Having trouble reading this newsletter? Click HERE to view it in your browser.

September 19, 2018


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

Last week, the state Agency for Health Care Administration (AHCA) provided training on the Statewide Medicaid Managed Care (SMMC) Program. This training session was presented by Beth Kidder, Deputy Secretary for Medicaid via a webinar that was widely attended and lasted for approximately two hours.

AHCA began the training session by explaining the program’s success over the first five years.

Ms. Kidder touted the success of the LTC portion of the SMMC program emphasizing the increase in HCBS for recipients.

The current expectations of the SMMC program requires the health plans to transition those in Medicaid long-term care to HCBS when appropriate to meet a 35% nursing facility ratio. 

The significant update to this transition requirement is the negotiated new benchmarks of the health plans under the new contract.The new required transition benchmark is 25% in nursing home and 75% HCBS.

There is one region currently meeting this new threshold.  The overall ratio is nowhere near the current or future goal.Below is a chart from the August FAHA H&S newsletter showing July 2018 ratios statewide:

Additionally, the new SMMC contract has separated the dental benefit from the MMA or LTC benefit package. The dental benefit will be provided by dental plans separately. Recipients will choose or are assigned a dental plan in addition to their MMA or LTC health plan offering during the rollout. The three dental plans offered statewide are: DentaQuest, Liberty Dental and MCNA Dental.

AHCA explained recipients will be assigned to their current health plan if the health plan continues to operate in the region. The new impact to recipients will be the additional assignment of a separate dental plan. Additionally, there will be one plan for LTC recipients versus the previous LTC and MMA (for secondary payment) arrangement. Now, the two options are classified as LTC+ or Comprehensive. Basically, these two options are LTC and MMA combined for ease of use.

The recipients will soon receive notification from AHCA about the rollout of the SMMC program in their region. Below is a chart showing the rollout and the approximate date of recipient letter.

Continuity of Care is in place for 60 days if a recipient is transitioned to a different health plan during the roll-out. The health plans are required to honor ongoing treatment including prescriptions during this period.

If recipients are interested in choosing a different plan they can do this online or by phone. Online: www.flmedicaidmanagedcare.com or call 1-(877) 711-3662.

AHCA will provide a Dental 101 Overview training presentation in the future and we will pass that information onto you.

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



Training Webinar Scheduled for Fall to Meet Requirements of the SMMC Contract

The first in a series of three training webinars is scheduled for October 4th at 2:00pm EST and will provide best practices and tools related to the antipsychotic percentage requirements of the SMMC contract. This will be an important session that will include a presentation by the FAHA H&S Medical Directors, Dr. Ken Brummel-Smith and Dr. Paul Katz. FAHA H&S members will have free access to these webinars. An alert email will be sent out next week with specifics on how to enroll for the webinar.


When hospitals build skilled nursing networks, how narrow is too narrow? Skilled nursing providers have faced pressure to break into area hospitals’ top-tier referral groups – the increasingly select few deemed fit to managed acute care operators’ patient populations across the continuum. Read more...

Health plan updates

NaviNet, our provider website, provides you with the member information you need. Aetna offers a variety of tools to help you get the information you need.. Read more...

Sunshine Provider Report Fall 2018. Oral health offers clues to overall condition. Several health conditions can affect a patient’s oral health: Alzheimer’s disease, diabetes, HIV/AIDs, Osteoporosis. Read more...

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

Copyright Information: Copies of the articles and other information in this publication may be non-commercially reproduced for the purpose of educational or scientific advancement. Otherwise, no part of this publication may be reproduced or utilized in any form, or by any means, mechanical or electronic, including photocopying, microfilm and recording, or by any information storage and retrieval system, without the written permission of the managing editor. For permission to reproduce, contact the principal/editor via email or phone at (850) 999-6034. 

The information provided via this newsletter is provided “as is” without representations or warranties, express or implied. LeadingAge Florida makes no representations or warranties in relation to the legal information on this website.