Click here to view the letter to CMS and the Medicaid managed care policies. [2.71KB PDF]
Florida Medicaid Reform (2011-2014)
Approved 3-Year Extension of the 1115 Research and Demonstration Waiver
On December 15, 2011, the Centers for Medicare and Medicaid Services (CMS) approved the 3-year waiver extension request the Agency submitted on June 30, 2010. The waiver extension period for Florida’s Section 1115 Research and Demonstration Waiver is December 16, 2011 through June 30, 2014. The following are links to the federal approval documents for the 3-Year waiver extension request.
Click here for the Waiver Extension Request and related Documents, 06/30/10-12/15/11.
Click here for clarification from CMS regarding Low Income Pool Tier-One Milestone, 12/13/11.
1115 Amendment Requests
Please click on the following link to view the amendment requests submitted to CMS in accordance with CS/HB 7107 on
August 1, 2011.
http://ahca.myflorida.com/Medicaid/statewide_mc/index.shtml
Medicaid Reform Annual Report
The annual report documents accomplishments, project status, quantitative and case-study findings, utilization data, and policy and administrative issues in the operation of the 1115 research and demonstration waiver for each year of the waiver. The annual reports are completed and made available 120 days after the end of each demonstration year
Click here to view the completed annual reports.
Medicaid Reform Quarterly Reports
The quarterly progress reports provide an analysis and the status of the various operational areas of the 1115 research and demonstration waiver. The quarterly reports are completed and made available 60 days after the end of each quarter.
Click here to view the completed quarterly reports.
Enhanced Benefits Reward$ Program
Florida Medicaid wants to encourage you to make healthy choices and participate in activities that will help keep you from getting sick. Beneficiaries in Florida Medicaid Reform plans will be eligible for enhanced benefits if they take part in specific activities. The goal is to reward your healthy behavior.
Click on the links for more information on Enhanced Benefits for:
- Beneficiaries
- Enhanced Benefits Products
- Universal Form (English and Spanish)
- Enhanced Benefits Reward$ Program Welcome Letter (English and Spanish)
- Frequently Asked Questions
- Providers
- Monthly Enhanced Benefits Report
- Enhanced Benefits Panel Meetings
- EBIS Health Plan Credit File Validator
Presione (Click) aquí para obtener esta información en español
- Medicaid Reform Choice Counseling
- Medicaid Reform Training for Beneficiaries
- Choice Counseling Face-to-Face Sessions
- Medicaid Reform Brochure for Medicaid Beneficiaries
Provider Information
As part of the Agency’s commitment to enhancing the implementation of reform, the Agency continues to expand its communication with providers that are considering developing a benefit package and submitting an application as a Medicaid HMO or Provider Service Network. This web page is one of many ways that the Agency communicates with potential plan applicants and current health plan contractors to provide the tools needed to complete the application and contracting processes. We encourage you to visit this site regularly.
Current Year:
Year Four - Broward, Duval, Baker, Clay, and Nassau Counties
Previous Years:
Year Three - Broward, Duval, Baker, Clay, and Nassau Counties
Year Two - Broward, Duval, Baker, Clay, and Nassau Counties
Year One - Broward and Duval Counties
Low Income Pool (LIP)
The Low Income Pool (LIP) is established to ensure continued government support for the provision of health care services to Medicaid, underinsured and uninsured populations. Click here to proceed to the LIP information.
Medicaid HMOs
The State of Florida purchases health care services from commercially licensed HMOs. The Bureau of Managed Health Care, along with the Bureau of Health Systems Development, is responsible for the approval and monitoring of all Medicaid HMO contracts in the state. Bureau staff conduct desk and on-site reviews throughout the year to ensure contract compliance.
Click here to proceed to reports on HMO Comprehensive Enrollment Reports.
Policy Transmittals - Reform
HMO Provider-Related Information - Non Reform
Technical Advisory Panel (TAP)
The Agency for Health Care Administration (AHCA)
appointed nine people to serve on the Medicaid reform Technical Advisory Panel. The
Panel was created by the Florida Legislature in House Bill 3B and will advise AHCA on
various implementation issues with Medicaid reform. Click here to proceed to the TAP information.
Florida Medicaid Reform (2005-2011)
Approved 1115 Research and Demonstration Waiver Initial 5-Year Application
In 2005, the Florida Legislature passed Senate Bill (SB) 838, authorizing the Agency to seek an experimental, pilot, or demonstration project waiver, pursuant to section 1115 of the Social Security Act (SSA) to create a statewide initiative to provide a more efficient and effective service delivery system that enhances quality of care and outcomes in the Florida Medicaid program. To effectively implement the program, the Agency submitted a draft application to the Centers for Medicare and Medicaid Services (Federal CMS) on August 30, 2005, requesting a section 1115 Research and Demonstration Waiver in order to waive statutory provisions under section 1902 of the SSA. The draft 1115 waiver application was posted on Agency's website on August 31, 2005.
On October 3, 2005, the Agency submitted the official waiver application to Federal CMS after posting the draft application for 30 days as required by SB 838. Federal CMS reviewed the application and after intensive negotiations with Florida, granted approval on October 19, 2005, to waive certain federal statutory provisions and move forward in reforming Medicaid as authorized by SB 838. To view the Approved 1115 Waiver Application, as well as the draft waiver application, you may visit the ‘Medicaid Reform Waiver Application’ webpage by clicking here.
In December 2005, the Agency submitted an implementation plan to the Florida Legislature, which summarized the implementation milestones and activities that had been undertaken and would be completed before beginning operation of the waiver on July 1, 2006, and, if legislative approval had been obtained, expansion statewide by 2011. To view the Implementation Plan, you may visit the ‘Implementation Plan’ webpage by clicking here.
Beginning in January 2006 through June 2008, the Agency held a series of informational meetings/workshops on Medicaid Reform for providers, beneficiaries, and advocates in the demonstration counties of Broward, Duval, Baker, Clay, and Nassau prior to implementation of the waiver on July 1, 2006. To view the meetings/workshop schedules and handouts, you may visit the ‘Previous Meetings/Workshops’ webpage by clicking here.
Please mail your comments or suggestions to:
Medicaid Reform
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308
Email your comments and suggestions on Medicaid reform to
medicaidreform@ahca.myflorida.com
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