New State Initiatives in Medicaid amp;DCF Financing and Contracting医疗补助和国家计划新；DCF融资承包.pptVIP

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2018-06-22 发布于江西
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New State Initiatives in Medicaid amp;DCF Financing and Contracting医疗补助和国家计划新；DCF融资承包.ppt

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NewStateInitiativesinMedicaidamp;amp;DCFFinancingandContracting医疗补助和国家计划新；DCF融资承包.ppt

Lucia Maxwell, FADAA Managed Care Consultant New State Initiatives in Medicaid and DCFFinancing Contracting Major Changes MH/ SA Integration Medicaid/ DCF “Braided” Funding Provider Sponsored Networks PSN/ Managed Care Partnerships At risk contracting replaces fee for service HMOs included Assumptions: State funding of the public BH system will be controlled, with predictable increases. “Managed” services result in increased client access and more appropriate (best practices) and cost effective care. Medicaid and DCF both fund services to essentially the same client population. First initiatives were in Medicaid MH pilots in area #6 (1997) and #1(2002) Prepaid mental health plans and HMOs, both capitated (pre-paid, fixed amount, per member per month) 2004 Legislature extended pre-paid plans statewide, phase in 2004-2006 Substance abuse remains ffs until 2006 without further legislative direction. Authority already in F.S. for DCF initiatives SB 1258 (2001) SB 2404 (2003) HB 1843 (2004) AHCA and DCF: joint planning, budgeting, procurements, contracting, and monitoring DCF can establish fee for service, pre-paid capitation and pre-paid case rates by administrative rule DCF authorized to contract with: A single managing entity or a provider network in each area or region “Managing entity” is defined as: 1. A network of existing providers with an ASO that can function independently 2. An ASO that is independent of local provider agencies, or 3. An entity of state or local government. NO competitive bidding is required if DCF contracts with the Medicaid managing entity (by 2006.) DCF may contract with a Managing Entity for: Data management Data reporting Clinical program management Administrative functions NO changes in local match: amt, sources, ratio New DCF Concept Paper Proposes that DCF contract for MH and SA services with the Managing Entity selected by AHCA Medicaid to provide services to Medipass enrollees. ME model is a