The Agency for Health Care Administration (Agency) has posted a Request for Information (RFI) relating to the procurement of the Statewide Medicaid Managed Care (SMMC) Program (AHCA RFI 014-21/22 Re-Procurement of the SMMC Program. The RFI may be viewed HERE.  

In preparation for the upcoming procurement, the Agency is seeking information from entities and stakeholders with direct experience in the managed health and long-term care industries regarding best practices and innovations in business models as well as service delivery for Medicaid managed care.  

The Agency is interested in innovative ideas and best practices to:  

• Leverage the managed care delivery system, either through expanded benefits or other mechanisms, to promote sustainable economic self-sufficiency among Medicaid recipients in the short and long term. 
• Improve birth outcomes for mothers and infants through and beyond 12-month postpartum coverage period. 
• Utilize value-based payment designs to simultaneously increase quality and reduce costs.
• Maximize home and community-based placement and services through proactive aging-in place strategies. 
• Improve integration of dental and primary care services for children and adolescents. 
• Align quality metrics and outcomes with the Florida State Health Improvement Plan. 
• Enhance specialty health plans services to improve outcomes for recipients. Increase the number of plans to address target populations with specific health conditions or needs. 
• Increase access to community-based pharmacists within prescription benefit manager networks.
• Improve mental health outcomes for children and adolescents. 
• Improve coordination of care for individuals enrolled in both the Medicare and Medicaid programs. 
• Decrease mortality rates for recipients with complex chronic diseases and address payment strategies for high-cost therapies and prescription drugs in development. 
• Consider innovative delivery methods, including care bundling, that empower recipients in making more informed health care decisions. 
• Improve providers’ experience with the SMMC Program.
• Improve recipients’ experience with the SMMC Program. 
• Increase timely access to providers and services. 
• Achieve cost savings throughout the SMMC Program.  

The Agency will consider information gathered from responses to this RFI in preparing the competitive procurement for the Statewide Medicaid Managed Care program which is scheduled for release in the fourth quarter of CY (Calendar Year) 2022.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Ron DeSantis (R) signed into law on April 6, two bills, HB 1209,, effective July 1, 2022, which allows registered pharmacy technicians, with appropriate training, to administer vaccines to adults, and SB 544, also effective July 1, 2022, which allows a pharmacist to dispense an emergency opioid antagonist, an auto injection delivery system or intranasal application, pursuant to a pharmacist’s order or to a non-patient-specific standing order.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Revised PML Tip Sheet, beginning March 1, 2022, an enhancement will be applied to the NPI Mapping Logic which will affect providers and health plans who submit claims and/or encounters to Florida Medicaid. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Florida Medicaid public Web Portal that details the changes. Health plans are encouraged to review the tip sheet to understand how the enhancement will affect their encounter submissions. Health plans can stay connected by visiting the Florida Medicaid public Web Portal often for the most up-to-date information on these changes. For additional assistance, please contact the Health Plan Support team by emailing healthplan.support@gainwelltechnologies.com.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

As part of the Agency for Health Care Administration’s (Agency) quality initiatives, the Agency requested that each Medicaid health plan develop provider resource guides with direct service lines, escalation contacts, and after-hours instructions covering a wide range of service areas. The following service areas can be found in each plan’s resource guide: 

• Behavioral Health 
• Case Management 
• Community Resources 
• Perinatal Care 
• Pharmacy 
• Subcontracted Services 
• Transportation  
• Utilization Management 

The Agency’s goals with this initiative are to improve communication and coordination between plans and providers, and more specifically: to reduce readmissions by improving communication among health plans and providers; to improve members’ access to timely and appropriate services post-discharge; and to streamline the coordination of behavioral health services for members, especially those with substance use disorder (SUD) and opioid use disorder (OUD). 

Each plan’s resource guide has been posted publicly on their respective websites, but may be easily accessed from the Florida Medicaid Health Plan Resources page on the Agency’s website. The Agency encourages providers to explore the resource guides for the health plans with which they contract and to utilize them to coordinate services for members they serve. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Agency for Health Care Administration (Agency) is in the process of updating the 2022 fee schedules, which includes updates to procedure codes and reimbursement rates for services provided in the fee-for-service Medicaid delivery system. The Agency’s fee schedule drafts are available on the Agency’s website here.  

Prior to initiating the rule making process, the Agency is requesting feedback from providers regarding inconsistencies or discrepancies that may be present in the draft fee schedules. Feedback may be provided through this survey link. The link will be active until 5:00pm EST on February 7, 2021. 

The purpose of this exercise is to identify any errors in the fee schedules. It is not an opportunity to request increases in the reimbursement rates, unless there is a valid concern that an error occurred in developing this year’s rates.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Effective January 1, 2022, the UnitedHealthcare of Florida, Inc., and UnitedHealthcare Insurance Company Dual-Eligible Special Needs Plans (D-SNP) changed their names to Care Improvement Plus South-Central Insurance Company d/b/a UnitedHealthcare Dual Complete. All member benefits, provider networks, and plan telephone numbers remain the same. United Healthcare continues to be responsible for the services provided to members of United Healthcare Dual Complete Plan including Medicare and Medicaid services. The website will remain www.UHCCommunityPlan.com  

Contact numbers: Member and Provider Services: 1-844-560-4944  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Department of Health has issued a Notice of Meeting/Workshop Hearing. The Board of Pharmacy will conduct a workgroup meeting to discuss white bagging and brown bagging pharmacy practices, February 9, 2022, 1:00 p.m. ET at the DoubleTree by Hilton Hotel Deerfield Beach – Boca Raton, 100 Fairway Dr., Deerfield Beach, FL 33441.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Rule 64B16-28.108 related to labeling of Medicinal Drugs by pharmacy permits has been revised by the Board of Pharmacy and became effective November 28, 2021.  The revision is primarily for Institutional Class II, Modified Class II Type B, or Class III permits that are labeling patient specific medications.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Governor Ron DeSantis joined by Florida Speaker Chris Sprowls and Senate President Wilton Simpson to sign legislation that will protect Floridians from losing their jobs due to COVID-19 vaccine mandates and protect parents’ rights to make healthcare decisions for students. The bills were passed through a Special Session of the Florida Legislature and are effective upon the Governor’s signature. The legislation signed today is the strongest anti-mandate action taken by any state in the nation. Read about the legislation HERE.

Also in Florida, Agency for Health Care Administration Secretary Simone Marstiller issued the following statement in support of Florida’s challenge against the Biden Administration’s Centers for Medicare and Medicaid Services (CMS) rule mandating that health care workers receive the COVID-19 vaccine:

“The recent CMS rule issued by Biden Administration will not only damage our stretched health care industry but impact our most vulnerable and their ability to receive the health care they need,” said Secretary Simone Marstiller. “Tying Medicare and Medicaid funding to a vaccination mandate – funding that pays for medical care for elderly, disabled, and low-income individuals – is a blatant overreach of power that must be challenged. Thanks to the leadership of Governor DeSantis and Attorney General Moody, Florida is doing just that, to protect Florida jobs, ensure access to care, and empower individuals in making personal health care decisions for themselves and their families.”

Finally in Florida, the Florida HIE will be hosting a webinar on Tuesday, December 7^th at 12:00pm EST. Learn about how the Encounter Notification Service (ENS) provides benefits to providers and patients across Florida. You may register here.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.