THE HUMAN SERVICES DEPARTMENT AND THE BROWARD ADDICTION RECOVERY DIVISION RECOMMEND APPROVAL OF THE ABOVE MOTIONS.
This item supports the Board's Value of "Approaching human services collaboratively and compassionately, with special emphasis on the most vulnerable," and the Goal to "Effectively advocate for and acquire municipal, state and federal financial support to equitably address health and human services needs of the entire community, through a truly coordinated system of care."
Medicaid is a low income eligibility-based assistance program for qualified individuals. Historically, BARC has been able to recover some costs for treatment from Medicaid for clients receiving outpatient services. However, the Florida Medicaid system has recently undergone many changes. In 2011, Florida passed legislation to transition most Medicaid recipients from traditional fee-for-service Medicaid to Managed Care Medicaid. Within Broward County, there are four Medicaid Managed Care Organizations (MCO) for substance abuse and mental health.
Broward County’s grant-funded contract with the Broward Behavioral Health Coalition (BBHC) requires providers receiving more than $500,000 in funding meeting Medicaid Managed Medical Assistance (MMA) provider criteria to enroll as a Medicaid MMA provider. Pursuant to this requirement, the Broward Addiction Recovery Division (BARC) and the Elderly and Veteran’s Services Division (EVSD) initiated the enrollment process and have been involved in protracted negotiations for long-term service contracts with the four Medicaid MCOs acting as Third Party Administrators (TPA) for the Medicaid health plans in Broward County.
BARC/Human Services Department executed an interim contract with Beacon (formerly known as Psychcare, LLC) effective September 26, 2014 that was extended through March 31, 2016. The interim contract allowed invoicing Medicaid-eligible clients and services with pre-authorization. When this interim contract ended, the County was at an impasse with Psychare due to contractual language concerns in the permanent agreement and no further interim extensions were given.
BARC staff recently began negotiations with Beacon and the previous language concerns appear to be resolving. Negotiations between Beacon and BARC are nearing finalization and Beacon has offered a second interim contract allowing BARC to file claims on behalf of participating health plan members to receive payment for Medicaid-covered services for three months or until the long-term service contract is in place, whichever comes first. Beacon would not provide an interim contract for more than three months, stating that they would extend the contract if necessary. Since these negotiations have been protracted, it is anticipated that the interim contract will need to be amended to extend the term before the long term service contract is in place.
Beacon is the largest TPA in the Broward County region representing health plans such as Aetna, AvMed, Coventry, Humana, and Optimum. This interim contract will allow BARC to serve the largest portion of Broward County Medicaid plan members while continuing to work toward the final long term service contract.
The Office of the County Auditor's Performance Review of Broward Addiction Recovery Center March 2016 Report No. 16-04 recommended, “To maximize potential revenue, and offset some costs of providing treatment services, BARC should continue efforts to execute long term agreements with Medicaid carriers.” Execution of this interim contract will allow BARC to minimize fiscal impact of contract negotiation delays and demonstrate good faith efforts to comply with BBHC grant requirements. This revenue contract is estimated to generate $69,200 (approximately 20% of $369,000 as noted in the fiscal impact section) depending on the number of clients served and type of services provided.
This interim contract has been reviewed and approved as to form by The Office of the County Attorney.
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