Florida
Medicaid
Medicaid is the federal and state partnership that
gives health treatment for some people with low incomes. Its goal
is to grow the health of people who might otherwise go without medical
care for themselves and their kids. Medicaid is not the same
in every state.
In Florida,
the Agency for Health Care Administration (AHCA) creates and carries
out policies associated to the Medicaid program. A explanation of
the services offered by the Florida Medicaid program can be found
in the Summary of Services, 2004-2005. Updated 12/13/04
Florida implemented the Medicaid program on begening
of the year 1970, to give medical services to poor people. Over
the years, the Florida Legislature has authorized Medicaid compensation
for more services. A big grow happened in 1989, when the United
States Congress mandated that states offer all Medicaid services
allowable under the Social Security Act to children under the age
of 21.
The state Medicaid plan is the document that
defines how each state will operate its Medicaid program. Each state
submits its own plan to the Centers for Medicare and Medicaid Services
(CMS) for approval. The state plan addresses the areas of state
program administration, Medicaid eligibility criteria, service coverage,
and provider compensation. Follow this link for more information
regarding Medicaid state plans.
Administration and Funding
The Medicaid program is administered by Florida's
Agency for Health Care Administration (AHCA).
The Florida Medicaid program is authorized by Chapter
409, Florida Statutes, and Chapter 59-G, Florida Administrative
Code.
The Medicaid program is funded through federal and
state participation with Florida's counties contributing to inpatient
hospital and nursing home services. Matching federal funds are contingent
upon the state's continued compliance with Title XIX of the Social
Security Act and regulations in Title 42 of the Code of Federal
Regulations. The Medicaid budget for fiscal year 2003-04 is approximately
$12.5 billion.
The Agency for Health Care Administration contracts
with Health Management Systems, Inc. (HMS) to conduct the Medicaid
Third Party Liability (TPL) Program. HMS is responsible for identifying
additional sources of payments and recovering payments made by Medicaid
from liable third parties. TPL includes three major components:
Casualty (Tort) Recovery, Estate Recovery and Other Third Party
Insurance Recovery. TPL functions are described in Sections 409.910
and 409.9101, Florida Statutes.
Health Management Systems, Inc. (HMS) currently conducts
Medicaid Third Party Liability recovery for the State of Florida.
For TPL recovery information, visit their web site at http://www.flmedicaidrecovery.com
or call toll free (877) 446-7868 for questions regarding Casualty
Recovery, Estate Recovery, Other Third Party Insurance Payer, Insurance
Denials or Insurance Carrier Code Information. For questions regarding
Reimbursement for Medicaid Providers
or Other Recoupment Projects, call the HMS Provider Relations Unit
toll free (888) 831-2738.
Beneficiary Services
Do you need to know what services Florida Medicaid covers?
Do you need to know who provides Florida Medicaid services?
Do you need help with information and referral?
Do you need help with medical bills you are receiving?
Florida Medicaid Beneficiary Services can assist anyone who is receiving
Medicaid. You can call or have a family member call for you. Services
are free. Your records are confidential, except for the
purpose of administering the program. For more information regarding
these services, call the Area Medicaid Office that serves your county.
Miami-Dade & Monroe Counties
1-800-953-0555
Okaloosa and Walton Counties
1-800-303-2422, Ext. 263
Franklin, Gulf, Holmes, Jackson and Washington Counties
1-800-699-7068
Taylor and Liberty Counties Only
1-800-248-2243
Volusia, Baker, Clay, Flagler, Nassau and St Johns
Counties
1-800-273-5880
Pasco County
1-800-299-4844, Ext. 276
Hardee, Highlands, Manatee and Polk Counties
1-800-226-2316, #4
Fiscal Agent Procurement
The State of Florida Agency for Health Care Administration (AHCA)
is in the process of procuring a fiscal agent to meet the requirements
of the Florida Medicaid program beginning July 1, 2007.
Point of Contact
The State has designated the following person as the Issuing Officer
and sole point of contact for this procurement:
Angela Smith
Issuing Officer
2727 Mahan Drive, Mail Stop 56
Tallahassee, FL 32308
smitha@ahca.myflorida.com
Restriction on Communication
In fairness to all vendors, those vendors that may intend to submit
a proposal for this contract, as primary contractor or as a subcontractor
in any capacity, must now direct all communication related to the
procurement or to fiscal agent services during the term of the proposed
contract to the State’s designated point of contact. Sales
presentations and lobbying efforts related to this procurement are
expressly prohibited, except as allowed as part of the formal procurement
process.
Current Status
The State has posted the Request for Proposal (RFP) that describes
State requirements in detail. Follow this
link to the Department of Management web site to download the
documents. Some of the highlights of the requirements are:
- Installation of a system new to Florida (not a
takeover of the existing system).
- Development of a combined FMMIS/DSS that meets
business functional requirements under a Medicaid Information
Technology Architecture (MITA) structure of organization.
- Relational databases and Web-based architecture
throughout FMMIS/DSS.
- Real-time or near real-time processing.
- Use of rules engines, workflow management engines
and other tools that can be applied across components to manage
recipient enrollment, provider administration, claims processing
and other functions.
- Use of appropriate subcontracts to handle specialized
business functions such as health outcome reporting, Pharmacy
Benefits Management, Decision Support, rate-setting, and fraud
and abuse detection and control.
- For every function, employ best-of-breed software,
tools, methods, and subcontracts to apply current, proven solutions.
- Use of Commercial-Off-The-Shelf (COTS) software
to lower costs and to provide more flexible and efficient management.
- Web-based claim submission, eligibility verification,
reference materials and public information.
- Implement a Benefit Plan structure with the flexibility
to quickly and accurately add new service plans and implement
requirements of Florida Medicaid reform.
- Receive and process encounter data from managed
care organizations and determine sound fee schedules based on
many criteria.
- Significant increases in automation and efficiency,
and better integration with computer systems operated by trading
partners, providers, and government agencies.
- Significant improvement in administrative and
status reporting.
- Develop and implement an Electronic Health Record
during the term of the contract.
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