Florida House of Representatives' 2011 Medicaid Reform Bills Would Move Medicaid Patients Into Managed Care
The Florida House of Representatives' Office of Public Information issued a recent report on Medicaid Reform for 2011. To view the complete report, click here.
The Florida House of Representatives’ Health & Human Services Committee has filed two state Medicaid reform bills for the 2011 Legislative Session, HB 7107 and a linked bill, HB 7109.
HB 7107 proposes to re-create the Florida Medicaid Program as a statewide, integrated managed care program consisting of three elements:
· Managed Medical Assistance for current recipients of general Medicaid services
· Managed Long-Term Care for current recipients of long-term care Medicaid services
· Managed Long-Term Care for Persons with Developmental Disabilities for those presently receiving Medicaid services for individuals with developmental disabilities.
HB 7109 makes date-specific, conforming changes which align existing law with the proposed changes in HB 7107. The language proposes to:
· Eliminate the existing fee-for-service structure providing all Medicaid recipients with a choice of managed care plans including traditional Health Management Organizations (HMOs), Provider Service Networks (PSNs), and specialty plans with expertise in specific medical conditions.
· Establish eight state regions within which plans will compete for state Medicaid contracts based on value.
· Limit the number of plans allowable in each of the eight regions in order to promote plan stability, while also providing choices to recipients.
· Improve managed care accountability with provider network standards, accreditation requirements, continuous improvement requirements, performance monitoring, penalties for early withdrawal, and prompt payment and fraud and abuse requirements.
· Pay plans risk-adjusted rates, based on patient encounter data. Risk-adjusted rates will ensure plans are paid more for sicker patients in order to allocate resources appropriately and discourage plans from trying to enroll only healthy patients.
· Require achieved savings rebates to incentivize plans to improve patient outcomes and cost-effective health services.
Frequently Asked Questions: Medicaid Reform
Who is responsible for determining Medicaid Eligibility?
The Social Security Administration determines eligibility for Supplemental Security Income (SSI). Recipients of SSI are automatically eligible for Medicaid. The Florida Department of Children and Families (DCF) determines eligibility for low-income children and families, aged persons, persons with disabilities, and persons seeking institutional care.
Once eligible, who is responsible for enrolling eligible persons in the Medicaid program?
The Department of Children and Families is responsible for enrolling Floridians in Medicaid.
What is an HMO (Health Maintenance Organization)?
HMOs are health plans that rely on a specific network of physicians and other providers to deliver health services to the plan enrollees. HMOs are prepaid – receiving a fixed amount per member per month – and must bear the risk of covering medically necessary care with that fixed amount.
What is the difference between Medicaid and Medicare?
Medicaid is the state and federal partnership that provides health coverage for certain people with low incomes who are eligible because of their age, financial situation and medical condition.
Medicare is a federal health insurance program for people who are age 65 or older or disabled. It is administered by the federal Department of Health and Human Services and Centers for Medicare and Medicaid Services (CMS). Eligibility for Medicare is not based on the person’s income or assets.
The Florida House of Representatives’ Health & Human Services Committee has filed two state Medicaid reform bills for the 2011 Legislative Session, HB 7107 and a linked bill, HB 7109.
HB 7107 proposes to re-create the Florida Medicaid Program as a statewide, integrated managed care program consisting of three elements:
· Managed Medical Assistance for current recipients of general Medicaid services
· Managed Long-Term Care for current recipients of long-term care Medicaid services
· Managed Long-Term Care for Persons with Developmental Disabilities for those presently receiving Medicaid services for individuals with developmental disabilities.
HB 7109 makes date-specific, conforming changes which align existing law with the proposed changes in HB 7107. The language proposes to:
· Eliminate the existing fee-for-service structure providing all Medicaid recipients with a choice of managed care plans including traditional Health Management Organizations (HMOs), Provider Service Networks (PSNs), and specialty plans with expertise in specific medical conditions.
· Establish eight state regions within which plans will compete for state Medicaid contracts based on value.
· Limit the number of plans allowable in each of the eight regions in order to promote plan stability, while also providing choices to recipients.
· Improve managed care accountability with provider network standards, accreditation requirements, continuous improvement requirements, performance monitoring, penalties for early withdrawal, and prompt payment and fraud and abuse requirements.
· Pay plans risk-adjusted rates, based on patient encounter data. Risk-adjusted rates will ensure plans are paid more for sicker patients in order to allocate resources appropriately and discourage plans from trying to enroll only healthy patients.
· Require achieved savings rebates to incentivize plans to improve patient outcomes and cost-effective health services.
Frequently Asked Questions: Medicaid Reform
Who is responsible for determining Medicaid Eligibility?
The Social Security Administration determines eligibility for Supplemental Security Income (SSI). Recipients of SSI are automatically eligible for Medicaid. The Florida Department of Children and Families (DCF) determines eligibility for low-income children and families, aged persons, persons with disabilities, and persons seeking institutional care.
Once eligible, who is responsible for enrolling eligible persons in the Medicaid program?
The Department of Children and Families is responsible for enrolling Floridians in Medicaid.
What is an HMO (Health Maintenance Organization)?
HMOs are health plans that rely on a specific network of physicians and other providers to deliver health services to the plan enrollees. HMOs are prepaid – receiving a fixed amount per member per month – and must bear the risk of covering medically necessary care with that fixed amount.
What is the difference between Medicaid and Medicare?
Medicaid is the state and federal partnership that provides health coverage for certain people with low incomes who are eligible because of their age, financial situation and medical condition.
Medicare is a federal health insurance program for people who are age 65 or older or disabled. It is administered by the federal Department of Health and Human Services and Centers for Medicare and Medicaid Services (CMS). Eligibility for Medicare is not based on the person’s income or assets.
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