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August 23, 2018


Medicaid New Five-Year Contract Begins January 1, 2019

Please review previous articles on our ongoing analysis of the upcoming new Statewide Medicaid Managed Care contract effective January 1, 2019. This week is focused on the published Agency New SMMC Program goal related to the percentage of enrollees receiving long-term care services in their own home or community instead of a nursing home.

This is a goal of the current SMMC contract but, has been given further emphasis within the new SMMC contract. It is evident by the requirements of the contract and the negotiation and award process the Agency will place special emphasis on this goal. Further, the health plans are offering additional expanded benefits related to the transitioning of appropriately approved nursing home residents into HCBS. Some of this increase in HCBS will be realized through Assisted Living placement or the ability to age in place due to increased services to the home. These services include home delivered meals, housing assistance, home care services, aide services, home health and other expanded benefits.

Below is a snapshot of the current percentages of Medicaid LTC enrollees residing in a nursing home or within a HCBS setting.

The overall state Medicaid LTC average for those residing in a nursing home is 43% with 57% residing in a HCBS setting. South Florida has the highest percentage of Medicaid LTC within the HCBS setting. The HCBS participation percentage has steadily increased since the inception of the SMMC program in 2013.

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

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

Training webinars related to the new SMMC contract are scheduled for October 4, November 8, and December 11, 2018. Further information on times and how to participate in the webinar will be announced soon. The first webinar in October will address best practices in lowering of the anti-psych percentage within your long-stay nursing home. More specifically, we will help you develop specific policy and procedures and internal processes to address the lowering of anti-psych percentage within your long-stay nursing facility. This specific quality measure is reviewed within the health plan re-credentialing process for nursing homes. 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. Attending and applying our training sessions is critical for you to preserve your health plan contracts. The November and December webinars will focus on what to expect and how best to work within the requirements of the new SMMC contract. Further details on these important educational events will be forthcoming.


Skilled Nursing Stuck in Awkward Middle Between Old and New Payment Models. Narrowing networks of referral providers have been a top concern for skilled nursing facilities over the last two years, with industry leaders preaching the importance of improving certain metrics in order to impress hospitals and home health agencies. Read more...

Health plan updates

Updates to Availity Gateway Improve Processing Experience. Updates to the Availity Gateway, effective August 18, 2018 release, will decrease claim holds and allow for a more seamless processing experience. Read more...

Florida Blue’s Improved Concurrent Review Fax Cover Sheet for Sending Clinical Information.
BC/BS has updated the Concurrent Review fax cover sheet that’s used for authorization requests when a member is already in a facility and treatment plans are already underway. Now the cover sheet is easier and saves your time. Read more...

Electronic Fund Transfer (EFT) – Molina has partnered with ProviderNet for EFT. Access to the ProviderNet portal is FREE to our participating providers and we encourage you to register after receiving your first check from Molina.Read more...

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

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