AHCA releases invitation to barter for Statewide Medicaid Managed Care Program – State of Reform

AHCA releases invitation to barter for Statewide Medicaid Managed Care Program – State of Reform

The Florida Company for Well being Care Administration (AHCA) launched an invitation to negotiate for the upcoming new Statewide Medicaid Managed Care Program (SMMC) contract on Tuesday.

Most Medicaid recipients in Florida are enrolled within the SMMC, which covers 4.4 million people, and consists of:

  • Managed Medical Help (MMA), which offers Medicaid-covered medical providers like physician visits, hospital care, prescribed drugs, psychological healthcare, and transportation for these providers. Most Medicaid recipients obtain their care from a plan that covers MMA providers.
  • Lengthy-Time period Care (LTC), which offers Medicaid LTC providers like nursing dwelling, assisted residing, or dwelling care. LTC recipients should be not less than 18 years outdated, and meet nursing dwelling degree of care necessities (or meet hospital degree of care necessities if they’ve cystic fibrosis).
  • Dentalwhich offers all Medicaid dental providers for kids and adults. All individuals on Medicaid should enroll in a dental plan.

This would be the second SMMC re-procurement for the reason that program started in 2013. Present contract holders embrace Centene, Group Care Plan, CVS/Aetna, Elevance Well being, Florida Group Care, Humana, Molina, and UnitedHealthcare.

Present contracts started in December 2018 and have been slated to run by means of 2024. The  new contracts will run from Oct. 1st, 2024, by means of Dec. thirty first, 2030.

The upcoming procurement will award contracts for MMA and LTC. Proposals are due on Aug. fifteenth, and the anticipated award date is Dec. eleventh.

Necessary deadlines for the method embrace:

  • Could third: deadline for the receipt of written questions
  • June twenty seventh: anticipated date for company responses to written questions
  • Aug. fifteenth: deadline for receipt of responses; public opening of responses
  • Aug. seventeenth: anticipated posting of respondent names for supplier remark
  • Sept. fifth: deadline for receipt of supplier feedback
  • Oct. 2nd by means of Nov. seventeenth: anticipated dates for negotiations
  • Dec. eleventh: anticipated posting of discover of intent to award

The company intends to award contracts to nationally accredited managed care plans that:

  • Incentivize worth and high quality
  • Provide an enhanced service supply system and integration of behavioral and bodily well being providers
  • Guarantee the provision of complete, quality-driven supplier networks
  • Streamline processes that improve the enrollee and supplier expertise
  • Present expanded advantages focused to enhance outcomes for enrollees
  • Have fine quality scores and excessive charges of enrollee satisfaction
  • Are in a position to ship an environment friendly, high-quality, revolutionary, cost-effective, built-in healthcare supply mannequin
  • Present pathways in direction of self-sufficiency, goal, and independence

The anticipated time period of the contract will start from the date of the contract’s execution by means of Dec. thirty first, 2030. The contract can’t be renewed, nonetheless, the company might prolong the ensuing contract’s time period to cowl any delays throughout the transition to a brand new plan.

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