April 2015 - Request to Amend Florida’s 1115 MMA Waiver - LIP (Project Number 11-W-002064) and Public Input

Federal Authorities

Managed Medical Assistance

April 2015 - Request to Amend Florida’s 1115 MMA Waiver - LIP (Project Number 11-W-002064) and Public Input

The State is seeking federal authority to amend Florida’s 1115 Managed Medical Assistance (MMA) Waiver (Project Number 11-W-00206/4) to redesign elements of the Low Income Pool (LIP) and extend the program from July 1, 2015 until June 30, 2017. The newly redesigned LIP program ensures access to care for low income populations that are not eligible to participate in Medicaid or other subsidized coverage programs and complements the MMA program by strengthening connections between critical safety net providers and the MMA program.

The request to redesign and continue funding of the LIP program is in response to discussions with the Centers for Medicare and Medicaid Services (CMS) about how best to structure the pool in light of new and different coverage opportunities for low income Floridians:  Florida’s Medicaid program’s shift to the MMA program as well as opportunities available under the Affordable Care Act.

The State contracted with Navigant Consulting Incorporated to conduct the CMS required study on the LIP program. The study concluded that the LIP program would need to continue in Florida even if all coverage options were fully exploited. In response to these findings and discussions with CMS, the redesigned LIP program contains the following features:

• Reduced linkage of payments to local source of funding and
• Continued focus on maintaining access and quality of care to vulnerable populations.

The State is not requesting authority to make any changes to the MMA program as authorized under this waiver. The State is seeking waiver and expenditure authority to redesign and extend the LIP program.  Specifically, the State seeks expenditure authority of Section 1115(a)(2) of the Social Security Act for expenditures for uncompensated care costs incurred by providers for health care services to uninsured and or underinsured, and associated projects to support such care through the redesigned Low Income Pool.

Waiver History (2006-2015)

The following is an historical description of the federal and state authority granted since authorization of the waiver (Project Number 11-W-00206/4) was obtained in 2005.

Initial 5-Year Period (2006-2011):  On October 19, 2005, Florida's 1115 Research and Demonstration Waiver named “Medicaid Reform” was approved by Federal CMS. The program was implemented in Broward and Duval Counties July 1, 2006 and expanded to Baker, Clay and Nassau Counties July 1, 2007.  The program was terminated August 1, 2014 with the implementation of the MMA program.  The state authority to operate this program is located in s. 409.91211, F.S., and sunsetted October 1, 2014.

Three-Year Extension Period (2011-2014):  On December 15, 2011, the State received Federal CMS approval to extend the waiver to maintain and continue operations of Medicaid Reform for the period July 1, 2011 to June 30, 2014. 

MMA Waiver Amendment (2013):   On June 14, 2013, the State received Federal CMS approval to amend the waiver to terminate the Medicaid Reform program and implement the MMA program as approved by Federal CMS.  The name of the waiver was changed to Florida’s MMA program. 

Three-Year Waiver Extension (2014-2017):  During the 2011 Florida Legislative session, the Florida Legislature passed and Governor Scott signed legislation to expand managed care in the Florida Medicaid program with the creation of the MMA program.  Part IV of Chapter 409, F.S., directed the Agency to submit any federal waiver or state plan amendment requests to Federal CMS as necessary to implement the MMA program no later than October 1, 2014.  In accordance with this directive, the Agency sought and received approval to extend the waiver authorization period from July 31, 2014 until June 30, 2017. The LlP program was authorized to extend for one year, from July 1, 2014 through June 30, 2015 with the total amount not to exceed $2.16 billion.

To view the July 31, 2014, approved Special Terms and Conditions of the waiver, Waiver Authorities document, Expenditure Authorities document and the Approval Letter, please click on the following links:

• July 31, 2014 Approval Letter [ 307.5 kB ]
• Special Terms and Conditions CMS Approved July 31, 2014 [ 1.3 MB ]
• Waiver Authorities CMS Approved July 31, 2014 [ 62.2 kB ]
• Expenditure Authorities CMS Approved July 31, 2014 [ 203.5 kB ]

Public Notice and Public Comment April 21, 2015 - May 22, 2015

The Agency will provide for a 30-day public notice and comment period prior to the submission of the waiver amendment to Federal CMS. The Agency will consider all public comments received regarding the development of the waiver amendment.

The 30-day public notice and public comment period begins April 21, 2015 through May 22, 2015. To view a comprehensive description of the waiver amendment request, please click the following link:

Public Notice Document - LIP Amendment [ 285.6 kB ]

Public Meetings/Workshops

The dates, times and locations of the public workshops to be held are as follows:

Schedule of Public Meetings
Location	Date	Time
Orlando University of Central Florida College of Medicine Lewis Auditorium Health Sciences Campus 6850 Lake Nona Blvd Orlando, FL 32827-7408 Conference Call in # 1-877-809-7263 Participant Code #498 365 37	April 29, 2015	2:00p.m. – 4:00p.m. FAR [ 24.3 kB ]
Miami Agency for Health Care Administration 8333 NW 53rd Street Suite 200 Doral, FL 33166 Conference Line: 1-877-299-4502 Participant Code: 229 029 90#	April 30, 2015	2:00p.m. – 4:00p.m. FAR [ 24.3 kB ]
Tallahassee Agency for Health Care Administration 2727 Mahan Drive Building 3, Conference Room A Tallahassee, FL 32308 Conference Line: 1-877-299-4502 Participant Code: 265 591 27#	May 1, 2015	2:00p.m. – 4:00p.m. FAR [ 24.3 kB ]

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting Heather Morrison at (850) 412-4034 or by email at [email protected].

If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1 (800) 955-8771 (TTY) or 1 (800) 955-8770 (Voice).

Submit Comments

The 30-day public comment period begins April 21, 2015 through May 22, 2015.

To submit comments by postal service or internal email, please follow the directions outlined below.  When providing comments regarding the 1115 MMA Waiver amendment request, please have ‘1115 MMA Waiver Amendment Request’ referenced in the subject line.

Mail comments and suggestions to:

1115 MMA Waiver Amendment Request

Office of the Deputy Secretary for Medicaid

Agency for Health Care Administration

2727 Mahan Drive, MS #8

Tallahassee, Florida 32308

You may also e-mail your comments and suggestions to [email protected]

• Legislation that would implement this model has been proposed, and can be found the following link:

Florida Senate Medicaid Hospital Funding Programs April 1, 2015 [ 1.4 MB ]

• If you are interested in learning more about the Managed Medical Assistance program, please click on the following links to view an overview and frequently asked questions about the program:

Managed Medical Assistance Snapshot [ 394.1 kB ]

 

• For more information on 1115 Research and Demonstration waivers you may visit the Federal CMS website at the following link:  https://www.medicaid.gov/medicaid/section-1115-demo/about-1115/index.html .
• The Agency will post all public comments here for public review periodically throughout the 30-day public notice and comment period.

Public Comments as of May 22, 2015 [ 8.4 MB ]