CHARLIE CRIST GOVERNOR Members Present 1. Mark T. Knight (phone) 2. David Verinder 3. Margret Brennan 4. Michael Good 5. Tom Wilfong 6. Terry Meek 7. Scott Davis 8. Mark T. Knight (phone) Members Absent 1. Mary Lou Tighe 2. Kevin Kearns Agency Staff Present 1. Michele Hudson 2. Melanie Brown-Woofter 3. Lecia Behenna 4. Edwin Stephens 5. Shannon Bagenholm 6. Lecia Behenna Others in Attendance 1. Jenny Robertson 2. John Goodrich 3. Lori Hundley 4. Paul Belcher 5. Mary Pat Moore Better Health Care for all Floridians IGT TAP Meeting 2727 Mahan Drive Conference Room A Tallahassee, FL August 23, 2010 1:00 p.m. - 3:00 p.m. ELIZABETH DUDEK INTERIM SECRETARY 272 7 Mah an Dri ve, MS# Tallahassee, Fl ori da 323 08 Visit AHCA online at http://ahca.myflorida.com
6. Eric Prutsman 7. Kathy Pilkinton 8. Sue Conte 9. Belita Moreton 10. Lindy Kennedy 11. Tony Carvalho 12. John Owens 13. Clark Scott Others in Attendance by Phone 1. Elaine Peters 2. Janet Carter 3. Michelle Summers 4. Marty Lucia 5. Meredith Berger 6. Dave Musgrave 7. Jeff Harris 8. Jan Gorrie 9. Mary Beth Dyer I. Welcome Michele Morgan, Bureau Chief, Medicaid Program Analysis, opened the meeting of the Intergovernmental Transfer (IGT) Technical Advisory Panel and welcomed the members and non-members in attendance by telephone and in person. Michele Morgan was joined by Melanie Brown-Woofter, Bureau Chief, Health Systems Development. II. Approval of Minutes
The meeting minutes from the July 20, 2010 IGT TAP meeting were unanimously approved. III. Medicaid Updates Currently working with actuaries, no update on status of draft rates. Hospital rates have been set. Meeting with health plans will be delayed a week. Execute letters of agreements under the approved Federal Medical Assistance Program (FMAP). Preparing a memo for providers once state adopts & modifies the budget for FMAP. Currently, no timeline as of yet (federal buybacks). August 18, 2010 Low Income Pool (LIP) Council meeting update given by Phil Williams: 1) LIP Council providing AHCA with comments on preliminary draft document regarding enhanced primary cure funding for LIP Council proviso (deadline of COB August 23, 2010) 2) Deadline of September 3, 2010 for LIP Council members for requests of the distribution models for their September 15th LIP Council meeting. 3) Extend the capitation rates until September 30, 2010. IV. Explanation of State Capitation Methodology Michele Morgan discussed the state s authority to establish a supplemental payment methodology for managed care plans. No request for a waiver is necessary for payment unless there s something unique about it. Current authority is the proviso. Will need to go before the Legislative Budget Committee (LBC) in order for it to be built into the state authority (statute). State plan amendment and rules could be impacted and may need changes. Contract changes are only required if you want to put in specific criteria as to whom the providers are and qualifying their definitions. We need to look specifically at clarifying what the criteria are in order to receive the supplemental payments. Who sets the rates: Florida - the Agency actually sets the rate. In Florida, we look at the current Agency processes. Look at the counties providing the funding. In Michigan, an agreement was reached between the hospital association and managed care association that allowed for a distribution methodology and how the health plan would pay those providers. Kevin Kearns asked when is a realistic time the rates would be available and can move forward to a legislative committee or could we do it sooner? Michele Morgan replied that we must issue the report no later than Jan 1, 2011and the 2011 legislative session would be the next time it could be picked up.
Scott Davis noted that we need to preserve the IGTs as part of that funding source but we still have a LIP 4 and, if we get the waiver extension, another LIP for a period of time. What is at stake in terms of what the IGTs are funding would be distribution, maintaining extensions and buybacks. Michele Morgan noted that the LIP funding is not part of this methodology. IGTs are $800 million now. Some providers are exempt from the cap & some buyback the rate cuts outside of the model. We want to find a way to preserve a piece of that as well? Yes! This methodology could potentially free up money but those are not required to pay from there because that s where the allocation credits are. Mark Knight asked if the LIP funds were going to shrink. Michele Morgan explained that LIP is a set billion dollars. Mark Knight also asked if we would need to free up dollars for other agencies to participate and Michele Morgan confirmed that we would. The payment we make to the managed care must be a payment in full. Kevin Kearns asked if we are trying to keep LIP separate from the discussion on the reimbursement of the managed care and providers. Michele Morgan confirmed that we are trying to keep the two issues separate even though they are related for now. Will free up money currently that IGT may or may not be maxed out to fund LIP and hospital related items. Want to reach into that pool of IGT and reallocate those funds into managed care. Managed care is not subject to any caps other than a reasonable amount of reimbursement. The opportunities we re looking for are to bring in more revenue and matching of IGT funds. V. Impacts/Possibilities of Developing a Workable Methodology/ Primary Assumptions Impact to the plans: changes amongst health plans as they change utilization - Key item: reimbursement rate that can be negotiated. Certain amount identified used as a pass through, supplemental payment to fund hospital payments. Not a set amount the hospital will have to accept (can negotiate). Impacts to managed care to Florida as a whole: can maintain our programs, can t assure that everyone would remain whole. More appropriately reimburses exemption and buyback methodology would all be built in. Counties will also be able to maintain continuity. Payment methodology and working methodology may be able to alleviate some of those concerns. The counties providing the money will be carved out and specifically used to fund the hospital payment. May not be directly reimbursed to the provider but we could possibly do it by county but a larger area would be more realistic. Dr. Michael Good noted that the Physician Upper Payment Limit (UPL) applies to care provided to Medicaid patients in a fee for service environment. The state needs a workable methodology to enable Physician UPL payments to apply to Medicaid managed care patients as the state considers expanding managed care.
Margaret Brennan noted that part of the responsibilities of this panel is to create and establish how the payments will be made back to the facilities. Because of our limitations on how the state can direct payments we need to outline how that can be done. The payment could be weighed and changed. Tom Wilfong asked if methodology will take into account the location of the facility. Michele Morgan responded that it will not and it will be based on recipients. Mr. Wilfong also asked if the county should be concerned about funding in order to making the facility whole. If we re looking at taking the enrollment of the health plan and looking at those recipients to see what hospital they qualify for then we need to start with the resident then identify based on actual facility. Mr. Wilfong asked what the county s expectation should be. Should it be that their making their facility in their county whole? Margaret Brennan added that most counties want the money to stay in their county & community because their tax payers dollars are supporting this. Michele Morgan responded that for distribution, the methodology will focus on hospital s utilization & the number of days they provided services regardless of what county they are located in and which hospitals were used. Mr. Wilfong added that we need to look at who qualifies to receive a supplement payment? Which hospital qualifies for supplemental payment? We want to get as close to a zero sum equation as possible. Mr. Wilfong added that contracting is less important to the current world as it will be in the future world. You could solve how to reimburse people not participating and the IGT issues in one policy. Mr. Wilfong added that he would like to see it broken up into a non participating agreement Scott Davis asked if it is vital that health plans have a contract with a particular provider or if it s sufficient that they utilize the provider? Margaret Brennan replied that her county has a comprehensive agreement with their hospitals so the money they send they know comes back to their community. Scott Davis replied that sounds like the IGT money is attached to the counties facility not the residents. Michele Morgan stressed the importance of reaching out to the hospitals & counties to get more counties involved in providing money. If we could get more counties on board then we could look at something more broadly. There is a way to build in an incentive to build back in the amount of money (so money can go back to those providers). Michele Morgan stressed that the panel needs to address the question of what do we need to do to get people to see the incentives? Scott Davis noted that as long as we have LIP 4 (at least in the short run) how we come up with a distribution methodology that is workable. Michele Morgan replied that the short term is based on fee for service and reminded the panel that keeping LIP away from this is a good idea. Margaret Brennan asked how to communicate for the counties? Michele Morgan responded that we need to provide a list of which counties put up what amount of money for their counties as well as outside them. Which counties didn t put up any money? Kevin Kearns asked what the scope will be given today s managed care climate. Michele Morgan explained that $800 million is just exemptions state wide.
Physician UPL: Michele Morgan explained that medical schools provide certified public expenditures (CPEs) as the state share of Physician UPL payments. The state receives corresponding federal match. We receive a list of providers from each qualifying entities. We will pay the physician UPL based on the volume of services provided to Medicaid FFS patients up to a certain threshold and that is paid quarterly. Roughly $100,000,000 annually. Physician UPL payments for Medicaid Managed care members are currently not funded at all. We want to bring in a program or policy for Centers for Medicare and Medicaid Services (CMS) to allow us to make comparable physician supplemental payments for managed care members, in addition to continuing to pulling down Physician UPL dollars for those fee for service patients. Michele Morgan confirmed she would provide a list of IGT payments including the amount of funding put up by each funding entity (local government, county, or taxing district) for discussion at the next meeting. May need to look at an analysis of health plans and their utilization. Reach out to the counties to provide an update on statewide enrollment. What would be the total IGT pot needed? At least 2 health plans (19 counties). Research on South Carolina. Mercer has conducted a California analysis. Look at some of the utilizations between health plans & hospitals. Statewide scope on managed care. VI. Closing Comments Michele Morgan thanked all the members for their attendance and reminded everyone that the next IGT TAP meeting would be held on September 8, 2010 at AHCA from 1:00pm 3:00pm. VII. Adjournment The meeting was adjourned at 3:00pm. Sara Michele Morgan Bureau Chief, Medicaid Program Analysis