Florida Statutes 409.981 – Eligible long-term care plans
Current as of: 2023 | Check for updates
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(1) ELIGIBLE PLANS.–Provider service networks must be long-term care provider service networks. Other eligible plans may be long-term care plans or comprehensive long-term care plans.
1(2) ELIGIBLE PLAN SELECTION.–The agency shall select eligible plans for the long-term care managed care program through the procurement process described in s. 409.966 through a single statewide procurement. The agency may award contracts to plans selected through the procurement process on a regional or statewide basis. The awards must include at least one provider service network in each of the nine regions outlined in this subsection. The agency shall procure:
(a) At least 3 plans and up to 4 plans for Region A.
Terms Used In Florida Statutes 409.981
- Agency: means the Agency for Health Care Administration. See Florida Statutes 409.962
- Comprehensive long-term care plan: means a managed care plan, including a Medicare Advantage Special Needs Plan organized as a preferred provider organization, provider-sponsored organization, health maintenance organization, or coordinated care plan, that provides services described in…. See Florida Statutes 409.962
- Contract: A legal written agreement that becomes binding when signed.
- Eligible plan: means a health insurer authorized under chapter 624, an exclusive provider organization authorized under chapter 627, a health maintenance organization authorized under chapter 641, or a provider service network authorized under…. See Florida Statutes 409.962
- Medicaid: means the medical assistance program authorized by Title XIX of the Social Security Act, 42 U. See Florida Statutes 409.962
- Provider service network: means an entity qualified pursuant to…. See Florida Statutes 409.962
(b) At least 3 plans and up to 6 plans for Region B.
(c) At least 3 plans and up to 5 plans for Region C.
(d) At least 4 plans and up to 7 plans for Region D.
(e) At least 3 plans and up to 6 plans for Region E.
(f) At least 3 plans and up to 4 plans for Region F.
(g) At least 3 plans and up to 5 plans for Region G.
(h) At least 3 plans and up to 4 plans for Region H.
(i) At least 5 plans and up to 10 plans for Region I.
(3) QUALITY SELECTION CRITERIA.–In addition to the criteria established in s. 409.966, the agency shall consider the following factors in the selection of eligible plans:
(a) Evidence of the employment of executive managers with expertise and experience in serving aged and disabled persons who require long-term care.
(b) Whether a plan has established a network of service providers dispersed throughout the region and in sufficient numbers to meet specific service standards established by the agency for specialty services for persons receiving home and community-based care.
(c) Whether a plan is proposing to establish a comprehensive long-term care plan and whether the eligible plan has a contract to provide managed medical assistance services in the same region.
(d) Whether a plan offers consumer-directed care services to enrollees pursuant to s. 409.221.
(e) Whether a plan is proposing to provide home and community-based services in addition to the minimum benefits required by s. 409.98.
(4) PROGRAM OF ALL-INCLUSIVE CARE FOR THE ELDERLY.–Participation by the Program of All-inclusive Care for the Elderly (PACE) shall be pursuant to a contract with the agency and not subject to the procurement requirements or regional plan number limits of this section. PACE plans may continue to provide services to individuals at such levels and enrollment caps as authorized by the General Appropriations Act.
(5) MEDICARE ADVANTAGE SPECIAL NEEDS PLANS.–Participation by a Medicare Advantage Special Needs Plan shall be pursuant to a contract with the agency that is consistent with the Medicare Improvement for Patients and Providers Act of 2008, Pub. L. No. 110-275. Such plans are not subject to the procurement requirements if the plan’s Medicaid enrollees consist exclusively of dually eligible recipients who are enrolled in the plan in order to receive Medicare benefits as of the date the invitation to negotiate is issued. Otherwise, Medicare Advantage Special Needs Plans are subject to all procurement requirements.