EXHIBIT A-4-d SPECIALTY SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA RESPONDENT NAME: Florida MHS, Inc., dba Magellan Complete Care A. RESPONDENT BACKGROUND/EXPERIENCE SPECIALTY SRC#1 – Specialty Experience (Statewide): The respondent, including respondent’s parent, affiliate(s) or subsidiary(ies), shall provide a list of all current and/or recent (within five (5) years of the issue date of this solicitation [since July 14, 2012]) contracts for managed care for the proposed specialty population. If the respondent does not have experience with the provision of managed care to the proposed specialty population, the respondent shall not submit a response to this SRC. The respondent shall provide the following information for each identified contract: a. The specialty population served; b. The name and address of the client; c. The name of the Contract; d. The specific start and end dates of the Contract; e. A brief narrative describing the role of the respondent and scope of the work performed, including covered populations and covered services; f. The use of administrative and/or delegated subcontractor(s), their scope of work; g. The annual contract amount (payment to the respondent) and annual claims payment amount; h. The scheduled and actual completion dates for contract implementation; i. The barriers encountered that hindered implementation (if applicable) and the resolutions; j. Accomplishments and achievements; k. Number of enrollees, by health plan type (e.g., commercial, Medicare, Medicaid); and l. Whether the contract was capitated, fee-for-service or other payment method. For this SRC the respondent shall not include subcontractor experience. Response: OVERVIEW A detailed list of Magellan managed care contracts covering the past five years, and providing all of the data elements requested in items a. through l. is included in [Specialty SRC #01, Attachment 1: Magellan Complete Care Contract Listing]. As requested, the attachment covers five years of Medicaid contracts. However, Magellan’s commitment to public sector healthcare in Florida goes back almost 20 years to the time we started providing fee-for-service pharmacy and utilization management services to Medicaid enrollees in the state. As the state started to roll out managed care, Magellan participated, first as administrator of several regional Prepaid Mental Health Plans (PMHPs) and then as MCO in AHCA Area 10. Most recently, we have served as AHCA’s Statewide Medicaid Managed Care (SMMC) serious mental illness (SMI) specialty plan since 2014, providing integrated behavioral health, and pharmacy services to more than 50,000 adults and youth with complex health care needs – in other words, AHCA ITN 009-17/18, Attachment A, Exhibit A-4-d, Page 1 of 100 EXHIBIT A-4-d SPECIALTY SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA exactly the membership we propose to serve statewide through this procurement. At Magellan, the SMMC program represents an opportunity to continue to evolve and transform health care delivery within a managed care model, keeping Florida at the forefront of public sector innovation, and bringing continuity and stability at a time of transition and uncertainty for the Medicaid program at a federal level. While our fully integrated specialty plan has only been operating since 2014, our work, and the partnership with AHCA it represents, is the culmination of decades of specialized experience. The best practices embedded in our Florida operation evolved as the result of numerous lessons learned in the field, working directly with enrollees, and addressing their often complex and challenging needs. Working closely with the State over the past four years, Magellan has implemented a person-centered, evidence-based system of care for individuals with multiple behavioral and physical challenges. In the process, we have addressed significant access barriers, and personally reached out to, and successfully engaged, individuals who in many cases have spent most of their lives outside the healthcare system. Our mission is to build upon what we have accomplished to date with AHCA and our enrollees, and to truly lead more Floridians to healthy and vibrant lives, our company mission. We are proud of our legacy of tackling some of the most costly and complex specialty health areas, and developing concrete, replicable solutions that improve outcomes for our enrollees, while managing public program costs. Nationally, other states are very interested in the work that ACHA is doing to create a specialized view of how we manage the care and costs for the “super utilizers” in the Medicaid program. People with SMI are a subset of the most complex of Medicaid enrollees. ACHA’s leadership on this issue, and in creating this specialty plan has placed Florida at the forefront of Medicaid managed care. Magellan is honored to be part of this work. On the following pages, we specifically address each of the four evaluation criteria included in this question. CRITERIA 1: THE EXTENT THE MEDICAID POPULATION SERVED… Each of the contracts summarized in [Specialty SRC #01, Attachment 1: Magellan Complete Care Contract Listing] includes a description of the membership served in column “a” and the scope of services provided in column “e”. As the information in the contract table illustrates, Magellan’s roots lie in behavioral health – one of the most challenging health care specialties – and as we have grown, our experience in complex niche areas of health care has likewise expanded. Today, we are differentiated by our broad and deep capabilities in critical specialties, including not only mental health and substance use, but also radiology, oncology, physical medicine, pain management, pharmacy management, and medical pharmacy. In contracts that cover a broad range of products (Medicaid, commercial and federal programs) and reflect flexibility in both capitated and administrative financial arrangements, Magellan today covers a total of more than 50 million individuals, or nearly 1 in 6 Americans nationwide. This total does not include the millions of people who receive services through our fee-based pharmacy programs. Our commercial division provides services to more than 100 health plans and provider organizations. Our government division provides general healthcare and integrated complex population management through more than 70 direct contracts with counties, states and federal agencies, including Medicaid, Medicare, and the Department of AHCA ITN 009-17/18, Attachment A, Exhibit A-4-d, Page 2 of 100 EXHIBIT A-4-d SPECIALTY SUBMISSION REQUIREMENTS AND EVALUATION CRITERIA Defense. Our pharmacy division provides pharmacy services to the state government agencies of 27 states and the District of Columbia; processed approximately 17 million claims every month in 2016; and had oversight of nearly $17 billion in annual Medicaid drug spend. With specific regard to our public sector membership, Magellan provides behavioral health and/or specialty health – imaging, cardiac management, pain management, PT/OT and similar services – to over 11 million Medicaid and dual Medicaid/Medicare members, and approximately 1.7 million Medicare-only members on behalf of nearly 50 health plan customers. Of these members, we estimate that approximately 60 percent are aged 18 or younger, and a substantial sub-set have a diagnosis of serious emotional disability (SED). Further, an estimated 20 percent of our public markets membership is eligible for ABD benefits (this figure excludes individuals served through our Medicaid PBM contracts, which are not reimbursed on a capitated basis). To serve these members effectively, Magellan has prioritized building teams that have a significant percentage of clinicians working directly with members. We are proud that more than 40 percent of Magellan employees and staff are clinicians or other individuals who require a professional credential to fulfil their daily work requirements. We believe our commitment to excellence in the workforce translates to superior interactions with, and outcomes for, our members. The Magellan Complete Care specialty program is the culmination of more than four decades of overall managed care experience, and more than two decades of experience working directly and specifically with state Medicaid agencies to improve the behavioral and physical health of members. Specifically, as a pioneer in Medicaid managed care, Magellan implemented one of the first behavioral health carve-out contracts in Iowa in 1996. A hallmark of that program was the community reinvestment program we spearheaded, working with both traditional and non- traditional providers, to expand community-based resources for people with mental illness. Later, in Iowa and Arizona, Magellan took our coordinated care model to the next level by implementing two innovative Integrated Health Home (IHH) programs, through which Magellan provided fully coordinated services to more than 45,000 individuals. In Pennsylvania, where Magellan has delivered county-based behavioral health services since 1997, we have operated an integrated health care portal for more than a decade. Lessons learned from all of these initiatives informed our proposed design for the Specialty HMO in Florida. In AHCA, we found an ideal State partner and leader to help us refine the model, a vision of better public sector healthcare delivery that is increasingly shared by other states as they implement their own integrated service models for complex populations. Four years later, Magellan Complete Care