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|October 18, 2018
EXPANDED BENEFITS OFFERED IN NEW SMMC CONTRACT YEAR
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.”
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.
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:
RIPPED FROM THE HEADLINES
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....
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