SMMC) program. During Florida’s 2014 legislative session, HB 5201 was passed. This bill allows children receiving PPEC services to voluntarily enroll in Florida’s MMA program upon federal approval. This bill is subject to signature by Florida’s Governor, and this notice is subject to withdrawal if the bill does not become law.
The purpose of the Florida Medicaid PPEC services is to enable recipients under the age of 21 years with medically-complex conditions to receive medical and therapeutic care at a non-residential pediatric center. Currently under Florida law, children receiving PPEC services are excluded from participating in the MMA program and, therefore, would be unable to receive services from an MMA plan such as the Children’s Medical Services Network. The proposed amendment to the 1115 MMA Waiver will allow for those children receiving PPEC services and currently enrolled in the Children’s Medical Services Network or another MMA plan to remain in that plan without disruption of services, ensuring their continuity of care and participation in the MMA program. It would also allow children not currently enrolled in a Medicaid managed care plan to select an MMA plan to take advantage of the higher standards required of the plans and the expanded benefits offered by the plans.
Public Notice and Public Comment Period: June 1, 2014 – June 30, 2014
The Agency will conduct a 30-day public notice and comment period prior to the submission of the proposed amendment request to Federal CMS. The Agency will consider all public comments received regarding the proposed amendment request. The 30-day public notice and public comment period begins June 1, 2014 and ends June 30, 2014. This public notice and public comment period is being held to solicit public input from recipients, providers and all stakeholders and interested parties on the development of the proposed amendment request to Florida’s 1115 MMA Waiver.
To submit comments by postal service or internet email, please follow the directions outlined below. When providing comments regarding the proposed amendment to the 1115 MMA Waiver, please have ‘Proposed Amendment to 1115 MMA Waiver’ referenced in the subject line. Mail comments and suggestions to:
Proposed Amendment to 1115 MMA Waiver
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308
Email your comments and suggestions to: FLMedicaidWaivers@ahca.myflorida.com.
More information is available on the Agency’s website at the following link: http://ahca.myflorida.com/medicaid/statewide_mc/mma_fed_auth.shtml.
SUMMARY DESCRIPTION OF THE 1115 MMA WAIVER:
Florida’s 1115 Research and Demonstration Waiver was initially approved by Federal CMS October 19, 2005 to operate for the period from July 1, 2006 to June 30, 2010. Implementation of the waiver occurred in Broward and Duval Counties on July 1, 2006 with expansion to Baker, Clay and Nassau Counties occurring July 1, 2007. Federal CMS granted temporary extensions of the waiver until December 15, 2011, when final approval of the extension request was granted, for the period from December 16, 2011 to June 30, 2014.
On June 14, 2013, Federal CMS approved an amendment to the waiver that allows for implementation of an improved statewide model of managed care in 2014 and the continuation of the Low Income Pool program. The amendment also changed the name of the waiver to the Florida Managed Medical Assistance Waiver.
On November 27, 2013, the Agency submitted another three-year waiver extension request to Federal CMS to extend Florida’s 1115 MMA Waiver for the period July 1, 2014 to June 30, 2017. With the submission of the three-year waiver extension request, the state is seeking federal authority to extend Florida’s MMA Waiver for the period July 1, 2014 to June 30, 2017. The waiver is designed to implement a new statewide managed care delivery system without increasing costs and to continue the Low Income Pool program. The program is guided by principles designed to improve coordination and patient care while fostering fiscal responsibility.
The MMA program will provide primary and acute medical care for the majority of Medicaid recipients through high quality, competitively selected managed care organizations. Moving from a fee-for-service system to the MMA program, the program increases consumer protections as well as quality of care and access for Floridians in many ways including:
- Increases recipient participation on Florida’s Medical Care Advisory Committee and convenes smaller advisory committees to focus on key special needs populations;
- Ensures the continuation of services until the primary care or behavioral health provider reviews the enrollee’s treatment plan (no more than sixty calendar days after the effective date of enrollment);
- Ensures recipient complaints, grievances and appeals are reviewed immediately for resolution as part of the rapid cycle response system;
- Establishes Healthy Behaviors programs to encourage and reward healthy behaviors and, at a minimum, requires plans offer a medically approved smoking cessation program, a medically directed weight loss program and a substance abuse treatment plan;
- Requires Florida’s External Quality Review Organization to validate each plan’s encounter data every three years;
- Enhances consumer report cards to ensure recipients have access to an understandable summary of quality, access, and timeliness regarding the performance of each participating managed care plan;
- Enhances the plan’s performance improvement projects by focusing on six key areas with the goal of achieving improved patient care, population health and reducing per capita Medicaid expenditures;
- Enhances metrics on plan quality and access to care to improve plan accountability; and
- Enhances the state’s comprehensive continuous quality improvement strategy, focusing it on all aspects of quality improvement in Medicaid.
