Calendar Year 2001 Adjusted Community Rate Proposal Modifications Under the Benefit Improvement Protection Act Submitted by Florida Health Care Plan, Holly Hill, Florida

EXECUTIVE SUMMARY:

The objectives of this review were to determine whether Florida Health used the additional capitation payments in a manner consistent with the Benefits Improvement Protection Act (BIPA) requirements and (2) supported the modifications to the 2001 proposal.  About $1.2 million of the $6.9 million increase in Florida Health's revised proposal was not used in a manner consistent with BIPA requirements or was not supported.  We recommended that Florida Health refund $1,247,220 to the Centers for Medicare & Medicaid Services or, as an alternative, deposit this amount in a benefit stabilization fund for use in future years.  We also recommended that Florida Health ensure that estimated costs in future proposals are properly supported.  Florida Health agreed with our recommendations.