Organizations across the Florida healthcare landscape believe the Agency for Health Care Administration (AHCA) should increase physician payment rates, reduce administrative burdens and delays in credentialing for providers, and implement value-based payment models focusing on maternal and behavioral healthcare to improve the state Medicaid program.
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AHCA closed the RFI on June 3rd, receiving responses from dozens of organizations recommending operational strategies and best practices to advance and improve the current SMMC program.
This is the second re-procurement since the SMMC program started in 2013.
The Florida Medical Association (FMA), in its response, cited relatively low levels of physician participation in the state Medicaid program compared to the Medicare program.
“According to the latest Physician Workforce Annual Report published by the Florida Department of Health, the most common reason that physicians do not accept Medicaid is low reimbursement,” FMA stated in its response letter. “In total, the report found that 44% of physicians who do not accept Medicaid patients do so due to the unacceptably low reimbursement offered by the program.
According to the report, this amounts to 5,935 physicians who do not accept Medicaid patients due to low reimbursement. Conversely, 745 physicians indicated that they do not accept Medicare patients due to low reimbursement.”
In addition to raising Medicaid reimbursement rates, FMA also recommended that AHCA expand the Managed Medical Assistance Physician Incentive Program (MPIP), a program that guarantees enhanced rates at or above the Medicare level for physicians who meet certain criteria. FMA said AHCA should make all physicians and physician services eligible for the MPIP in order to attract more physicians to the Medicaid program, in turn enhancing the timeliness and availability of care for Medicaid beneficiaries.
FMA says that AHCA should require a plan that has been operating under the SMMC program for at least 2 years to immediately begin paying at least the Medicare rate to all physicians for all covered services.
The Florida Association of Health Plans (FAHP) suggested streamlining quality metrics and exploring alternatives to liquidated damages for these metrics, and collecting members’ preferred method of communication for eligibility purposes. FAHP also recommended reinforcing that prepaid dental plans in the SMMC program must coordinate with health plans to ensure transportation, care coordination, and “any need for sedation services for members.”
The Florida Hospital Association (FHA) suggested improving provider experience by streamlining the credentialing of providers and shortening the time to load providers into the various health plan systems, and reducing the delays and administrative burdens associated with prior authorization.
FHA also recommended that AHCA closely monitor adherence with contractual payment timeframes, as well as prohibit health plans from denying claims when prior authorization was granted and from denying claims for not meeting timely filing requirements if it is an adjusted claim. It also recommended implementing standards and accountability for third-party vendors.
FHA also suggested improving timely access to services for the Medicaid population by reducing delays in credentialing providers and continuing the flexibilities for telehealth coverage allowed during the public health emergency.
The association recommended utilizing value-based payment models to increase quality and reduce costs, improving birth outcomes for mothers and infants beyond the 12-month postpartum coverage period and requiring plans to develop incentive programs for providers to increase screenings and referrals to treatment.
FHA also recommended improving behavioral health outcomes for children and adolescents by incentivizing the integration of behavioral and primary care within provider organizations by offering integrated contracts at enhanced rates for providers that provide integrated care.