Q & A – CATEGORY – COST BASED PROVIDERS:

** How will COST BASED PROVIDERS be paid?
ADVANTAGE FLORIDA HEALTH PLAN as a Fee For Service PSN will pay the COST BASED PROVIDERS just as they are paid now.
The challenge is for the Cost Based Providers and PSN to find the right funding approach when the FFS model transitions to a Prepaid Capitated PSN model.

We will work with each Cost Based Provider to find a solution that is equitable. Considerations will include:

• The use and conditions of the Low Income Pool
• Un-bundled services for ADVANTAGE FLORIDA HEALTH PLAN funded members
• Use of other services and programs to bring additional revenue to the Provider Organizations
• Nursing Home Diversion Waiver in approved counties
• Florida Senior Care in pilot counties
• Medicare Special Needs Plan (SNP) in approved counties
• Explore how ADVANTAGE FLORIDA HEALTH PLAN could assist with the issues contributing to the need for Cost Based payments and still be within the mission of the PSN
• The supply of reimbursable services is critical to Cost Based Reporting (CBR) transition. Understanding what is referred out and what services the PSN might be able to contract for your services is important.