Prepaid Mental Health Plan
Community Stakeholder Meeting
AHCA Areas 3 and 4
December 16, 2004 – Jacksonville, FL
December 17, 2004 – Ocala, FL
• Deborah McNamara
– Prepaid Mental Health Plan Coordinator
– (850) 414-0633; firstname.lastname@example.org
• Trecia Perry
– Prepaid Mental Health Plan Contract Manager
– (813) 871-7600 x133; email@example.com
• Jorja Daniels
– Prepaid Mental Health Plan Area Coordinator
– (813) 871-7600 x132; firstname.lastname@example.org
Purpose of the Stakeholder
• Present an overview of the Prepaid
Mental Health Plan
• Answer questions
• Elicit feedback and
HB 1843 and
Mental Health Services
• Prepaid Mental Health Plans will be
implemented statewide by July 1, 2006.
• Health Maintenance Organizations will
provide community mental health services to
their members statewide.
• Children in the HomeSafeNet database will
receive services through a specialty prepaid
network beginning July 1, 2005.
What Does This Mean?
• One Prepaid Mental Health Plan in each AHCA area
will provide mental health care for people enrolled in
the MediPass program.
• Members of Medicaid HMOs will be excluded from
participating in the Prepaid Mental Health Plan.
• Children in the HomeSafeNet database will be
excluded from participating in the Prepaid Mental
Health Plan. A new prepaid plan will be developed
operated by the Community-Based Care
Organizations beginning July 1, 2005.
AHCA Area Request for Prepaid Mental Health
Proposal Release Plan Implementation Start
5, 7 December 2004 May 2005
2, 3, 4 February 2005 July 2005
11 June 2005 November 2005
8, 9, 10 October 2005 March 2006
What is a Prepaid Mental
• A Prepaid Mental Health Plan is a managed
care organization that contracts with AHCA to
provide mental health services to its
members though a capitated payment
• AHCA pays a per member, per month
(PMPM) fee to the plan based on the age and
eligibility category of each member.
Who will be our Prepaid
Mental Health Plan provider?
The Prepaid Mental Health Plan contractor must:
– Have experience in providing community mental
– Be licensed with the Department of Insurance
under Chapter 624, 636, or 641.
– Be accredited through an organization such as the
Joint Commission on Accreditation of Health Care
Organizations, the Commission on Accreditation
of Rehabilitation Facilities, the National Committee
for Quality Assurance, or the Utilization Review
• A Request for Proposal is released by AHCA.
• Interested parties submit a Notice of Intent to Submit
a Proposal to AHCA.
• AHCA will hold a Bidder’s Conference to give
interested parties an opportunity to ask informal
questions about the requirements.
• All formal questions must be submitted to AHCA in
writing. A written response will be prepared and will
become an addendum to the RFP.
• Interested parties submit proposals to AHCA.
• No less than three reviewers will evaluate and score
• The entity whose proposal receives the highest score
will be awarded the contract.
Who is eligible to be in the
Prepaid Mental Health Plan?
Any Medicaid recipient who elects to enroll in
MediPass for the provision of their physical
health care services will be assigned to the
Prepaid Mental Health Plan for the provision
of their mental health services, unless they are
Who is NOT eligible to be in the
Prepaid Mental Health Plan?
• Recipients who have both Medicaid and Medicare.
• Persons living in an institutional setting, such as a nursing
home, state mental health treatment facility, or prison.
• Medicaid-eligible recipients receiving services through Hospice.
• Recipients in the Medically Needy Program.
• Newly enrolled recipients who have not yet chosen a health
• SOBRA eligible pregnant women and presumptively eligible
• Individuals with private major medical coverage.
• Members of a Medicaid HMO.
• Children enrolled in the HomeSafeNet database.
• Recipients receiving FACT services.
• Services must be:
• Services cannot be:
–More restrictive than those offered in
the fee-for-service plan
Services Covered by the
Prepaid Mental Health Plan
• Inpatient Psychiatric Hospital Services
–45 days for adult recipients
–365 days for children
• Outpatient Psychiatric Hospital Services
• Psychiatric Physician Services
• Community Mental Health Services
• Mental Health Targeted Case Management
Community Mental Health Services
• Individualized Treatment Plan Development and
• Evaluation and Assessment Services
• Medical and Psychiatric Services
• Mental Health Counseling/Therapy
• Psychosocial Rehabilitative Services
• Therapeutic Behavioral On-Site Services
• Self-Help/Peer Services
• Crisis Intervention Mental Health Services and Post-
Stabilization Care Services
• Monitoring of recipients in:
–State Mental Health Treatment Facilities
–Jails and Juvenile Detention Facilities
–Residential Treatment Facilities
• Provision of services to residents in Assisted
Living Facilities with a Limited Mental Health
• The Prepaid Mental Health Plan provider has
flexibility to offer additional services that it
• Optional Services listed as part of the bidder’s
original proposal become mandatory services
once the contract is executed.
• Examples may include:
Services NOT Covered
• Specialized Therapeutic Foster Care
• Therapeutic Group Care Services
• Behavioral Health Overlay Service (BHOS)
• Statewide Inpatient Psychiatric Program (SIPP)
• Residential treatment programs, long-term care
• Medical/Surgical Interventions
• Florida Assertive Community Treatment Services (FACT)
• Comprehensive Behavioral Health Assessments
• Qualified Evaluator Services
• Substance Abuse Services
Downward Substitution of
• Prepaid Mental Health Plan providers may
offer alternative services to their members.
• Examples of downward substitutions include
psychologists and social workers in private
• Services provided as a downward substitution
may not be more restrictive than the level of
care available in the fee-for-service system.
• Direct service providers must be available to every
– 30 minutes typical travel time in urban areas
– 60 minutes typical travel time in rural areas
• Appointment times:
– Immediate access for emergencies
– Within 23-hours for urgent appointments (e.g.,
non-emergent allergic reactions to medication)
– Within 7 days for routine appointments
• Ratios of staff members to recipients for
• Requirements for staff members trained in
specific specialty areas (e.g., young children,
domestic violence, etc.)
• The Prepaid Mental Health Plan provider
must be an active participant in the mental
health treatment community.
• The plan is required to develop linkages to
other vital community systems, such as the
schools, the criminal justice system, and
agencies serving the homeless.
Medicaid Managed Care
• Each AHCA area will have a Medicaid
Managed Care Advisory Group that meets
• Members include the Prepaid Mental Health
Plan contractor, Medicaid HMOs, the
Department of Children and Families, mental
health care providers, and local advocacy
• Recipients of care are encouraged to become
Transition Plan for New
• The Prepaid Mental Health Plan is required to
provide an transition plan for new enrollees.
• For recipients who have been participating in
treatment during the previous six months, the
plan must continue to authorize services until
the Individualized Treatment Plan is reviewed
and a transition plan is developed.
Grievances and Fair Hearings
• The Prepaid Mental Health Plan is
required to have a grievance and
appeal system in place that is approved
• Members may access the Department
of Children and Families Medicaid Fair
• The Prepaid Mental Health Plan
contractor must have a quality
• The quality improvement program will
be reviewed by AHCA and by the
External Quality Review Organization.
• The Prepaid Mental Health Plan contractor is required to submit
reports to AHCA on a regular basis.
• Examples of reports include:
– The number of members assigned to each provider.
– The results of annual member and stakeholder satisfaction
surveys conducted by the plan.
– Grievances and the actions taken by the plan to resolve the
– Community outreach activities.
– Service utilization.
– Critical incidents.
– Financial reports.
• Conducted jointly between AHCA and the
Department of Children and Families.
• A minimum of two on-site monitoring visits
• Quarterly desk reviews.
• Annual evaluations by the External Quality
How can the community
• Get to know your local AHCA staff. Each
Prepaid Plan will have AHCA staff members
assigned to provide oversight and answer
• Actively participate in your local Medicaid
Managed Care Advisory Group.
• Area One Prepaid Mental Health Plan
Request for Proposal:
• 1915b Waiver Information:
Please Send Comments
Deborah McNamara, LCSW
Agency for Health Care Administration
2727 Mahan Drive, MS 20
Tallahassee, FL 32308