Statewide Medicaid Managed Care: Overview - Florida
Statewide Medicaid ManagedCare: Overview
FL Medicaid Managed Care Today –A SnapshotCurrent 3.1 million enrollees receive services throughSMMC16 Medicaid health plansEnrollmentHowServicesAreDeliveredToday Managed Medical Assistance – 3 million inMMA health plans Dental services included Includes specialty plans Long-term Care – 100,000 in LTC orComprehensive health plans Comprehensive plans offer both long-termcare and managed medical services2
The New SMMC Contracts:Building on Success3
What is Changing?2013SMMC ProgramBegins(5 year contracts withplans)2017-2018First Re-procurementof Health Plans;Procurement ofDental PlansTwo Program Components: Managed Medical Assistance(MMA) Program Long-term Care (LTC) ProgramDecember2018NewContracts(MMA, LTC &Dental) BeginTwo Program Components: Integrated MMA and LTC Dental4
SMMC: The First Five Years The SMMC program started operation in 2013-2014. The first 5 years of the program have been verysuccessful. Robust Expanded Benefits, Enhanced ProviderNetworks, and Care Management have led to: Improved health quality outcomes High patient satisfaction Increased opportunity for individualsneeding long-term care to transition from anursing facility to their own home or othercommunity living5
Florida Medicaid Quality Scores At or Abovethe National Average: Continued Improvement70%Scores better than the National AverageScores at the National Managed CareCalendar Year201021%3%Managed CareCalendar Year2011Managed CareCalendar Year20128%12%Managed CareCalendar Year2013*2014 TransitionYearMMA CalendarYear 20156%MMA CalendarYear 201611%**MMA CalendarYear 2017*Calendar Year 2014 was a transition year between Florida’s prior managed care delivery system and the SMMC program implementation. **The HEDISspecifications for the Follow-up After Hospitalization for Mental Illness measure changed for the CY 2017 measurement period. Follow-up visits with a mentalhealth practitioner that occur on the date of discharge are no longer included in the numerator as previously required in the CY 2016 specifications. FloridaMedicaid plan rates and statewide weighted means are compared to national means that are calculated using the previous year’s service data. Since the CY2016 and CY 2017 measure specifications do not align, results are not comparable and the measure was excluded.6
SMMC Negotiation SuccessesMajor ProgramImprovements! Gains for RecipientsGains for ProvidersImproved QualityMore & RicherExpanded Benefits7
Gains for RecipientsHealth PlansAccess to Care When you Need it:Double the primary care providers in eachnetwork Access to Care When you Need it:Guaranteed access to after hours care andtelemedicine where available Improved Transportation: New level ofaccountability with benchmarks to ensurerecipients arrive and are picked up fromappointments in a timely manner. Dental Plans 8
Gains for RecipientsHealth PlansDental PlansBest Benefit Package Ever: Additional benefits atno extra cost to the state. More than 55 benefitsoffered by health plans and extensive adult dentalbenefits offered by dental plans. Model Enrollee Handbook:Information and content has been standardizedacross all health plans’ enrollee handbooks forgreater ease of use. 9
Gains for ProvidersHealth PlansBetter Pay:More pediatric physicians will be eligible toreceive Medicare level of reimbursementthrough the Medicaid Physician IncentiveProgram Less Administrative Burden:High performing providers can bypass priorauthorization Less Administrative Burden:Plans will complete credentialing for networkcontracts in 60 daysDental Plans 10
Gains for Recipients & ProvidersHealth PlansDental PlansPrompt Authorization of Services:Health plans will provide authorization decisions: Within 7 days of receipt of standard request. Within 2 days of an expedited request. Smoother Process for Complaints, Grievances,and Appeals:Health plans agreed not to delegate any aspect ofthe grievance system to subcontractors. 11
New SMMC Program GoalsThe Agency has established goals to build on the success of theSMMC program and to ensure continued quality improvement:Reduce potentiallypreventable hospitalevents (PPEs):AdmissionsReadmissionsEmergency departmentvisitsImprove birth outcomes:Reduce Primary C-SectionRatePre-term Birth RateRate of NeonatalAbstinence SyndromeIncrease the percentageof enrollees receivinglong-term care services intheir own home or thecommunity instead of anursing facility12
Health Plans Commit to Higher Performance:Potentially PreventableHospital Events 22% average reduction inpotentially preventableAdmissions 21% average reduction inpotentially preventableReadmissions 14% average reduction inpotentially preventableEmergency Dept. VisitsBirth Outcomes 12% average reduction inPrimary C-Section Rate 10% average reduction inPre-Term Deliveries 15% average reduction inbabies born with NeonatalAbstinence Syndrome (NAS)13
Dental Plans Commit to Higher Performance:Potentially Preventable Dental Related Events 5% average reduction in Potentially PreventableDental Related Emergency Department Visits(Year 1) 9% average reduction (Year 5)14
HEDIS Annual Dental Visit:Major Gains Under Statewide Medicaid Managed CareContinue15
Dental Plans Commit to Higher Performance:Improve Child Access to Dental Care Annual Dental Visit: An average 3% increase yearover-year above the annual target in the ITN Preventive Dental: An average 1% increase yearover-year above the annual target in the ITN16
LTC Transition Incentive Success Continues17
LTC Plans Commit to Higher PerformanceLTC Transitions to CommunityThe law requires that base rates be adjusted to provide an incentivefor plans to transition enrollees from nursing facilities (NF) to the community(HCBS).Current ContractsRequired Transition Incentive Until 35% NF18
LTC Plans Commit to Higher PerformanceLTC Transitions to CommunityNegotiated New Benchmarks:New ContractsRequired Transition Incentive Until 25% NFNF25%HCBS75%19
Expanded BenefitsThe enhanced benefit package is the most abundant everavailable to Florida Medicaid recipients and includes, for thefirst time, a variety of extra benefits focused on:Health plans: Substance abuse & mental health treatmentAlternative pain management services, Doula services,Vaccines for adults . . . And so much more!Dental plans: The most comprehensive adult dental benefitpackage ever offered in Florida, including preventive,diagnostic, restorative, periodontics . . . And special additionalservices for pregnant women . . And more!20
Health Plan Expanded Benefits21
Health Plan Expanded Benefits (con’t.)22
Dental PlanExpanded Benefits for AdultsBenefitDentaQuestLibertyMCNAPreventive Diagnostic PLACEHOLDER Periodontics Oral and Maxillofacial Surgery Adjunctive General Services Diabetic Testing Practice Acclimation for Individuals withIntellectual Disabilities Restorative23
New Elements and Plans24
SMMC Operates StatewideHealth plans operateon a regional basis.For example, a planmay be selected tooperate statewide, ora plan may beselected to operate in1 or more of11 regions.Region 2HolmesJacksonNassauGadsdenW altonLeonBayHamiltonMadisonDuvalBakerLibertyRegion 1GulfW n 4PutnamFlaglerLevyMarionRegion 3VolusiaRegion 7LakeCitrusSeminoleHernandoDental plans willoperate on a statewidebasis. Each dental planwill operate in allregions of the state.OrangePascoRegion 5OsceolaPolkRegion 6ManateeHardeeSt. LucieHighlandsSarasotaRegion 1: Escambia, Okaloosa, Santa Rosa, and WaltonRegion 2: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon,Liberty, Madison, Taylor, Wakulla, and WashingtonRegion 3: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and UnionRegion 4: Baker, Clay, Duval, Flagler, Nassau, St. Johns, and VolusiaRegion 5: Pasco and PinellasRegion 6: Hardee, Highlands, Hillsborough, Manatee, and PolkRegion 7: Brevard, Orange, Osceola, and SeminoleRegion 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and SarasotaRegion 9: Indian River, Martin, Okeechobee, Palm Beach, and St. LucieRegion 10: BrowardRegion 11: Miami-Dade and MonroeDe SotoCharlotteLeeMartinGladesHendryRegion 8Palm BeachBrowardCollierRegion 9Region 10DadeRegion 1125
SMMC Health and Dental PlansSMMC Participating Health and Dental PlansKnown as:Full Business Name:Aetna Better HealthCoventry Health Care of Florida D/B/A/ Aetna Better Health ofFloridaHumana Medical PlanHumana Medical PlanMolina HealthcareMolina Health Care of FloridaSimply Healthcare Plan (Formerly Amerigroup and BetterHealth)Simply HealthcareStaywellWellcare of Florida D/B/A Staywell Health Plan of FloridaSunshine HealthSunshine State Health PlanUnitedHealthcareUnited Health Care of FloridaFCCFlorida Community CareVivida HealthBest Care Assurance D/B/A Vivida HealthPrestigeFlorida True Health D/B/A/ Prestige Health ChoiceCCPSFCCN D/B/A Community Care PlanLighthouse Health PlanLighthouse Health PlanMiami Children'sMiami Children's Health PlanChildren's Medical Services PlanChildren's Medical Services NetworkClear Health Alliance- HIV/AIDs Specialty PlanClear Health Alliance- HIV/AIDs Specialty PlanMagellanFlorida MHS, Inc d/b/a Magellan Complete CareStaywell- Serious Mental Illness Specialty PlanStaywell- Serious Mental Illness Specialty PlanSunshine Health - Child Welfare Specialty PlanSunshine - Child Welfare Specialty PlanMCNA DentalManaged Care of North AmericaDentaQuestDentaQuest of FloridaLIBERTYLiberty Dental Plan of FloridaPlan TypesComprehensive PlansLong-Term Care Plus PlansManaged Medical Assistance PlansSpecialty PlansDental Plans26
SMMC Health and Dental PlansAwards Included in Intents to Award Posted through 9/7/18RegionsChildren’sMedicalLighthouse MiamiServicesHealth Plan Children's PlanClearHealthAllianceHIV/AIDsLTC MMASpecMMAAetna Humana Molina SimplyUnitedBetter Medical Health HealthSunshine HealthHealth Plancare care Staywell Health careFCCVividaHealth Prestige alIllnessSunshineHealth ChildMCNA DentaWelfare Dental QuestLIBERTYSpecSpecSpecDenDenDenRegion 1CompComp CompRegion 2CompComp CompLTC SpecSpecSpecSpecDenDenDenRegion 3CompComp CompComp* LTC SpecSpecSpecSpecDenDenDenRegion 4CompComp* LTC SpecSpecSpecSpecSpecDenDenDenRegion 5CompComp CompComp*Comp CompLTC SpecSpecSpecSpecSpecDenDenDenRegion 6 Comp* CompComp Comp CompComp LTC SpecSpecSpecSpecDenDenDenComp Comp CompLTC SpecSpecSpecSpecDenDenDenComp CompLTC MMASpecSpecSpecSpecDenDenDenComp CompLTC SpecSpecSpecSpecDenDenDenCompComp*Comp Comp CompLTC Region 7 Comp* CompRegion 8CompRegion 9CompRegion 10CompRegion 11 Comp CompComp*Comp*Comp LTC MMAMMAMMAMMAMMASpecComprehensive PlansLong-Term Care Plus PlansManaged Medical Assistance PlansSpecialty PlansDental Plans* Plans awarded an MMA contract through settlement; however will operate as comprehensive plans pursuant to the terms of the settlement.27
28
29
SMMC Plan Roll Out ScheduleSMMC Health and Dental Plan Roll-out ScheduleTransition DatePhase 1 December 1, 2018Phase 2January 1, 2019Phase 3 February 1, 2019RegionsIncluded9101156781Counties2Indian River, Martin, Okeechobee, Palm Beach, St. LucieBrowardMiami-Dade, MonroePasco, PinellasHardee, Highlands, Hillsborough, Manatee, PolkBrevard, Orange, Osceola, SeminoleCharlotte, Collier, DeSoto, Glades, Hendry, Lee, SarasotaEscambia, Okaloosa, Santa Rosa, WaltonBay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty,Madison, Taylor, Wakulla, Washington34Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, UnionBaker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia30
Who is Required to Enroll in SMMC?Managed Medical Assistance (this is NOT changing):Most Medicaid recipients must enroll in an MMA plan,except: Individuals eligible for emergency services only due toimmigration status Medically Needy (share of cost) individuals Family planning waiver eligibles Women eligible through the breast and cervical cancerprogram Dual eligible recipients whose Medicaid benefits arelimited (partial duals) Individuals with intellectual disabilities who are on theiBudget waiver or on the waiting list (voluntary to enroll)31
Who is Required to Enroll in SMMC?Long-Term Care (this is NOT changing):Recipients are mandatory for enrollment if they are: 65 years of age or older, or age 18 or older andeligible for Medicaid by reason of a disability. Determined by the Comprehensive AssessmentReview and Evaluation for Long-Term Care Services(CARES) preadmission screening program to require:– Nursing facility care as defined in s. 409.985(3); or– Hospital level of care, for individuals diagnosedwith cystic fibrosis.32
Who is Required to Enroll in SMMC?Dental (this is NEW):All Medicaid recipients are required to enroll in a dental planwhether they are enrolled in an MMA or LTC plan or are receivingtheir services through the fee-for-service system (includingMedically Needy and iBudget enrollees) except:– Individuals eligible for emergency services only due toimmigration status– Women enrolled through the family planning waiver– Presumptively eligible pregnant women– Partial dual eligible– Dual Eligibles enrolled in a D-SNP or FIDE-SNP– Individuals residing in one of the following institutional settings: State mental health hospital if under the age of 65 years Psychiatric Residential Treatment Facility–Recipients enrolled in Program of All-Inclusive Care for the Elderly(PACE)33
Dual Eligibility and Dental Plan EnrollmentSome Medicare/Medicaid dual eligibles MAY be required to enroll in adental plan, depending on whether they have full Medicaid eligibility(full dual) and their choice of Medicare delivery system.Dual Eligibility Group required to enroll inDental?YesNoSometimesFull Duals (QMB Plus)Partial Duals (SLMB, QI1, QMB)Sometimes: If a FULL dual is enrolled in one of thethe below- Are they required to enroll in Dental?YesNoOriginal Medicare (FFS Medicare)Medicare Advantage PlanD-SNPFIDE-SNP34
How to Determine Recipient Plan Enrollment SMMC Health Plans: Who can enroll?– The type of health plan a recipient can choose depends onwhether they are eligible for: Just MMA services Just LTC services Both MMA & LTC services Whether they have certain conditions– Recipients who are enrolled in both the MMA and LTCprogram must choose one health plan for all services.35
How to Determine Recipient Plan Enrollment Dental Plans: Who must enroll?– All recipients who receive MMA services must also choose adental plan.– All recipients who receive their medical services through thefee-for-service system must choose a dental plan, with verylimited exceptions.36
SMMC Plan TypesManaged MedicalAssistance PlanProvides ManagedMedical Assistanceservices to eligiblerecipients.This plan type cannotprovide services torecipients who areeligible for Long-termCare services.Long-Term Care ovides ManagedMedical Assistance(MMA) services andLong-Term Careservices to recipientsenrolled in the LongTerm Care program.Provides ManagedMedical Assistanceservices and LongTerm Care servicesto eligiblerecipients.ProvidesManaged MedicalAssistanceservices toeligible recipientswho are definedas a specialtypopulation.Providespreventive andtherapeuticdental servicesto all recipientsin managedcare and all andfully eligiblefee-for-serviceindividuals.This plan typecannot provideservices to recipientswho are only eligiblefor MMA services.37
Dental Plan or Health Plan: Who covers what? All full benefit Florida Medicaid recipients will be required toenroll in a dental plan to receive dental services, with verylimited exceptions. This means that all recipients receiving health care through anMMA plan will also be enrolled in a dental plan. How will care be coordinated?38
Minimum Services Covered byDental Plans Office Visits Analgesia and Sedation Cleanings Injectable Medications Fluoride Application Palliative Treatment Sealants Hospitalization Space Maintainers Prosthodontics (Dentures) Orthodontics (limited) Periodontal Services Oral Exams (initial every 6 months) Root Canals X-rays Fillings and Crowns39
Dental Plan or Health Plan: Who covers what?Type of Dental Service(s)Emergency dental services in a facilityDental Plan Covers---Non-emergency (scheduled) dentalservices in a facilityDental services by a dentalproviderDental services with sedation in anoffice settingDental services by a dentalprovider with a requiredsedation permitDental services (general or specialty)without sedation in an office setting,County Health Department, orFederally Qualified Health CenterD-codes when rendered bythe dental providerDental services by a dentalproviderPharmacy---Transportation---Health Plan CoversAll emergency dental services andreimbursement to the facilityReimbursement to the facility,anesthesiologist and ancillaryservicesAnesthesiologist (MD or ARNP)when required for sedationDental services provided by a nondental providerDrugs prescribed by a health careprovider or a dental provider withinscope of practiceTransportation to all dental servicesprovided by the dental or healthplan, including expanded dentalbenefits40
Recipient Types & Plan Selection41
Recipient Types & Plan SelectionThis recipient must choose:One MMA or Comprehensive plan in their regionANDOne dental plan in their region42
Recipient Types & Plan SelectionThis recipient must choose:One MMA, Comprehensive or Specialty plan in their regionOne dental plan in their region43
Recipient Types & Plan SelectionThis recipient must choose:One LTC or Comprehensive plan in their regionANDOne dental plan in their region44
Recipient Types & Plan SelectionThis recipient must choose:One LTC or Comprehensive plan in their regionANDOne dental plan in their region45
Recipient Types & Plan SelectionMUST BE ENROLLED IN LTCThis recipient must choose:One LTC or Comprehensive plan in their regionANDOne dental plan in their regionNOTE: Those enrolled in LTC cannot enroll in a Specialty Plan46
Recipient Types & Dental PlanSelectionMUST BE ENROLLED IN LTCALL recipients must choose:One dental plan in their region47
How will the Transition to NewSMMC Plans Impact Recipients? Recipients will be assigned to a new health plan, if theircurrent health plan was not awarded a contract. (Impacted)– Will be assigned to a different health plan– Can change plans if they choose Recipients will remain in their current health plan, if theircurrent health plan was awarded a contract. (Non-Impacted)– Will be assigned to their current health plan– Can change plans if they choose48
Impacted vs. Non-ImpactedImpacted RecipientsRecipients who will have to enroll in a new health plan because theircurrent health plan will not receive a contract under the new program.Recipients will be assigned a health plan. They will have 45 days (approx.)to contact Choice Counseling if they wish to make a different plan choice.Non-Impacted RecipientsRecipients who will not have to enroll in a new health plan because theircurrent health plan will receive a contract under the new program.Recipients will be notified that they are assigned to their current plan.If no action is taken, they will remain in their current plan.They will have 45 days (approx.) to contact Choice Counseling if they wishto make a different plan choice.49
How will the Transition to NewDental Plans Impact Recipients? All recipients will be assigned to a Dental plan If one of the three awarded Dental plans was previouslythe dental sub-contractor for a recipient’s MMA plan,they will be assigned to that Dental plan. Can change plans if they choose Will have approximately 45 days to contact ChoiceCounseling if they wish to make a different planchoice.50
Impacted vs. Non-Impacted Review All recipients will receive a letter notifying them of ahealth plan AND dental plan assignment All recipients will be given the opportunity to choose anew health plan and a new dental plan, even if they arenot impacted Not all recipients will have to enroll in a new health plan.If their current plan was awarded a new contract, theymay be able to stay with that plan. All recipients will have to enroll in a new Dental plan Continuity of Care provisions will ensure that there is NOinterruption in care.51
Impacted vs. Non-Impacted Review:Recipients Eligible for Specialty PlanAll recipients will receive a letter notifying them of a healthplan AND dental plan assignment and enrollment options.Recipients with MMA and Specialty: Will be assigned totheir current plan (whether Specialty or MMA) if that planreceived a new contract. If their current plan has NOT received a contract, they willbe assigned to the Specialty plan for which they areeligible.MUST BE ENROLLED IN LTCRecipients with MMA and LTC and Specialty: Will be assigned to their current LTC plan if that planreceived a new Comprehensive or LTC Plus contract. If their current LTC plan did not receive a contract, will beassigned to their current MMA plan if that plan received anew Comprehensive or LTC Plus contract.52
What if My Health Plan is Staying? What happens if my plan is staying and is still available in myregion?– You will be assigned to your current plan and will receive anotice about 45-days prior to the transition date.– You can accept the assignment or choose a different plan.– You are also allowed a 120-day change period from thestart of the transition to change plans.53
What if My Health Plan is Leaving? What happens if my plan is leaving and is not available in myregion?– You will be assigned to a new plan and will receive noticeabout 45-days prior to the transition date.– You can accept the assignment or choose a different plan.– You will also be allowed a 120-day change period from thestart of the transition to change plans.54
What if I Have Different Plans for MMA and LTC?Current LTC is “Staying”Current LTC plan “Leaving”/ Current Neither Current LTC nor MMA plan isMMA Plan is “Staying”, as a“Staying” as a Comprehensive or LTCComprehensive or LTC Plus planPlus planIf your current MMA plan has beenYou will be assigned to your current awarded a Comprehensive or LTC Plus You will be assigned to a newLTC plan for both your LTC and MMA contract, you will be assigned to your Comprehensive or LTC Plus Plan forservices.current MMA plan for both your LTC both your LTC and MMA services.and MMA services.You will receive notice about 45 daysbefore the transition date. You canaccept the assignment or choose adifferent plan.You will receive notice about 45 daysbefore the transition date. You canaccept the assignment or choose adifferent plan.You will receive notice about 45 daysbefore the transition date. You canaccept the assignment or choose adifferent plan.You will have a 120-day change period You will have a 120-day change period You will have a 120-day change periodfrom the start of the transition tofrom the start of the transition tofrom the start of the transition tochange plans.change plans.change plans.55
When will recipients be notified? Recipients will be sent a letter approximately 45 days prior tothe transition date for their region letting them know theirplan assignment and transition date.Phase123TransitionDateRecipientLetter Date12/01/18 egionsCounties9Indian River, Martin, Okeechobee, Palm Beach, St. Lucie10Broward11Miami-Dade, Monroe5Pasco, Pinellas6Hardee, Highlands, Hillsborough, Manatee, Polk7Brevard, Orange, Osceola, Seminole8Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota1Escambia, Okaloosa, Santa Rosa, Walton2Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, Washington3Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter,Suwannee, Union4Baker, Clay, Duval, Flagler, Nassau, St. Johns, Volusia56
Continuity of Care During the Transition Health care providers should not cancel appointments withcurrent patients. Health plans must honor any ongoingtreatment, for up to 60 days after MMA and LTC starts in eachregion, that was authorized prior to the recipient’s enrollmentinto the plan.– MMA: up to 60 days, OR until the enrollee’s primary carepractitioner or behavioral health provider reviews theenrollee’s treatment plan.– LTC: up to 60 days, OR until the enrollee receives acomprehensive assessment, a plan of care is developed,and services are authorized and arranged as required toaddress the LTC needs of the enrollee.57
Continuity of Care During the Transition Providers will be paid. Providers should continue providing any servicesthat were previously authorized, regardless ofwhether the provider is participating in theplan’s network. Plans must pay for previously authorizedservices for up to 60 days after MMA and LTCstarts in each region. Plans must pay providers at the rate previouslyreceived for up to 30 days.58
Continuity of Care During the Transition Prescriptions will be honored. Plans must allow recipients to continue toreceive their prescriptions through their currentprovider, for up to 60 days after MMA starts ineach region, until their prescriptions can betransferred to a provider in the plan’s network.59
Next Steps60
How Do Recipients Choose a Plan? Recipients may enroll in a plan or change plans: Online at: www.flmedicaidmanagedcare.com By calling toll-free 1-877-711-3662 or1-866-467-4970 (TTY) and speaking with a choicecounselor OR using the Interactive Voice Responsesystem Choice Counselors assist recipients in selecting a planthat best meets their needs. This assistance will be provided by phone, howeverrecipients with special needs can request a face-to-facemeeting.61
What is the Process for Enrolling in aPlan? Recipients are encouraged to work with a Choice Counselor tochoose the health plan that best meets their needs.Recipients haveabout 45 days tochange their initialplan assignmentbefore their regiongoes live.Recipients have 120days afterenrollment tochange plans.After 120 days,enrollees must stay intheir plan for theremainder of the 12month period beforechanging plans again.*Enrollees can changeproviders within theirplan at any time.*Recipients may change plans again before the remainder of the 12 month period,but only if they meet certain criteria.62
Member Portal Go to www.flmedicaidmanagedcare.com and click thelogin/register button in the top navigation bar.63
Member Portal Enrollees can use the member portal for plan enrollment anddisenrollment, monitoring their enrollment status, filingcomplaints, modifying their profile, and more.64
Member Portal Features65
SMMC Plan Contacts: Provider de mc/pdf/mma/SMMC ProviderPlan Contacts 2018-08-06.pdf66
How to Keep Informed Agency de mc/index.shtml Provider alerts: Sign up online athttp://ahca.myflorida.com/medicaid/statewide mc/signupform.html Webinars Targeted outreach with stakeholders67
http://ahca.myflorida.com/medicaid68
Stay loridaTwitter.com/AHCA FL69
Questions?Email questions to the SMMC Inbox atflmedicaidmanagedcare@ahca.myflorida.com70
Access to Care When you Need it: Double the primary care providers in each . Comprehensive Plans Long-Term Care Plus Plans Managed Medical Assistance Plans Specialty Plans Dental Plans * Plans awarded an MMA contract through settlement; however will operate as comprehensive plans pursuant to the terms of the settlement. 28. 29.
program, Statewide Medicaid Managed Care (SMMC) (Part IV of Chapter 409, Florida Statutes). Statewide Medicaid Managed Care has two program components: Long Term Care Managed Care Program oImplementation begins 7/1/12 with release of ITN oCertain recipients will be required to e
Managed Care 101 Medicaid, Managed Care, and Children More than 70% of Medicaid beneficiaries are enrolled in private managed care organizations (MCOs) Almost 9 of every 10 children enrolled in Medicaid and CHIP receive health care through a managed care arrangement 39 states rely on MCOs to cover all or some of their Medicaid
majority of individuals receive most health care services from Florida Medicaid. Statewide Medicaid Managed Care program Managed Medical Assistance program (Implemented May 2014 –August 2014) Approximately 2.6 million enrollees in 20 plans Long‐term
This move to statewide implementation of Florida’s Section 1115 Medicaid managed care waiver not only was lengthy, but subject to much controversy.2 Significant changes have occurred along the way in the state’s vision for reforming its Medicaid program, and the growth of Medicaid managed care in
population is served by managed care. Per RCW 74.09.522, "The Legislature finds that competition in the managed health care marketplace is enhanced, in the long term, by the existence of a large number of managed health care system options for Medicaid clients. In a managed care delivery system, whose goal is to focus on prevention, primary
Florida’s proposal to provide Medicaid long-term services and supports (LTSS) through managed care. As is generally the case in Medicaid managed care, Florida’s move to managed care is being promoted by the state as a way to provide care in a more coordinated fashion, but in practice may limit access to care
2 Federal Medicaid managed care regulations12 released in April 2016 further emphasize the importance of access to care for all Medicaid populations, especially children and youth with special needs. Upon taking office, the Trump administration indicated that it will be reviewing the Medicaid managed care regulations, while states are moving forward with
services through managed care.1 Medicaid managed care programs provide a wide array of acute health care services (primary, specialty and behavioral health care, pharmacy, dental and diagnostic services) and LTSS (nursing, home health care, therapy services, home and community-based services, nursing facility and attendant care).
