CS/HB 7107 Summary

• Establishes a statewide integrated managed care program for all Medicaid covered services, with mandatory enrollment for most Medicaid recipients effective January 1, 2013 (managed medical assistance) and July 1, 2012 (long-term care).

• Creates 11 regional procurement areas and requires the Agency for Health Care Administration to select a limited number of eligible plans through competitive invitations to negotiate, with quality-based selection criteria and a minimum 5% savings guarantee.

• Mandates comprehensive plan accountability requirements including physician compensation at Medicare rates, emergency service coverage, access standards, encounter data reporting, grievance processes, and achieved savings rebates to the state.

• Establishes separate long-term care managed care program for eligible seniors and disabled adults, with CARES program determining nursing facility care needs and assigning enrollees to care levels.

• Exempts specific populations from mandatory enrollment (family planning-only, breast/cervical cancer-only, emergency Medicaid for aliens, and prescribed pediatric extended care recipients) and allows some exemptions to participate voluntarily.