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November 7, 2018


Recipients receive transition letters in mid-October 2018

The rollout transition to the new SMMC contract period begins December 1, 2018. Recipients should have received their transition letters in mid-October for regions 9, 10, and 11. These letters will explain which health and dental plans are assigned to the recipient.

According to AHCA, recipients’ current health plan will not change if that health plan continues to do business in the region. Because of the potential for administrative errors, it is important that your staff check all the residents’ eligibility in December to ensure the health plan assignments are as expected. If you find an error in assignment and/or the resident would like to change their health plan, Choice Counseling will assist in that change. The Choice Counseling contact information is www.flmedicaidmanaged.care.com or 1-877-711-3662.

Regions 9 and 10 have a significant shift in the health plans offered with the following health plans having lost in these regions: Amerigroup, Coventry and United. The remaining and new plans for these regions are: Florida Community Care, Humana, Staywell and Sunshine.

In addition to the health plan assignment, all recipients will be assigned a separate dental plan.  

In the previous SMMC contract period, dental benefits were provided via the MMA program. Benefits provided to adults in the dental plan include:

• Dental exams (limited to emergencies and dentures)
• Dental X-rays (limited)
• Prosthodontics (dentures)
• Extractions
• Sedation
• Ambulatory Surgical Center or Hospital-based Dental Services provided by a dentist
• Expanded benefits: preventative, diagnostic, restorative, periodontics, oral and maxillofacial surgery, adjunctive general services, diabetic testing, practice acclimation for adults with intellectual disabilities

For further detail on the roll-out beginning next month and information on how to prepare and transition, please join the webinar next Thursday, November 15 at 2:00pm offered free to FAHA H&S members. Please register here.

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


Few Medicare Advantage Plans Will Offer New Home Care Benefits in 2019 - Medicare Advantage (MA) plans are allowed to cover a range of in-home care services for the first time in 2019, but few insurers are going to do so, according to recent analyses of plan offerings. Experts believe these types of benefits could gain a lot more traction in the next two to three years. 

Health plan updates

Expansion of Dual Eligible Special Needs Plans (DSNPs) beginning January 1, 2019. Aetna is expanding their 2019 Dual Eligible Special Needs Medicare Advantage HMO Plans. These plans are available to individuals who are eligible for Medicare and Medicaid coverage and live within a DSNP county. Read more....

Sunshine Health offers provider training/orientation webinars in November. Sunshine is offering multiple training webinars for all lines of business in November 2018. Please go to their website to register for the upcoming training sessions.

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

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