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January 24, 2019

STATEWIDE MEDICAID MANAGED CARE(SMMC) AHCA UPDATE

Nursing Facility Services Payment in Statewide Medicaid Managed Care

According to the January 22 AHCA alert, the new SMMC contracts for 2019-2023 require the health plans to cover nursing facility services for health plan enrollees who are not yet enrolled in Long-Term Care (LTC) program.

Nursing facility services for health plan enrollees who are not yet enrolled in the LTC program can no longer be directly billed to the Agency (fee-for-service). Providers must seek reimbursement for these services from health plans in accordance with the Agency’s rollout schedule. This AHCA document provides detailed information on this update.


Statewide Medicaid Managed Care Continuity of Care Information

Phase three of the rollout begins in a few days on February 1 for regions 1, 2, 3 and 4. The Agency has updated a few tools to assist with the implementation of the SMMC statewide. This includes a list of the health plans links to their Continuity of Care information:

SMMC Plan Website Links with Continuity of Care Information

Aetna

https://www.aetnabetterhealth.com/florida/providers/

CCP

https://www.ccpcares.org/providers/providers-for-mma/provider-services

CMS Plan

http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/updates-events/index.html

Florida Community Care

https://fcchealthplan.com/

Humana

http://apps.humana.com/marketing/documents.asp?file=2520076

Lighthouse

https://lighthousehealthplan.com/en/

Magellan

https://magellancompletecareoffl.com/for-providers/continuity-of-care-provisions/

Miami Children's

https://www.miamichildrenshealthplan.com/

Molina

https://www.molinahealthcare.com/members/fl/en-US/Pages/home.aspx

Positive

https://positivehealthcare.net/florida/phc/about/coc/

Prestige

https://prestigehealthchoice.com/provider/index.aspx#continuity

Simply

https://www.simplyhealthcareplans.com/florida-provider/home

Staywell

https://www.wellcare.com/Florida/Providers/Bulletins

Sunshine

https://www.sunshinehealth.com/content/dam/centene/Sunshine/pdfs/EIS-TCM-billing-guidelines.pdf

United

https://www.uhcprovider.com/en/health-plans-by-state/florida-health-plans/fl-comm-plan-home.html

https://www.uhcprovider.com/en/health-plans-by-state/florida-health-plans/fl-comm-plan-home/fl-cp-prior-auth.html

Vivida Health

https://vividahealth.com/en/

Dental Plan Website Links with Continuity of Care Information

DentaQuest

http://dentaquest.com/state-plans/regions/florida/fl-dentist-page/

Liberty

https://client.libertydentalplan.com/FLMedicaid/Provider/FAQ

MCNA

https://www.mcnafl.net/dentists/


Additionally, the SMMC Snapshot has been updated and is a useful tool for your staff and family members and/or caregivers.

The feedback from the health plans and providers has been a relatively smooth transition in the new SMMC rollout.

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

 

 


RIPPED FROM THE HEADLINES

Why Skilled Nursing Providers Could Embrace Shorter Lengths of Stay - As Medicare Advantage plans continue to pressure skilled nursing operators, one leader predicts that innovative providers can survive by leaning into the changes. Read more...

 

Updated: CMS to Test Hospice Carve-In Under Medicare Advantage - The Medicare Advantage (MA) carve-in that many industry insiders pegged as “inevitable” has finally arrived. Read more...

Health plan updates


Sunshine Health Provider Manual. The updated Sunshine Health provider manual for Medicaid (MMA), Comprehensive Long-Term Care (LTC) is attached for your reference.
Read more...

 

Staywell(WellCare) Long-Term Care Transition Quick Reference Guide. Staywell’s LTC quick reference guide that includes local contacts for assistant the continuity of care information.
Read more...

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

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