FLORIDA ~ MEDICAID by sot11826

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									                                 FLORIDA                                  ~
                                 MEDICAID"
                                A Division of the Agency for Health Care Administration

  CHARLIE CRIST                                                                               THOMAS W. ARNOLD
                                 Better Health Care for all Floridians
   GOVERNOR                                                                                      SECRETARY



                                                    December 16, 2009



Policy Transmittal: PSN 09-03

Dear Medicaid Reform Provider Service Network:

The purpose of this policy transmittal is to provide guidelines for Medicaid Reform Fee-For-
Service (FFS) Provider Service Networks (PSNs) to develop the comprehensive plan required for
transitioning to a capitated PSN, as required by Attachment II, Exhibit 15, A., Insolvency
Protection, of the September 1, 2009 Health Plan Contract.

Pursuant to s. 409.91211(3)(e), F.S. (as revised in the 2009 Legislative Session), a Reform FFS
PSN must convert to capitation by no later than the begimling of the sixth year of operation,
unless the PSN opts to convert to capitation earlier. Prerequisite to executing a capitated
contract, the existing Reform FFS PSN must submit a comprehensive conversion workplan,
complete and submit the Medicaid Reform FFS PSN Conversion Application, and successfully
pass all phases of the conversion application review process.

The conversion workplan must describe in detail how the PSN intends to meet the requirements
in the conversion application. For your convenience, a sample workplan format is also enclosed.
The conversion workplan must include goals and action steps for each submission requirement
listed in the Conversion Application Checklist of Mandatory Items, (See Conversion
Application, Section II, C.)

Pursuant to the health plan contract, a new FFS health plan must submit its conversion workplan
to the Medicaid Bureau of Health Systems Development (HSD) no later than the last calendar
             th
day of the 24 month of the PSN's initial Medicaid Reform service operation. For those PSNs
that began operation in 2006, their conversion workplans are due March 31,2010.

Each FFS PSN shall submit to HSD its completed Reform PSN Conversion Application by
August 1 of the fourth year of the respective PSN's initial Medicaid Reform service operation.




2727 Mahan Drive, MS# 8                                                                        Visit AHCA online at
Tallahassee, Florida 32308                                                                http://ahca.myHor id a, com
Policy Transmittal: PSN 09-03
December 16,2009
Page Two

The PSN must submit its workplan and conversion application, by its respective due dates as
indicated above, to its HSD plan analyst at the following address:

       Agency for Health Care Administration
       PSN Contracting and Policy Unit
       Bureau of Medicaid Health Systems Development
       2727 Mahan Drive, MS 50
       Tallahassee, FL 32308

The conversion application is located on the Agency for Health Care Administration (Agency)
website at the following link: http://fdhcdev/Medicaid/medicaid reform/provider/yearfour.shtml.

If you have any questions or require further clarification regarding this policy transmittal, please
contact your Agency Bureau of Health Systems Development plan analyst at (850) 487-2355.

                                              Sincerely,


                                              ~--_.
                                              Phil E. Williams
                                              Interim Deputy Secretary for Medicaid

PEW/fd
Enclosure: Sample Workplan Format
                                                              SAMPLE WORKPLAN FORMAT

                                                               [PSN NAME]
                                          WORKPLAN FOR MEETING AHCA REQUIREMENTS TO CONVERT
                                        FROM MEDICAID REFORM FEE-FOR-SERVICE PSN TO CAPITATED PSN

  Please note that this is just a sample format. You may choose to use a different format; however, your workplan must be detailed and include
  the goals and action steps for each submission requirement listed in the Conversion Application Checklist of Mandatory Items (See Conversion
  Application, II.C.).

                                                             Goal 1: Third Party Administrator
                                                                               .


                                                                                                                   TA~",,,,         ACTUAL
                                                            ,IIUN   ~I   t:... ~                                                    DATE OF
                                                                                                                                  COMPLETION
       1.1     Evaluate feasibility of becoming a licensed TPA versus ,sLlbcontracting with a TPA_            .
                                                                                                                  01/0112010      •.
                                                                                                                                                 I
       1.2     Interview TPAs                                    ._-       .-                                     03/15/2010
       1.3     Subcontract with TPA licensed by Florida DFS, Office of Insurance Regulation                       05/01/2010

                                                              Goal 2: Develop Business Plan

I                                                         ACTION STEPS                                        I    T.6:Rl";r""1
                                                                                                                                    ACTUAL
                                                                                                                                    DATE OF
                                                                                                                                  COMPLETION

       ~.~ ~~:I~~:~:~Jri~harter        and list of bLlsiness plan cons.i.deratioQ;;----         ---·--~I:~I                                    I
        23     Draft bus.inessp l a n .                                                               ._          04/01/2010
,----,2=-,.4   Finalize businElss plan                                                                            07/01/2010

    Submit the workplan to your AHCA Health Systems Development plan analyst at the follOWing address:

               PSN Contracting and Policy Unit
               Bureau of Medicaid Health Systems Development
               2727 Mahan Drive, MS 50
               Tallahassee, FL 32308




                                                                                   SAMPLE

								
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