Statewide Medicaid Managed Care ProgramIn 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency to create the Statewide Medicaid Managed Care (SMMC) program. The SMMC program has two key components: the Managed Medical Assistance program and the Long-term Care Managed Care program. On August 1, 2011, the Agency submitted the required documents requesting the necessary authorities to implement the program. Choose a tab above to view Guidance statements and specific information regarding the Long-term Care Managed Care and Managed Medical Assistance programs. Choose an arrow below to view General information about the program.
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Comments and Questions?Members of the media should contact the Office of Communications at AHCACommunications@ahca.myflorida.com or by calling 850-412-3623. Members of the public can email comments and suggestions about the Statewide Medicaid Managed Care program to FLMedicaidManagedCare@ahca.myflorida.com or mail them to: Statewide Medicaid Managed Care program |
Program Overview and Summary
SMMC Guidance Statements |
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From time to time during program development and implementation, the Agency will post guidance statements to provide the public with clarification regarding program components. These statements have no effect on the procurement and the procurement requirements will be based solely on the provisions contained in the ITN and procurement documents. Participation of Medicare Advantage SNP plans in the SMMC LTC Component [48KB] 5/18/2012 Aging Network Service Providers May 17, 2012 [47KB] 5/17/2012 Related to the March 16, 2012, Version of the Long-term Care Managed Care Data Book [66KB] Provision of Case Management Services [52KB] Reimbursement for Transportation Services [52KB] HMO Certificate of Authority [44KB] Enrollment in Medicare Advantage plans that are not subject to competitive procurement [44KB] |
Long-term Care Managed Care | ||||||||||||||||||||||||||||||||||||||||||||||||||||
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The Long-term Care Managed Care component of the Statewide Medicaid Managed Care program will be implemented first. HB 7107 sets specific timelines for implementation of the Long-term Care Managed Care component:
The Agency must competitively procure plans to serve the Long-term Care Managed Care population. Further, the Agency is required to conduct simultaneous procurements for Long-term Care Managed Care plans in each of the 11 regions. There is a specified minimum and maximum number of plans for each region as demonstrated in the chart below.
The Agency anticipates release of the procurement no later than July 1, 2012. Agency Requests Non-binding Letter of Intent from Potential Long-term Care PlansTo assist with planning, the Agency is interested in receiving a non-binding Letter of Intent to Bid from interested parties. If you intend to submit a bid, please send a letter to the Agency by April 18, 2012 that identifies your company name and the region(s) for which you intend to submit a response. Such a letter is completely voluntary and the decision not to submit a letter will have no effect on this or any other procurement. Letters should be sent via email to FLMedicaidManagedCare@ahca.myflorida.com. Request for Letters of Intent for Bid [31KB] List of Respondents [44KB] 4/27/2012 |
Long-term Care Managed Care Federal Correspondence and Authorities |
Program Overview and Summary Long –term Care Managed Care:Request for new 1915 (b)/(c) waiver
Federal and State Correspondence after Request Submission October 6, 2011 Response to Informal Questions on the 1915(b) submission [79KB] November 22, 2011 Response to Formal Questions on the 1915(b) submission [2.46MB] December 8, 2011 Response to Formal Questions on the 1915(c) submission [2.46MB] |
Long-term Care Managed Care Technical Advisory WorkgroupAs defined in HB 7107, Section 26, the following is the language providing the authority for the Long-term Care Managed Care Technical Advisory Workgroup: Section 409.9841, F.S. (1) Before August 1, 2011, the agency shall establish a technical advisory workgroup to assist in developing: (a) The method of determining Medicaid eligibility pursuant to s. 409.985(3), F.S. Next Meeting - To Be DeterminedChoose an arrow below to view Previous Meeting Information.
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Long-term Care Managed Care Data Book |
In preparation for the release of the procurement that will secure contracts with health plans to participate in the Long-term Care (LTC) Managed Care component of the Statewide Medicaid Managed Care (SMMC) program, the Agency for Health Care Administration (Agency) released the LTC data book. The data book provides relevant background information that prospective plans will find useful in the development of their Invitation to Negotiate (ITN) response. The LTC data book provides the three most recent years of summarized regional and statewide historical fee-for-service data together with encounter data for populations expected to be eligible for the SMMC LTC program and data for Medicaid services that will be the responsibility of the LTC plans. Certain adjustments have been made to historical data in the data book, and additional adjustments to the data are expected to be made as the negotiation of actuarially sound rates with the plans occurs. An updated data book will be included in the ITN that will be posted no later than July 1, 2012. Data Book Narrative [125KB] Attachment - SMMC LTC Data Summary [971KB] Attachment - SMMC LTC Data Summary [1.65MB] If you are unable to download these documents, please contact us at FLMedicaidManagedCare@ahca.myflorida.com for further assistance or to request a copy of these documents through another medium. |
Managed Medical Assistance |
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The Managed Medical Assistance component of the Statewide Medicaid Managed Care program will be implemented second. HB 7107 sets specific timelines for implementation of the Managed Medical Assistance component:
The Agency must competitively procure plans to serve the Managed Medical Assistance population. Further, the Agency is required to conduct simultaneous procurements for Managed Medical Assistance plans in each of the 11 regions. There is a specified minimum and maximum number of plans for each region as demonstrated in the chart below.
The Agency anticipates release of the procurement no later than January 1, 2013. |
Managed Medical Assistance Federal Correspondence and Authorities |
Program Overview and Summary of Requests to federal CMS Request(s) for Amendment of the Florida Medicaid State Plan Request(s) for Amendment of the 1115 MEDS AD Waiver
Request(s) for Amendment of the 1115 Medicaid Reform Waiver
Federal and State Correspondence after Request Submission The Agency anticipates release of the procurement no later than January 1, 2013. For more information on the Managed Medical Assistance program please refer to the Frequently Asked Questions. Federal and State Correspondence after Request Submission |
