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June 20, 2019


Medicare Advantage Plans Look for SNFs with the Ability to Accept Higher Level of Acuity Members

More than previous years, the Medicare Advantage health plans are specifically interested in skilled nursing facilities with the ability to accept higher acuity patients. Some health plans are requesting questionnaires as an entry point for negotiations that include specific questions related to clinical capabilities. Examples of the types of services Medicare Advantage health plans are requesting:

1. Can you take new/existing trachs? How new of a trach can you accept? **
2. Do you take vents?
3. Can you take wean able vents? Are you able to wean vents? **
4. Will you take a member with a Dobhoff?
5. Can you provide bedside dialysis (PD or HD)? **
6. Do you do TPN/Lipids?
7. Do you offer therapy seven days a week? Assessments or actual therapy on weekends?
8. Please list any services that make your facility unique and may not be offered at other locations.

** These items are repeatedly requested by Commercial payors

Some FAHA H&S members have indicated they are considering adding bedside dialysis and/or other specialized care to be more competitive.

As Medicare Advantage plans continue to evaluate their networks it is important to consider your clinical capabilities. Including marketing those capabilities to both the health plans and your referral sources. This includes reminding those referrals sources of the level of clinical acuity you can accept.

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


Hospital Exec: ‘Almost Nothing’ Won’t Move to the Home Amid Shift to Lower-Cost Care Settings. The siphoning of residents from skilled nursing facilities into the home health space remains a troubling trend for institutional operators, and an executive at one of the nation’s largest health systems sees nothing but acceleration ahead.  Read more...

What Percent of New Medicare Beneficiaries Are Enrolling in Medicare Advantage? People new to Medicare can receive their Medicare benefits through either traditional Medicare or private plans, such as HMOs or PPOs, known as Medicare Advantage plans. Older adults and younger beneficiaries with disabilities have said that they make this choice based on premiums and out-of-pocket costs, access to desired providers, the reputation of the company offering the plan, ads and other marketing materials, and the advice of brokers, family members and friends. Read more...

Health plan updates

Utilization Management – List of UM Nurses. Freedom Health provides a list of their Utilization Management and Concurrent Management nurses for all the counties they’re doing business in Florida. Read more...

Provider Resource Guide. Humana Medicaid Provider Resource Guide – Statewide. A variety of provider materials and resources are available on the Humana website (no registration required). Medicaid-specific materials, communications and quality resources can be found at Humana.com/Floridamedicaid. Read more...

Copyright 2019 — Publication of FAHA H&S
Chair: Brian Robare
President/CEO: Steve Bahmer
Principal/Editor: Dana McHugh

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