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

June 5, 2019


Ensure all Medicaid LTC Residents are Assigned to Health Plan after Medicaid Re-Certification

Always confirm the eligibility and health plan assignment of your Medicaid LTC residents after the Medicaid re-certification process. Recently, a FAHA H&S member experienced a situation that resulted in their resident be assigned to a different health plan after the Medicaid re-certification process. AHCA explained this happened due to the Medicaid LTC health plan having their membership frozen in areas of the state.

Currently, one of the largest Medicaid LTC health plans has their membership frozen in parts of the state. Health plans can have their membership frozen due to various reasons, including an issue with their network or other reasons deemed by AHCA to limit additional new membership until the issue is resolved. Generally, this process requires resolution of the identified issue and a sanction or fine.

Because of the frozen membership status, a health plan cannot receive or be assigned new members during this time-period.

Confirming the health plan assignment of your Medicaid LTC residents will ensure payment is received timely. Due to your staff having obtained the authorization from the newly assigned health plan to include when billing the health plan.

If you’ve received claims denials due to billing the incorrect health plan because of reassignment, contact the health plan to resolve as quickly as possible. If you need further assistance with this process please, contact me for additional assistance.

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


HMA Summary of Fiscal Year 2020 Medicare Proposed Rules for Medicare Part A Providers. Between April 17 and April 23, 2019, the CMS issued proposed rules for general acute hospitals paid under the Inpatient Prospective Payment System (IPPS), the skilled nursing facility (SNF) prospective payment system (PPS), the Intpatient Rehabilitation Facility (IRF) PPS, the Long-Term Care Hospital (LTCH) PPS, the Hospice PPS, and the Inpatient Psychiatric Facility (IPF) PPS. These proposed regulations include annual payment rate changes and other proposed policy changes.  Read more...

Health plan updates

OfficeLink Updates. June 2019 newsletter. Find updates on important changes to plans and procedures, drug lists, Medicare and state-specific information. Read More...

Network Bulletin. The June 2019 UnitedHealthcare national provider newsletter to health care professionals and facilities. Read More...

Copyright 2019 — 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.