A statewide task force released report today recommends that Florida move toward a “medical home” model of care for Florida Medicaid recipients.

The Medicaid Medical Home Task Force developed the following recommendations based on months of examing other state’s programs, as well as input from members:  

• Every Medicaid recipient should have a primary care provider (physician, ARNP, or physician’s assistant) who is available on a 24/7 basis.
• Patient care should be coordinated - the PCP must ensure that services to which recipients are referred have been received and that appropriate follow-up is done. PCPs should address both physical and behavioral health care needs of recipients and develop strong referral relationships with local mental health providers.
• The Task Force suggested using the NCQA Patient-Centered Medical Home standards as a starting point for developing the requirements to qualify as a medical home.
• The Task Force is interested in pursuing a 3-tiered approach to levels of medical homes, similar to Oklahoma.
• The Task Force recommends that an Advisory Board be appointed to assist the Agency during the planning and implementation of the Florida Medicaid medical home pilot project.

• New payment methodologies and primary care practice operations will need to be instituted for the medical home pilot. In general, based on the models from the other states that presented to the Task Force as well as the studies provided to the Task Force, adequate physician participation in the pilot is dependent upon the reimbursement rates for physician fees as well as any case management fee and/or incentive payments. Agency staff reported to the Task Force that in general, Florida Medicaid FFS rates for physician services are approximately 58% of Medicare rates, so increasing physician fees may be necessary to attract providers to participate in the medical home project. While increasing physician fees may be necessary, the Task Force strongly recommends that any program design should investigate payment methodologies to ensure a return on investment.

The 16-page report doesn’t define which which group of Medicaid enrollees - children, aged and disabled, etc. - should be moved into this model, but instead leaves that to an advisory board for further discussion.

 The medical home concept is being seriously considered by state lawmakers faced with growing Medicaid costs. Many advocacy groups favor this approach, including pediatricians, hospitals and consumer groups. The American Academy of Pediatrics has long supported this role of health care delivery for children.

Florida already has a “medical home” model within Children’s Medical Service. Children enrolled in the CMS Network are assigned a primary care physician who serves as a case manager. Children are referred to specialists including therapists through the primary care physician.

Some other points raised in the report, which can be found here:

The Task Force recommends that at least one rural area and one urban area with an academic setting/medical school be included as pilot sites. Local providers’ level of interest in participating in the medical home pilot should be taken into account. Special consideration should be given to areas with high levels of uncoordinated care, as evidenced by frequency of emergency room visits and hospital admissions.

The Task Force recognizes that successful medical home projects in other states have been predicated on a higher general reimbursement rate to physicians and other providers of health care services. To be successful in Florida, the Task Force finds that a medical home pilot project must address core funding issues for those who agree to provide health care services through this program. Strong consideration should be given to reimbursement models that include, but are not limited to: enhanced fees for services rendered, care management fees, and pay for performance/incentive payments.