NYAPRS Note: States are taking very different approaches to integrating managed Medicaid medical and behavioral health services for people with more extensive needs.
As OpenMinds reports below, Florida has selected a company most known for its behavioral healthcare management, Magellan Health Services, to manage fully integrated Medicaid care for Floridians with ‘serious’ multiple needs.
At the same time, New York is poised to essentially carve in its Medicaid fee for service behavioral health services in 2015, relying on health plans that may or may not contract with behavioral health organizations to operate new Health and Recovery Plans (HARPs).
Today is the last day to register for tomorrow’s NYAPRS Albany managed care forum that will feature representatives from 11 health plans (now including Affinity and CDPHP) and 5 behavioral health organizations. See more program details at http://www.nyaprs.org/e-news-bulletins/2013/005743.cfm and register at https://registration.nyaprs.org/?page=CiviCRM&q=civicrm%2Fevent%2Fregister&id=9&reset=1.
Florida Medicaid Selects Magellan For SMI Integrated Care Management Plan
Open Minds September 29, 2013
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On September 23, 2013, the Florida Agency for Health Care Administration (AHCA) announced that Magellan Complete Care of Florida was selected for eight regional contracts to launch a Medicaid specialty managed care plan to provide integrated behavioral and physical health care to beneficiaries with serious mental illness (SMI).
Magellan will receive a capitated rate to provide all state plan services, including pharmacy and transportation to receive state plan services. The AHCA announcement pertained to a competitive procurement for its Medicaid Managed Medical Assistance program (MMA), which is part of the 2011 Statewide Medicaid Managed Care (SMMC) program. The procurement sought proposals from general and/or specialty health plans to serve one or more of the state’s 11 regions. No other entities submitted bids to provide a MMA specialty plan for individuals with SMI.
The covered population for the SMI specialty managed care plan includes Medicaid beneficiaries diagnosed with a serious and persistent mental illness. Enrollment in a managed care plan is mandatory. During the initial rollout if a specialty plan is available, beneficiaries meeting specialty plan criteria will be allowed to enroll in a general medical plan or the specialty plan. If beneficiaries who meet specialty plan criteria do not make a plan selection during the choice enrollment period and a specialty plan is available, they will be automatically assigned to the applicable specialty plan. Otherwise, the beneficiary will be automatically assigned to a general managed care plan. If a specialty plan becomes available after the initial rollout but during the first contract year, the beneficiary can elect to switch from a general medical plan to enroll in the applicable specialty plan.
The Magellan Complete Care Serious Mental Illness Specialty Plan was awarded eight contracts to operate in Regions 2, 4, 5, 6, 7, 9, 10, and 11. The eight regions encompass 40 of Florida’s 67 counties. The Magellan Complete Care SMI plan will not operate in the Region 1 western panhandle counties (Escambia, Okaloosa, Santa Rosa, and Walton); the Region 3 counties in the northwestern area of the state (Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union); or in the Region 8 counties in the southwestern part of the state (Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota).
In 2011, the Florida Legislature directed AHCA to create the SMMC program with two key components: the MMA program and the Long-Term Care program. AHCA applied for a Medicaid waiver and began preparing to implement the SMMC program in two distinct phases. The first phase was to implement Medicaid managed long-term care for beneficiaries with disabilities needing long-term care services. Following a competitive procurement, AHCA awarded contracts in January 2013. CMS granted final approval for the Long-Term Care component of the waiver in February 2013.
AHCA released the second-phase MMA procurements for each region on December 28, 2012, with proposals due on March 15, 2013. On September 23, 2013, AHCA announced it had awarded 39 contracts to 10 general, non-specialty MMA plans and 63 contracts to five specialty MMA plans, including Magellan Complete Care. The specialty plans provide a tailored set of services based on member diagnosis or situation; these plans are for people diagnosed with HIV/AIDS, children involved in the child welfare and foster care systems, individuals with SMI, and adults with common chronic health conditions: cardiovascular disease, chronic obstructive pulmonary disease, congestive heart failure, or diabetes. The state anticipates that the MMA program will be available statewide by October 1, 2014; the MMA contracts will run through December 31, 2018.
Magellan Health Services, Inc. is a for-profit specialty health care management organization that manages behavioral health, radiology, and pharmacy benefits programs, and provides integrated health care programs for special populations. As of June 30, 2013, Magellan's customers included health plans, employers, and government agencies, serving approximately 34.0 million members in its behavioral health business, 17.4 million members in its radiology benefits management segment, and approximately 9 million members in its medical pharmacy management product. The pharmacy solutions segment served 40 health plans and employers, 25 states and the District of Columbia, and several pharmaceutical manufacturers. Magellan Complete Care of Florida is a new Medicaid health maintenance organization (HMO) that launched operations in Broward County, Florida in June 2013. The plan model centers around a Care Coordination Team composed of physicians, counselors, family, and caregivers.
A link to the full text of “Florida ITN 017 Seeking Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/122812flsmmcitn017partabc.htm.
A link to the full text of “Florida ITN 017 Seeking Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)—Part D, Scope” may be found in The OPEN MINDS Circle Library atwww.openminds.com/library/122812flsmmcitn017partdscope.htm.
OPEN MINDS also reported on Magellan Complete Care of Florida in “Magellan Health Services To Acquire 65% Stake In AlphaCare Of New York.” The article is available at www.openminds.com/market-intelligence/premium/omol/2013/082613strat2.htm.
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