Christine Jordan Sexton
In what could result in a seismic shift of hundreds of billions of Medicaid dollars among managed care providers, the state has begun taking the steps necessary to re-procure Florida’s Medicaid managed care program.
The Agency for Health Care Administration (AHCA) released on Friday a five-page request for information (RFI) asking entities with experience in the Medicaid managed health care and Medicaid managed long-term care industries to provide AHCA with some innovative ideas and best practices to improve Medicaid for the patients who receive the care as well as the providers who render the services.
The agency may use the information it obtains from the RFI to develop the new contracts it will ink with providers following the completion of the third Medicaid procurement.
In its request, AHCA has asked potential vendors to respond to its inquiries by the close of business on June 3.
Vendors are being asked to provide information on 12 different areas of interest, ranging from achieving cost savings throughout the statewide Medicaid managed care program to maximizing home- and community-based placement and services through proactive aging-in-place strategies.
The document also shows that the agency wants to improve birth outcomes for mothers and infants through and beyond a 12-month postpartum coverage period as well as promote “sustainable economic self-sufficiency.”
Potential respondents can send questions regarding the request for information to the agency until 5 p.m. on May 13. The agency said it will respond to timely submitted inquiries and will post answers on the MyFloridaMarketPlace website by May 20.
“Respondents who reply to this RFI may be invited to present their ideas in-person to agency leadership,” the request for information published May 6 notes. “An invitation to present in person does not prohibit an entity from responding to any related subsequent solicitation.”
AHCA launched the Medicaid managed long-term care program in 2013. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014.
The request for information released Friday indicates that the next procurement cycle is scheduled to begin sometime between October and December.
The statewide Medicaid managed care contracts are the largest contracts in the state. For the most part, only Medicaid managed care plans that competitively bid to provide services and submit a winning proposal can provide health care services in the statewide Medicaid managed care program.
Because most Medicaid services are provided through the managed care program and not through the fee-for-service program, the contracts are worth tens of billions for the winning Medicaid managed care plans.
The state’s mandatory Medicaid managed care law was nearly a decade old and AHCA officials pushed the Legislature in the 2022 Session to embrace changes they said would make the upcoming procurement administratively easier. To that end, lawmakers agreed to eliminate a requirement that the agency issue separate Medicaid bids in each Medicaid managed care region.
Additionally, lawmakers agreed to reduce the number of Medicaid regions from 11 to nine.
According to the document, the agency will determine “if a meeting with respondents is necessary” to clarify information the state received in the request for information. It’s not clear though that the agency would publicly notify any meeting it decides to have with the health plans following the request for information.
“In the event that the Agency decides to hold a meeting, the Respondent(s) will be notified via email,” the request for information reads.
ACHA RFI for Medicaid Managed Care Program by Andrew Wilson on Scribd
