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|July 12, 2018
THE AGENCY REQUIREMENTS ON THE HEALTH PLANS AND HOW THEY AFFECT NURSING FACILITY PROVIDERS
Medicaid New Five-Year Contract Begins January 1, 2019
Within the new contract, there is an eighteen-page section explaining the sanctions/liquidated damages and fines that will be applied if the requirements of the contract are not met. There are 100 specific items to be sanctioned or fined by the Agency ranging from $500 per day to $25,000 per occurrence based on the severity of the offense. These damages will not be passed through to the provider but, the health plans will be diligent in their requirements to ensure they are not fined. Below is a fine for not meeting credentialing requirements:
If you have questions, please contact Dana McHugh via email or by calling her at (850) 339-2909.
AHCA PROVIDES UPDATES ON SMMC PROGRAM AND ANNOUNCES REGIONAL ROLLOUT OF CONTRACT
The Agency provided updates on the SMMC program to the Medicaid Medical Care Advisory Committee on July 10, 2018. Some of the highlights included a summary of the past five-year experience and what is changing in the new five-year contract. Page 9 of the attached slide-deck illustrates the Agency’s new SMMC Program Goals. This slide-deck reveals the Agency’s intentions and goals for the upcoming five years of the SMMC program.
AHCA HAS SETTLED WITH THE PROTESTING
The Agency has announced the health plans who received the final protest settlements. Molina as a Comprehensive plan was awarded regions 8 and 11. Whereas, Prestige Healthchoice as a MMA plan was awarded regions 9 and 11. Below is an updated grid listing the health plan awardees:
RIPPED FROM THE HEADLINES
Managed Long-Term Services and Supports: Status of State Adoption and Areas of Program Evolution, chapter 3, page 47 of the MACPAC report to Congress. HMA Contributes MLTSS Research to MACPAC Report.
Health plan updates
Staywell, WellCare’s Medicaid health plan has provided an updated Florida Medicaid Provider Resource Guide.This guide explains how to access their provider portal and all the capabilities within the portal. Read the Guide...
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