The recently released Invitations to Negotiate (ITN) for Florida’s Statewide Medicaid Managed Care program (SMMC) parallels in large part the State’s initial procurements that were released in 2012 and 2013. Where the current ITN differs, however, should be of interest to all applicants and associated parties. This blog post addresses several of the more significant changes for consideration and may serve as a platform for questions to be addressed to the Agency for Health Care Administration (AHCA). Any such questions should be forwarded to the Agency, per the ITN requirements, no later than close of business on August 14, 2017. Specifics on this may be found in Attachment A, Instructions and Special Conditions, Section A.10 of the ITN. Given that no specification challenge was raised with the Agency during the 72-hour window after release of the ITN, the Agency’s question period will be the first opportunity for prospective respondents to raise concerns and request feedback on issues that may impact their responses.

This ITN is a reprocurement of the existing five-year contract for SMMC services in the State of Florida. It will impact over three million Medicaid recipients who currently receive Managed Medical Assistance (MMA) and Long Term Care (LTC) coverage through managed care organizations in Florida. New to this procurement will be the incorporation of certain Medicaid enrollees from the PAC, ACF, and TBI/SCI waivers. This is a result of legislation passed in the 2017 Florida Legislative Session expanding Medicaid long-term care coverage to these individuals. Estimated spending for the entire SMMC program exceeds $18 billion annually. The types of plans that will be evaluated under this procurement include Comprehensive, MMA Specialty, and (new to this program) Long-Term Care Plus. Recipients who live in a region where both Comprehensive and Long-Term Care Plus plans are offered will need to choose between them for coverage of their long-term care needs.

While separate and distinct procurements for the LTC and MMA programs were released in 2012 and 2013, the current ITN combines both programs under a single selection process in each region. Interested parties must submit both statewide and regional responses to the ITN for the service categories of interest. These responses will be reviewed and scored, then ranked by plan type. The top-ranked applicants for each plan type will be invited to enter into negotiations with the Agency’s selection staff. A table of scoring criteria can be found in the ITN, Attachment A, Instructions and Special Conditions, Table 4, Summary Score Sheet. The term of contracts awarded is anticipated to run from January 1, 2019 through September 30, 2023, barring protest(s) or other unforeseen circumstances.

Other changes of note in this ITN include the apparent elimination of a face-to-face, Question and Answer meeting with Respondents, and the utilization of certain Agency approved templates that must be incorporated in the responses. While seemingly ministerial in nature, failure to abide by such conditions may constitute grounds for rejection of a party’s response.

Finally, this ITN places additional requirements upon Provider Service Networks (PSNs) that were absent from the earlier procurement. While the statutory definition of a PSN has not changed and most, if not all, of award criteria for a PSN remains unchanged, the language of Attachment A, Instructions and Special Conditions, Section E. 2. e. requires that all capitated PSNS now must apply for and obtain a certificate of authority pursuant to Section 641.2019, Florida Statutes during the readiness review that is part of this ITN. While imposing what appears to be a significant burden on PSN Respondents that was not present in the earlier ITN, perhaps more problematic are the questions that may arise with respect to the reconciliation of this language with existing Office of Insurance Regulation (OIR) policies and guidance. Further clarification on this new requirement by the Agency may be necessary if the full implications are to be understood.