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June 13, 2018


Medicaid New Five-Year Contract Begins January 1, 2019

As was explained a few weeks ago, the state Agency for Health Care Administration (AHCA) has awarded the Medicaid new five-year contract beginning January 1, 2019. Several health plans did not win all the regions for which they applied, and in some cases no award was given. As a result, several health plans have protested the award decision.

The protest process involves the health plans meeting with AHCA to contest ACHA's decision of no (or limited) award. The entire protest process is still ongoing; AHCA has settled with two of the protesting health plans.

The two health plans awarded in the settlement are provider service networks “PSNs.” A provider service network is a health plan that is majority owned by providers. They are governed with the same requirements as the other Medicaid health plans. These PSN health plans are awarded the Medicaid Medical Assistance “MMA” Contact. The Medicaid MMA is commonly known as “community Medicaid”. These two new awards will not materially affect your communities or residents. As explained in the previous newsletter, the plan types are changing with the new contract. These new plan types will apply to your residents: Comprehensive and Long-Term Care Plus. Comprehensive provides MMA & LTC services under one health plan. Long-Term Care Plus provides MMA services for their LTC members in addition to the LTC. The result of these plan types is the Medicaid LTC resident receives all the Medicaid services through one managed care plan under either Comprehensive or LTC Plus.

The managed care plans awarded by region including the additional awards highlighted in green are:

We are tracking the protest process and will provide you updates.

FAHA H&S has contracted with ALL the managed care plans awarded Medicaid contracts. We will contact you in the next few months to complete the necessary credentialing paperwork to insure you are linked to the new contract.

In the coming months additional information and education on the contract requirements will be provided prior to the January 1, 2019 start date.




New Flexibilities for Medicare Advantage Plans. In April, the Centers for Medicare and Medicaid Services (CMS) released the Calendar Year (CY) 2019 Final Rate Announcement and Call Letter for Medicare Advantage (MA) and Part D.

Reigniting the physicians arms race, insurers are buying practices. In the turf war between hospitals and health insurers over physician practices, hospitals are winning by a long shot. But, they’d be ill advised to get too comfortable.

Health plan updates

Check Claim Status Via AvMed Website. You can check the status of claims using AvMed's website, including the verifying eligibility, authorization requests and electronic fund transfers. Read more...

Check Claim Status Via AvMed Website. You can check the status of claims using AvMed's website, including the verifying eligibility, authorization requests and electronic fund transfers. Read more...


Staywell (WellCare) Florida Medicaid Quick Reference Guide. This UPDATED quick reference guide is for the Staywell Medicaid MMA line of business, effective May 2018. Staywell Quick Reference Guide...


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

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