Pursuant to Section 409.966, Florida Statutes, traditional Medicaid services are to be provided to Florida recipients through a limited number of Managed Care Organizations (“MCOs”) in the 11 Regions of the state. The Agency released Invitations to Negotiate (“ITNs)” for each of the Regions inviting MCOs to submit proposals to provide coverage to Medicaid recipients in that Region. The proposals were submitted and evaluated, and on September 27, the Florida Agency for Health Care Administration (“AHCA”) released the list of recommended awards to MCOs in the 11 Regions.
Section 409.966 limits the number of MCOs that can operate in each Region, and therefore many MCOs were not awarded Regions for which they had submitted proposals. MCOs had to submit notice of intent to challenge within 72 hours of the award; with their formal protest filed by close of business October 7 However, several of the MCOs that submitted notices of intent to protest did not submit formal protests. The following MCOs met the filing deadline and have filed formal protests for the regions indicated:
• Molina Healthcare of Florida, Inc.
[Regions 1,4,5,6,7, 9,10,11]
• First Coast Advantage, LLC – PSN.
• Wellcare of Florida, Inc. d/b/a /Staywell Health Plan of Florida.
[Regions 4, 9, 10]
• South Florida Community Care Network– PSN.
• Care Access PSN, LLC – PSN.
• Integral Health Plan, Inc. d/b/a Integral Quality Care – PSN.
• Prestige Health Choice, LLC – PSN.
• Simply Healthcare Plans, Inc.
[Regions 5, 11]
• Coventry Health Care of Florida, Inc.
[Regions 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11]
AHCA is currently evaluating the protests filed for legal sufficiency and appropriate further action. The MCOs whose protests are deemed legally sufficient will have an opportunity in the next seven days to meet with the Agency and resolve the protest(s) by mutual agreement (we believe, but have not been able to confirm, that some MCOs have already begun meeting with AHCA). If unresolvable, the Agency will refer the protest(s) to the Division of Administrative Hearings for an administrative hearing before an administrative law judge.
Akerman is pleased to be able to offer this timely update and stands willing to discuss the matter further should you need additional information.