Florida Agency for Health Care Administration Long-Term Care Managed Care Technical Advisory Workgroup Meeting Report: February 13, 2012

The Florida Agency for Health Care Administration (“AHCA”) Long-Term Care Managed Care Technical Advisory Workgroup (“Workgroup”) met today, February 13, 2012, during which it adopted the previous meeting’s minutes and moved through the agenda quickly, discussing Scope Items 4 (relating to uniform claims submission), 5 (relating to presumptive eligibility), and 1 (relating to eligibility determination).

Scope Item 4, Uniform Claims Submissions: The Workgroup addressed the suggestions from the previous meetings to split the item into two parts.  Part 1 addresses the billing stage, which has several different options.  Part 2 provides recommendations for billing. The only other changes in Scope Item 4 were minor wording changes. Also providers have to program their systems in order to comply with technology requirements of the managed care program. The recommended changes were adopted and Scope Item 4 was finalized.  

Scope Item 5, Presumptive Eligibility:  The Workgroup addressed retroactive eligibility and plan to work through all technical issues before finalization. The goal is to be able to provide services before a final determination is made. The Workgroup discussed what may be an appropriate time period between application and determination of eligibility, and whether financial screening should occur during the initial determination of eligibility. The Workgroup agreed financial screening should be part of the initial determination of eligibility, but did not reach any consensus on the timeframe for determination of eligibility. 

The Workgroup also discussed presumptive eligibility for home and community-based care services as an alternative to nursing home care. There is a wait list for home and community based care services, and eligibility is determined only as space becomes available. The Workgroup discussed the possibility of having patients apply for home and community-based care services through their plan.

Michael Gardner, Executive Director of the Florida Association of Health Plans, asked if there was going to be any coordination between the Florida Department of Children and Family Services, as well as plans to improve the times needed for determination of eligibility.  AHCA officials responded that they work with applicants to facilitate collection of necessary data, but that they are limited by an applicant’s complicity in producing required documents. The wWorkgroup wants to find an incentive to get the individuals to turn in their documents as soon as possible. Current law requires that a medical care organization Case Manager will assist applicants, and the Workgroup would like to continue this with the future model.

Scope Item 1, Eligibility Determination: AHCA staff discussed several assumptions they have been operating under while designing the Long-Term Care Managed Care Program.  The first assumption is the initial three rate levels required by law to be assigned to each individual are intended to create risk adjustment for plans. The second assumption is that, as the Long-Term Care Managed Care Program is implemented, the State of Florida will identifying the most recent Comprehensive Assessment and Review for Long-Term Care Services (“CARES”) assessment for each individual who is to transition into the program. The third assumption is that certain elements of the CARES assessment will be used to assign an individual initial three rating levels. The CARES assessment elements used to determine the initial three rating levels will be determined by the State in consultation with contracted actuaries

AHCA stated that, at this time, they see no insurmountable barriers to the federal government granting the necessary waivers to implement the Medicaid managed care program, and the data books will be available April 1.

The next Workgroup meeting will take place on March 5, 2012 from 9:00-10:30 a.m. via conference call.

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