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October 18, 2018


Medicaid New SMMC Five-Year Contract Begins January 1, 2019

The rollout transition to the new SMMC contract period begins soon. Recipient letters will be mailed out by the Agency approximately 45 days prior to each phase going live. According to the Agency, “under the new contracts, recipients enrolled in the SMMC health plans will have access to the richest benefit package ever offered by Florida Medicaid.”

Expanded benefits are offered in addition to the standard benefit package offered by Medicaid. These expanded benefits are provided by the plans at no additional cost to the state.

Below are highlights of these expanded benefits:


The recipient letters should begin arriving in the next few weeks for regions 9, 10 and 11. It is important for your residents and/or guardians to review these letters to ensure they are assigned to their plan of choice. Instructions will be provided within the letter on how to adjust the health plan assignment if needed.

Below is the chart indicating the roll-out phase and the recipient letters mail-out:

The Agency continues to provide updates and education for the new SMMC contract that will be relayed to you within the newsletters.

If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909. 


Enrollee Continuity of Care For Transition Phase Roll-out

The health plans are required to provide continuity of care for new enrollees transitioning into the managed care plan. The following LTC health plans will not continue doing business in some or all of regions 9, 10, and 11: Amerigroup, Coventry and United. The enrollees previously assigned to these plans will be assigned to another health plan and given the opportunity to switch to the plan of their choice. The direction given by the Agency to the health plan is shown in the below passage from the contract that applies to all phases of the roll-out:


Skilled Nursing Providers Can Still Break Into Narrow Networks - Skilled nursing providers frequently fret about the rise of narrow networks – the closed-off groups of high-performing nursing homes that hospitals have developed to ensure the best quality and reimbursement outcomes for their patients. But even the narrowest preferred skilled nursing networks have gaps that smart providers can fill, as long as they know where to look.  Read more...

Health plan updates

Humana updates Medicare Advantage peer-to-peer review and provider dispute process. Prior to issuing a medical necessity denial in response to an authorization request, a Humana representative will contact the treating physician or other healthcare provider and offer a peer-to-peer review. Read more....

Sunshine Health offers provider training/orientation webinars in October and November. Sunshine is offering multiple training webinars for all lines of business in October and November 2018. Please go to their website to register for the upcoming training sessions.

Copyright 2018 — Publication of FAHA H&S
Chair: Brian Robare
President/CEO: Steve Bahmer
Principal/Editor: Dana McHugh

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