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Medicaid Managed Care Initiatives & The Aging Network Florida Update. By Robert Beck, President, PinPoint Results & Advocate for the FL Association of Area Agencies on Aging N4A Conference Meeting April 16, 2012. Florida’s Medicaid Managed Long Term Care Program.
Medicaid Managed Care Initiatives&The Aging NetworkFlorida Update By Robert Beck, President, PinPoint Results & Advocate for the FL Association of Area Agencies on Aging N4A Conference Meeting April 16, 2012
Florida’s Medicaid Managed Long Term Care Program • Efforts to establish Managed Long Term Care in Florida began in 2010 with final legislation passed in 2011. • 2011 Legislation HB 7107 and 7109 www.flsenate.gov • Establishes new Managed Care Program for Long Term Care Population beginning 2012; • Remaining non-long term care population (Medical Assistance) transition begins in 2013; • All long term care programs & providers are included in transition to Managed Care: Medicaid HCBS Waiver Programs, Nursing Homes, Assisted Living, ADRCs, etc. • Transition begins in 2012 (pending CMS approval of Florida’s Waiver Application)
Florida’s Medicaid Managed Long Term Care ProgramImplementation & Critical Provisions • In Florida, 11 Medicaid Regions – tracks to current Aging Network Regional Structure. • State Medicaid Agency release of competitive procurements to designate a minimum of 30 Managed Long Term Care Plans and 11 Provider Service Networks across the 11 regions (maximum of 53 plans possible). • Plans must offer contracts to Aging Network service providers that have previously participated in home and community-based waivers serving elders or community-service programs administered by the Department of Elderly Affairs. • After 12 months of active participation in a managed care plan's network, the plan may exclude providers from the network for failure to meet quality or performancecriteria.
Florida’s Medicaid Managed Long Term Care ProgramImplementation & Critical Provisions • Managed Long Term Care Plans – Important Selection Considerations: (3) QUALITY SELECTION CRITERIA.— The agency shall consider the following factors in the selection of eligible plans: • (a) Evidence of the employment of executive managers with expertise and experience in serving aged and disabled persons who require long-term care. • b) Whether a plan has established a network of service providers dispersed throughout the region and in sufficient numbers to meet specific service standards established by the agency for specialty services for persons receiving home and community-based care.
Florida’s Medicaid Managed Long Term Care ProgramImplementation & Critical Provisions • (4) PROVIDER NETWORK STANDARDS.—The agency shall establish and each managed care plan must comply with specific standards for the number, type, and regional distribution of providers in the plan's network, which must include: (h) Community Care for the Elderly (CCE) lead agencies • In Florida, CCE lead agencies are the Aging Networks’ Case Management entities and along with our Aging & Disability Resource Centers, form the bedrock of Florida’s HCBS Aging Network. • New Important Guidance Statement issued by Florida Medicaid Agency (April 4, 2012): Long-term Care Managed Care Plans selected to participate in the long-term care component of the SMMC program will be authorized to subcontract for case management services.
Florida’s Medicaid Managed Long Term Care ProgramAging & Disability Resource Centers – Roles & Responsibilities • House Bill 7109 states: • (3) The duties of an aging resource center are to: • (h) Assist clients who request long-term care services in being evaluated for eligibility for enrollment in the Medicaid long-term care managed care program as eligible plans become available in each of the regions pursuant to s. 409.981(2). • (i) Provide enrollment and coverage information to Medicaid managed long-term care enrollees as qualified plans become available in each of the regions pursuant to s. 409.981(2). • (j) Assist Medicaid recipients enrolled in the Medicaid long-term care managed care program with informally resolving grievances with a managed care network and assist Medicaid recipients in accessing the managed care network’s formal grievance process as eligible plans become available in each of the regions defined in s. 409.981(2).
Florida’s Medicaid Managed Long Term Care ProgramAging & Disability Resource Centers – Roles & Responsibilities • Current Status: • Florida’s ADRCs are continuing meetings & discussions with our State Medicaid Agency and Dept. of Elder Affairs for ADRCs to be designated as the ‘Choice Counseling’ entities under managed long term care. We believe this is critical to the programs success. • During the 2012 legislative session just ended in March, an additional $6 million appropriation was provided for Florida’s ADRCs to support choice counseling start up and workload activities. • The overall goal of ADRCs under managed long term care: • To electronically ‘hand off’ to the state enrollment broker an ‘enrollment ready’ client that has been determined eligible for the program, has been educated on their ‘options’ and has made an informed decision on which long term care plan BEST meets their needs.
Florida’s Medicaid Managed Long Term Care ProgramAging & Disability Resource Centers – Roles & Responsibilities • In Florida, Choice Counseling, (i.e., intake, assistance with Medicaid financial eligibility, information, face-to-face assessment, etc.), under Managed Long Term Care will be very critical to frail seniors and the disabled because: • 63.4 % of seniors seeking long term care assistance have NOcaregiver; • 49.1 % of seniors served by our Medicaid Waiver Programs today have dementia and; • 4.4 is the average number of serious health conditions senior enrolled in Florida’s Medicaid Waiver Programs have today. • Assisting seniors that are seeking long term care and that have no caregiver and may have dementia and that have an average of 4.4 serious health conditions by providing information on Managed Long Term Care Program enrollment options, Medicaid eligibility assistance, and helping seniors choose the most appropriate long term care provider that can meet their needs is the job of Florida’s Aging & Disability Resource Centers.
Florida’s Medicaid Managed Long Term Care Program • Closing Thoughts: • The overall theme of N4A’s letter to CMS is spot-on. • The Aging Network can and should play an important role in Managed Long Term Care. • In Florida, our Legislature has already recognized the value the Aging Network brings to the table. Equally important, some of our Managed Care Partners recognize this value and are eager to work as partners. • The Aging Network should be proactive in building relationships with managed care plans – we can achieve better outcomes, more efficiently by combining HCBS and Acute Care through Comprehensive, Coordinated Care Management with our managed care partners.
Florida’s Medicaid Managed Long Term Care Program • And finally, concerning ADRCs & Managed Long Term Care: • ADRCs are the perfect choice for providing HCBS case management and when working together with managed cares’ clinical care managers. Together, I believe we can create the perfect care management team! Quality of Care, continuity of care, and Management of Care can be Greatly Enhanced! • For ADRCs that do not provide care management, like in Florida, the Choice Counseling role – helping frail seniors with eligibility assistance, information, education, and most importantly, with enrollment assistance to NAVIGATE the system, IS OF UTMOST IMPORTANCE and is an appropriate role that ADRCs do Well today!
For Additional Information, please contact: Robert S. Beck, PinPoint Results, llc 307 W. Park Ave., Suite 101 Tallahassee, FL 32301 850-766-1410 firstname.lastname@example.org