Letter to CMS - Medicaid Managed Care Policies - Agency for ...

Attachment II, Section XVI, Item Q., Termination Procedures
Attachment II, Section XVI, Item S., Withdrawing Services from a County
Attachment II, Section XVI, Item V., Ownership and Management Disclosure
See current Medicaid Health Plan Model Contract at:
http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/med_prov_0912.shtml.
Future Policy Changes - Increase Stability and Minimize Turnover:
The legislated Statewide Medicaid Managed Care program, required to be operational for long-
term care by October 1, 2013, and for acute care services by October 1, 2014, includes the
following additional statutory requirements that will impact plan stability and minimize turnover:
Requires the Agency to select a limited number of eligible health plans through an
invitation to negotiate competitive procurement process instead of an open application
process (see s. 409.966(2), F.S.).
Requires managed care plan contracts to be five-years in length, with an extension
allowance (see s. 409.967(1), F.S.).
Requires financial penalties for plans that leave a region or reduce enrollment levels,
including reimbursing the Agency for the cost of enrollment changes and other transition
activities. Requires for departing provider service networks, a per-enrollee penalty of up
to three months’ payment and requires continuation of services for up to 90 days;
requires all other plans to pay a penalty of 25 percent of their minimum surplus
requirement pursuant to s. 641.225(1), F.S. See s. 409.967(2)(h)1., F.S.
Requires plans to provide at least 180-days notice before withdrawing from a region.
See s. 409.967(2)(h)1., F.S.
Requires the Agency to terminate all contracts in a region if a plan leaves a region
before the end of the contract term. See s. 409.967(2)(h)1., F.S.
See the Agency’s website on the Statewide Medicaid Managed Care program for related law
at: http://ahca.myflorida.com/Medicaid/statewide_mc/index.shtml#docs.
Page 4 of 4