Mission and Responsibilities Better health care for all Floridians . - - PDF document

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Mission and Responsibilities Better health care for all Floridians . - - PDF document

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Mission and Responsibilities Better health care for all Floridians . An Overview of the Agency for The chief health policy and planning entity for the state: Health Care Administration health facility licensure, inspection, and

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An Overview of the Agency for Health Care Administration

A Presentation for Florida’s Children and Youth Cabinet

By Elizabeth Dudek, Secretary August 31, 2011

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Mission and Responsibilities

  • “Better health care for all Floridians.”
  • The chief health policy and planning entity for the

state:

– health facility licensure, inspection, and regulatory enforcement; – investigation of consumer complaints related to health care facilities and managed care plans; – implementation of the certificate of need program; – operation of the Florida Center for Health Information and Policy Analysis; – administration of the Medicaid program and contracts with the Florida Healthy Kids Corporation; and – certification of health maintenance organizations.

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Agency Funding Overview

Base Budget Fiscal Year (FY) 2011/12

FTE General Revenue State Trust Funds Federal Funds Total Administration & Support 297.0 $3,642,248 $17,018,967 $22,977,691 $43,638,906 Health Care Services 748.5 $3,559,885,273 $4,015,506,271 $11,658,697,497 $19,234,089,041 Health Care Regulation 617.0 $135,778 $29,481,954 $19,675,429 $49,293,161 Total 1,662.5 $3,563,663,299 $4,062,007,192 $11,701,350,617 $19,327,021,108

General Revenue 18% State Trust Funds 21% Federal Funds 61%

Base By Fund Type

Admin & Support 0.23% Health Care Services 99.52% Health Care Regulation 0.26%

Base By Program

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Appropriation History

10,377,344,072 12,094,559,931 13,753,702,933 15,191,284,292 15,925,281,566 16,608,344,729 16,393,581,338 17,977,699,747 19,400,622,938 21,639,857,976

  • 5,000,000,000

10,000,000,000 15,000,000,000 20,000,000,000 25,000,000,000 Budget

1865 1596.5 1654.5 1677.5 1703.5 1710.5 1707.5 1685.5 1672.5 1662.5

FTE AHCA.MyFlorida.com

Division of Health Quality Assurance

  • The Division of Health Quality Assurance (HQA) is

responsible for:

– the state licensure and federal certification of health care facilities and providers and managed care organizations, – the review of architectural plans for health care facilities, – the investigation of consumer complaints against facilities and providers, – the provision of training to staff, and – the determination of need for certain health care facilities and services.

  • HQA has eight field offices that serve as local liaisons

to providers.

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HQA by the Numbers

  • Number of active, licensed providers: 29,925
  • Number of licenses processed: 11,295 initial, renewal

and Change of Ownership licenses processed

  • Number of complaints investigated: 5,531
  • Number of background screenings: 209,012 criminal

background checks conducted

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Children and Youth Hospitals

  • Florida has three licensed children’s hospitals:

– Miami Children's, All Children's, and Shriners in Tampa – Nemours Orlando is under construction.

  • There are at least 14 other hospitals that have named

their pediatric units “children’s hospitals,” but they are all units within general acute care hospitals.

  • 62 Florida hospitals have NICUs with a total of 1,643

beds.

– 28 of the hospitals have 697 Level III NICU beds.

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Children’s Treatment Facilities

  • There are four intensive residential treatment facilities

with a total of 240 beds that serve children and adolescents exclusively.

– One hospital has 4 IRTF beds collocated with 26 child/adolescent inpatient psychiatric beds and 60 adult psych beds.

  • There are three child/adolescent psychiatric hospitals,

66 child/adolescent beds and one child/adolescent psychiatric unit of 20 beds in Miami Children's Hospital.

  • There are 40 residential treatment centers for children

and adolescents with a total of 702 beds.

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Additional Children’s Facilities

  • There are approximately 40 licensed home health

agencies that primarily serve children.

  • Five licensed nursing homes have dedicated children’s

units and one nursing home serves only children.

  • There are 39 prescribed pediatric extended care centers

with a total of 1,496 beds.

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The Florida Center

  • The Florida Center for Health Information and

Policy Analysis is responsible for:

– collecting, compiling, analyzing, and disseminating health related data and statistics for the purpose of developing public policy, – promoting the transparency of consumer health care information through www.FloridaHealthFinder.gov, – implementing the statewide health information exchange infrastructure, – administering the Medicaid electronic health record provider incentive program, and – collecting adverse incident reports.

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Data Specific to Children and Youth

  • www.FloridaHealthFinder.gov includes information

about all patients discharged from the state’s hospitals and ambulatory surgical centers. Discharge data can be sorted by age group, so detailed information is available about all pediatric conditions and procedures.

  • The website also includes general health videos on

topics of interest to people who care for children.

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HQA Works with Children and Youth

  • Although not clients, residents or patients served by

AHCA-licensed providers may interact with other Agencies for example children who live in health care facilities or residential settings may interact with DCF, APD, or DOH depending upon their needs and services.

  • The managed care Subscriber Assistance Panel offers

an external review process for enrollees (including children) of health maintenance organizations, prepaid health clinics and exclusive provider organizations when the plan’s internal grievance process has been exhausted.

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The Division of Medicaid

  • The Division of Medicaid is the medical assistance

program that provides access to health care for low- income families and individuals.

  • Medicaid assists aged and disabled people with the

costs of nursing facility care and other medical expenses.

  • Eligibility for Medicaid is usually based on the family’s
  • r individual’s income and assets.
  • Medicaid has 11 field offices through the state.

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Medicaid by the Numbers

  • Number of Medicaid recipients as of June 30,

2011: 3,029,133

  • Number of enrolled providers as of July 2011: 115,821
  • Number of active providers who submitted a claim

between July 2010-July 2011: 74,034

  • Number of claims processed per month, on average:

13,278,295

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Medicaid Enrollment July 2009-June 2011

2,608,834 2,640,036 2,667,662 2,698,247 2,727,362 2,679,941 2,707,447 2,731,697 2,751,875 2,758,016 2,788,484 2,804,783 2,821,123 2,861,411 2,898,569 2,913,826 2,917,026 2,920,498 2,965,383 2,961,095 2,973,095 2,975,720 2,995,439 2,997,952 2,400,000 2,500,000 2,600,000 2,700,000 2,800,000 2,900,000 3,000,000 3,100,000 AHCA.MyFlorida.com

Medicaid Enrollment Age 0-20

Population Number of Youth % of total Medicaid Enrollment Age 0-5 709,129 24% Age 6-10 423,673 14% Age 11-18 538,015 18% Age 19-20 65,296 2% Total Title XIX Medicaid Enrollment Age 0-20 1,736,113 58%

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Medicaid Expenditures for Children’s Services

  • For FY 2009/10, 43.6% of the total Medicaid

expenditures were spent on Medicaid beneficiaries under the age of 21.

– Total expenditures: $14,588,622,385.34 – For beneficiaries under 21: $6,369,708,115.62

  • Some of the major expenditure categories were:

– Inpatient services – Physician services – Outpatient services – Prescribed medicines

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Florida KidCare

  • Florida KidCare has functioned since its inception in

1998 as an umbrella program that includes Medicaid, MediKids, Healthy Kids and the Children’s Medical Services Network.

  • The Agency for Health Care Administration is the lead

agency for federal and state funding and federal compliance, but KidCare does not have a designated lead agency for overall administration and policy.

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KidCare: An intra-Agency Partnership

Entity Responsibilities

Agency for Health Care Administration

Administers the Medicaid program (Title XIX) Administers the MediKids program (Title XXI, children 1 through 4) Serves as Title XXI state contact with Centers for Medicare and Medicaid Services Distributes federal funds for Title XXI programs Manages contract with Florida Healthy Kids Corporation Develops and maintains the Title XXI Florida KidCare State Plan

Department of Children and Families

Performs Medicaid (Title XIX) eligibility determination and application processing Administers Behavioral Health Network (part of Children’s Medical Services Network – Title XXI children 0 through 18)

Department of Health

Administers Children’s Medical Services Network (Title XIX and XXI – children 0 through 18 with special health care needs) Chairs the Florida KidCare Coordinating Council

Florida Healthy Kids Corporation

Under contract with the Agency, performs administrative functions for Florida KidCare (screens for Medicaid eligibility, eligibility determination for Title XXI, premium billing and collection, refunds and customer service) Administers Florida Healthy Kids program (Title XXI – children 5 through 18)

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Title XXI KidCare Enrollment July 2009-June 2011

228,704 231,247 229,873 230,601 234,676 236,671 237,180 239,046 240,057 246,275 251,714 254,217 255,742 256,758 256,062 255,451 254,436 255,169 256,386 254,328 255,781 255,616 253,472 252,447 210,000 215,000 220,000 225,000 230,000 235,000 240,000 245,000 250,000 255,000 260,000 July-09 August-09 September-09 October-09 November-09 December-09 January-10 February-10 March-10 April-10 May-10 June-10 July-10 August-10 September-10 October-10 November-10 December-10 January-11 February-11 March-11 April-11 May-11 June-11 AHCA.MyFlorida.com

EPSDT Health Program

  • Early and Periodic Screening, Diagnosis, and Treatment

(EPSDT) is Medicaid's comprehensive and preventive child health program for individuals under the age of

  • 21. In Florida, it is known as the Child Health

Check-Up program. It includes:

– screening services to detect physical and mental conditions; – vision services, including eyeglasses; – preventive, restorative and emergency dental services; – hearing services, including hearing aids; and – other medically necessary health services.

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Child Health Check-Up Service

  • The “screening” portion of the program includes:

– a comprehensive health and developmental history; – an assessment of past medical history, developmental history and behavioral health status; – physical exam and nutritional assessment; – developmental assessment; – updating of routine immunizations; – laboratory tests (including blood lead screening); – vision, hearing, and dental screening; – health education/anticipatory guidance; and – referral and follow-up for further diagnosis and treatment.

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Additional Programs for Children

  • Medical Foster Care
  • Prescribed Pediatric Extended Care (PPEC)
  • Dental Services
  • Statewide Inpatient Psychiatric Program

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Thank you! Questions?