Assistant Deputy Secretary for Medicaid Finance

The Assistant Deputy Secretary for Medicaid Finance is responsible for the oversight of the Bureaus of Contract Management, Program Analysis, and Program Finance.

Bureau of Medicaid Contract Management

This office manages the contract for the fiscal agent to maintain the Florida Medicaid Management Information System (FMMIS), enroll providers, and process claims for payment. In addition, Contract Management oversees claims resolution policies, provider enrollment policies, choice counseling services, provider publications, managed care communications, and resolves Medicaid recipient eligibility file problems on FMMIS.

Bureau of Medicaid Program Analysis

This office is responsible for data analysis, forecasting of Medicaid caseloads and expenditures, setting rates for health plans reimbursed on a capitated basis, managing risk adjustment payments and processes, calculating cost effectiveness and budget neutrality for all 1915(b) and 1115 waivers, performing audits on nursing home cost reports, and managing the Medicaid Encounter Data System.

Bureau of Medicaid Finance

This office is responsible for budget and fiscal planning, administration of the Low Income Pool and Disproportionate Share program, and setting rates for institutional providers who are reimbursed on a cost basis.

Assistant Deputy Secretary for Medicaid Operations

The Assistant Deputy Secretary for Medicaid Operations oversees the Bureau of Medicaid Services, the Bureau of Pharmacy Services, and the Performance, Evaluation and Research Unit

Bureau of Medicaid Services

The Bureau of Medicaid Services is responsible for the development, coordination and implementation of Medicaid program policies and procedures and administration of the program's medical authorization functions. It plans, develops and implements Medicaid program policies, procedures and special projects. It is responsible for the development and maintenance of administrative rules, and manuals related to services covered by Medicaid. It coordinates policy development with other departmental entities and health care organizations. It prepares and manages federal Medicaid waivers, prepares budget justifications for program issues, and analyzes the impact of new and amended state and federal laws and rules. The Bureau is also responsible for utilization management and prior authorization of certain Medicaid services. Finally, the Bureau is responsible for designing, advertising, procuring and monitoring services for specific medical care and unique medical utilization reviews via contracts.

This office develops Medicaid policies for:

• Behavioral health services
• Child health services
• Health facility services
• Health practitioners
• MediKids
• Long-term care services
• Home and community-based waiver programs.

In addition, this office performs administrative functions of the Medicaid program and administers medical authorization functions.

Bureau of Medicaid Pharmacy Services

The Bureau of Pharmacy Services is responsible for managing the Medicaid prescribed drug program. This involves maintaining a clinically and cost-effective Preferred Drug List (PDL) for fee-for-service recipients; managing the manufacturer rebate program which has netted a record cost-savings to the state over the past several years; and managing the vendors that support the prescribed drug program. The Bureau of Pharmacy Services also oversees the Medicaid Pharmaceutical and Therapeutics (P&T) Committee and the Drug Utilization Review (DUR) Board. To learn more, visit the Medicaid Pharmacy Services website.

Assistant Deupty Secretary for Medicaid Health Systems

Medicaid health systems includes the Bureau of Health Systems Development, the Bureau of Medicaid Field Operations, and the Choice Counseling Unit.

As the legislatively directed expansion of managed care is implemented, the number of Medicaid recipients who receive services through managed care plans will increase drastically to more than two million.  The Agency is directed to competitively procure for managed care plans statewide with the number of plans increasing from the current number of 21 up to possibly over 100.  Implementation of these efforts will be resource intensive and will require focused leadership and coordination between multiple bureaus and divisions in the Agency.

Bureau of Medicaid Field Operations

Medicaid has eleven area offices that serve as local liaisons to providers and recipients. The area offices handle claims resolution, provider relations and training, and manage transportation and Child Health Check-Up screenings on a local level.

Bureau of Medicaid Health Systems Development

The Bureau of Health Systems Development (HSD) is responsible for the following:

• Development and oversight of Medicaid's managed care programs including managing contracts with Health Maintenance Organizations (HMOs), Provider Service Networks (PSNs), Minority Physician Networks (MPNs), the prepaid dental health plan, and the MediPass program.
• The Disease Management initiative for the MediPass population.
• Management of the 1915 (b) Managed Care Waiver, the 1115 Medicaid Reform Waiver, and preparation of any federal Medicaid waiver requests.
• Development and implementation of Medicaid managed care policies, contracts, applications, and procedures along with other special projects.
• Development of managed care administrative rules.
• Coordination of managed care policy development with other departmental entities, the public and managed care programs.
• Preparation of budget justifications for program issues, and analysis of the impact of new and amended state and federal laws and rules related to managed care.
• Incorporation of new federal and state legislation into current managed care operations.