SUMMARY DESCRIPTION OF PROPOSED AMENDMENT: The Agency plans to submit an extension request for Florida’s 1115 MEDS-AD Waiver to the Centers for Medicare and Medicaid Services (CMS) for the period January 1, 2016 to December 31, 2018. The waiver provides Medicaid eligibility for individuals who meet the following criteria: • Have a disability or are age 65 or over, • Income is 88 percent of the federal poverty level or lower, and • Have assets that do not exceed $5,000 for individuals or $6,000 for couples; and are in one of the following Medicaid eligibility groups: • Group 1: Medicaid and Medicare (dual) eligibles receiving Medicaid-covered institutional care services, hospice services, or home and community-based services. • Group 2: Medicaid-only eligibles currently receiving Medicaid-covered institutional care services, hospice services, or home and community-based services. • Group 3: Medicaid-only eligibles not currently receiving Medicaid-covered institutional care services, hospice services, or home and community-based services. Individuals enrolled in the demonstration receive state plan benefits and may also receive pharmacy case management services. Applicable Medicaid state plan co-payments apply and services are delivered through the same delivery system available to state plan enrollees. The state seeks to use the current authorities granted by the Centers for Medicare and Medicaid Services (CMS) in December 2010 to continue the waiver. To view the full description of the extension request please see the public notice document published on the Agency’s website at the following link: http://ahca.myflorida.com/medicaid/MEDS-AD/MED_AD_1115_Waiver_2015-06.shtml PUBLIC NOTICE AND PUBLIC COMMENT PERIOD: May 21, 2015 – June 20, 2015 The Agency will conduct a 30-day public notice and comment period prior to the submission of the extension request to CMS. The Agency will consider all public comments received regarding the extension request. The 30-day public notice and public comment period begins May 21, 2015 and ends June 20, 2015. 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 extension request for Florida’s 1115 MEDS-AD Waiver. To submit comments by postal service or internet email, please follow the directions outlined below. When providing comments regarding the extension request for the 1115 MEDS-AD Waiver please have ‘Extension request for the 1115 MEDS-AD Waiver’ referenced in the subject line. Mail comments and suggestions to: 1115 MEDS-AD Waiver Extension Request 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. SUMMARY DESCRIPTION OF THE 1115 MEDS-AD WAIVER: The waiver provides Medicaid eligibility for individuals who meet the following criteria: • Have a disability or are age 65 or over, • Income is 88 percent of the federal poverty level or lower, and • Have assets that do not exceed $5,000 for individuals or $6,000 for couples; and are in one of the following Medicaid eligibility groups: • Group 1: Medicaid and Medicare (dual) eligibles receiving Medicaid-covered institutional care services, hospice services, or home and community-based services. • Group 2: Medicaid-only eligibles currently receiving Medicaid-covered institutional care services, hospice services, or home and community-based services. • Group 3: Medicaid-only eligibles not currently receiving Medicaid-covered institutional care services, hospice services, or home and community-based services. Individuals enrolled in the demonstration receive state plan benefits and may also receive pharmacy case management services. Applicable Medicaid state plan co-payments apply and services are delivered through the same delivery system available to state plan enrollees. The state seeks to use the current authorities granted by the Centers for Medicare and Medicaid Services (CMS) in December 2010 to continue the waiver. The waiver includes a Medication Therapy Management program as well as allows for data mining. Medication Therapy Management Program The Agency for Health Care Administration (Agency), through an agreement with the University of Florida (UF), provides Medicaid Drug Therapy Management (MTM) Program services to Medicaid recipients assigned to the MEDS-AD Waiver program. The goals of the program are to improve the quality of care and prescribing practices based on best-practice guidelines, improve patient adherence to medication plans, reduce clinical risk, and lower prescribed drug costs and the rate of inappropriate spending for certain Medicaid prescription drugs. Data Mining Data mining refers to the practice of electronically sorting Medicaid Management Information Systems claims through sophisticated statistical models and intelligent technologies to uncover patterns and relationships contained within the Medicaid claims and history files. Data mining has the goal of identifying abnormal utilization and billing practices that are potentially fraudulent.