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February 7, 2019

STATEWIDE MEDICAID MANAGED CARE(SMMC) ENROLLMENT DATA

The rollout of the SMMC finalizes in February 2019

February 1 marks the final phase of the SMMC rollout process. Regions 1, 2, 3 and 4 are included in this final phase and consist of approximately 3,270 Medicaid LTC enrollees and 105,567 MMA enrollees.

The membership for the SMMC Medicaid LTC enrollees by health plan for February is listed below:

There is a significant shift in membership between the health plans in some areas of the state. Most notably is the membership adjustment of United and Molina shifting to a smaller footprint. Simply Healthcare is new to the Medicaid LTC line of business but, the membership is mostly made up of the previous Amerigroup membership due to their purchasing Amerigroup. This is a similar circumstance for the Aetna membership having previously been enrolled under the Coventry name. The two new health plans with no existing membership via an acquisition are Florida Community Care and Staywell (WellCare).

Related to the AHCA goal of increasing the percentage of enrollees receiving HCBS for the Medicaid LTC contract with the health plans. The percentage of Medicaid LTC enrollees a nursing home versus a HCBS setting hasn’t changed much since we last reviewed in July 2018:




Statewide Medicaid Managed Care Continuity of Care Information

There have been several questions recently related to continuity of care with the shifting Medicaid LTC membership. Some health plans and AHCA have provided additional guidance to assist and ensure claims are paid timely during the transition. Below is the information provided by AHCA health plan continuity of care:


Additionally, Staywell (WellCare) provided additional detailed information that includes information on how to submit claims electronically via a clearinghouse.

If you are having problems accessing the health plans provider portals or electronic claims systems, please contact me for assistance. We have been working with the health plans to resolve portal issues and other claims questions.

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

 

 

 


RIPPED FROM THE HEADLINES

Using Value-Based Purchasing Arrangements to Improve Coordination and Quality of Medicare and Medicaid Nursing Facility - Motivations for states and health plans to implement value-based purchasing(VBP) with nursing facilities(NF) include: 1)a desire to shift away from fee-for-service systems that promote volume of care toward systems that promote value; and 2) opportunities to improve quality of care and control costs in NFs through efforts to reduce avoidable hospitalizations and/or provide care management services for high-need residents. Read more...

Health plan updates

Florida Community Care’s Provider Manual - FCC’s provider manual is offered as a reference guide to assist with many items including information on how to file claims and enroll in the provider portal. Read more...

 

Simply Healthcare Continuity of Care Notice - Simply would like to remind all providers that SMMC continuity of care requirements require that we pay for continuity of care services to enrollees transitioning to Simply. Read more...

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

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