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|September 19, 2018
AGENCY FOR HEALTH CARE ADMINISTRATION PROVIDES TRAINING ON THE SMMC PROGRAM
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.
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.
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 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
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