Program - What is Community Health?

Statewide Medicaid
Managed Care (SMMC)
Managed Medical Assistance (MMA)
Program
2
Why are changes being made to
Florida’s Medicaid program?
•
Because of the Statewide Medicaid Managed Care
(SMMC) program, the Agency is changing how a
majority of individuals receive most health care
services from Florida Medicaid.
Long-term Care program
Statewide Medicaid
Managed Care
program
(implementation Aug. 2013 –
March 2014)
Managed Medical Assistance
program
(implementation May 2014 –
August 2014)
2
The SMMC program does not/is not:
• The program does not limit medically necessary
services.
• The program is not linked to changes in the
Medicare program and does not change Medicare
benefits or choices.
• The program is not linked to National Health Care
Reform, or the Affordable Care Act passed by the
U.S. Congress.
– It does not contain mandates for individuals to purchase insurance.
– It does not contain mandates for employers to purchase insurance.
– It does not expand Medicaid coverage or cost the state or federal
government any additional money.
3
Discontinued Programs
• Once the MMA program is implemented,
some programs that were previously part of the
Medicaid program will be discontinued. This
includes the following programs:
– MediPass
– Prepaid Mental Health Program (PMHP)
– Prepaid Dental Health Plan (PDHP)
4
Who WILL NOT participate?
• The following groups are excluded from
program enrollment:
– Individuals eligible for emergency services only due to immigration
status;
– Family planning waiver eligibles;
– Individuals eligible as women with breast or cervical cancer; and
– Children receiving services in a prescribed pediatric extended care
facility.
– Individuals eligible and enrolled in the Medically Needy program
with a Share of Cost.
• Note: The Agency has applied to federal CMS for permission to
enroll this population in managed care. Until approval is granted,
this population will be served in fee for service.
5
Who MAY participate?
• The following individuals may choose to enroll
in program:
– Individuals who have other creditable health care coverage, excluding
Medicare;
– Individuals age 65 and over residing in a mental health treatment
facility meeting the Medicare conditions of participation for a hospital
or nursing facility;
– Individuals in an intermediate care facility for individuals with
intellectual disabilities (ICF-IID); and
– Individuals with intellectual disabilities enrolled in the home and
community based waiver pursuant to state law, and Medicaid recipients.
6
MMA Program &
DD Waiver (iBudget) Services
• Medicaid recipients enrolled in the DD Waiver
(iBudget) are not required to enroll in an MMA plan.
• DD Waiver (iBudget) enrollees may choose to enroll
in an MMA plan when the program begins in their
region in 2014.
• Enrollment in an MMA plan will NOT affect the
recipient’s DD Waiver (iBudget) services.
– Recipients can be enrolled in the DD Waiver (iBudget) and
an MMA plan at the same time.
7
Managed Medical Assistance Services
Minimum Required Covered Services: Managed Medical Assistance Plans
Advanced registered nurse practitioner services
Medical supplies, equipment, prostheses and orthoses
Ambulatory surgical treatment center services
Mental health services
Birthing center services
Nursing care
Chiropractic services
Optical services and supplies
Dental services
Optometrist services
Early periodic screening diagnosis and treatment services for
recipients under age 21
Physical, occupational, respiratory, and speech therapy
Emergency services
Physician services, including physician assistant services
Family planning services and supplies (some exception)
Podiatric services
Healthy Start Services (some exception )
Prescription drugs
Hearing services
Renal dialysis services
Home health agency services
Respiratory equipment and supplies
Hospice services
Rural health clinic services
Hospital inpatient services
Substance abuse treatment services
Hospital outpatient services
Transportation to access covered services
Laboratory and imaging services
8
Art therapy
Y
United
Y
Sunshine
Y
Staywell
Adult vision services (Expanded)
Simply
Y
SFCCN
Y
Prestige
Adult hearing services (Expanded)
Preferred
Y
Molina
Y
Integral
Coventry
Y
Humana
Better
Adult dental services (Expanded)
List of Expanded Benefits
First Coast
Amerigroup
Expanded Benefits
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Equine therapy
Y
Home health care for non-pregnant
adults (Expanded)
Influenza vaccine
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Medically related lodging & food
Y
Newborn circumcisions
Y
Y
Nutritional counseling
Y
Outpatient hospital services (Expanded)
Over the counter medication and supplies
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Pet therapy
Physician home visits
Y
Y
Pneumonia vaccine
Y
Y
Post-discharge meals
Y
Prenatal/Perinatal visits (Expanded)
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Primary care visits for non-pregnant
adults (Expanded)
Y
Y
Y
Y
Y
Y
Y
Y
Y
Shingles vaccine
Y
Y
Y
Y
Y
Waived co-payments
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NOTE: Details regarding scope of covered benefit may vary by managed care plan.
9
Where will recipients receive services?
• Several types of health plans will offer services
through the MMA program:
– Standard Health Plan
• Health Maintenance Organizations (HMOs)
• Provider Service Networks (PSNs)
– Specialty Plans
– Comprehensive Plans
– Children’s Medical Services Network
• Health plans were selected through a competitive
bid for each of 11 regions of the state.
10
Non-standard Health Plans
• Specialty Plan
– A specialty plan is a managed care plan that serves
Medicaid recipients who meet specified criteria based on
age, medical condition, or diagnosis.
• Comprehensive Plan
– Comprehensive plans are managed care plans that offer
both Long-term Care and Acute Care services.
• Children’s Medical Services Network
– Children’s Medical Services is the statewide managed care
plan for children with special healthcare needs.
11
Children’s Medical Services Network
• Children’s Medical Services is the statewide
managed care plan for children with special
healthcare needs.
• Enrollment into the Children’s Medical Services plan
will occur statewide on August 1, 2014.
• Children currently enrolled in Title XXI CMS will
transition to Title XIX CMS statewide plan on
August 1, 2014, if family income is under 133% of
the federal poverty level.
12
Managed Medical Assistance Program
Implementation
• The Agency has selected 14 companies to serve as
general, non-specialty MMA plans.
• Five different companies were selected to provide
specialty plans that will serve populations with a
distinct diagnosis or chronic condition; these
plans are tailored to meet the specific needs of the
specialty population.
• The selected health plans are contracted with the
Agency to provide services for 5 years.
13
Plans Selected for Managed Medical Assistance Program Participation (General,
Non-specialty Plans)
Note: Formal protest pending in Region 11 for MMA Standard Plans
2
X
3
X
4
X
6
X
7
X
X
X
X
X
8
X
9
X
10
X
X
X
X
X
Staywell
United
Healthcare
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Sunshine
Simply
X
X
5
11
SFCCN
Prestige
X
Preferred
X
Molina
Integral
1
Humana
First Coast
Advantage
Coventry
Better Health
Region
Amerigroup
MMA Plans
X
X
X
X
X
X
X
X
X
14
Plans Selected for Managed Medical Assistance Program Participation
(Specialty Plans)
MMA Plans
Positive
Healthcare
Florida
Magellan
Complete Care
Freedom Health, Inc.
Region
HIV/AIDS
Serious Mental
Illness
Cardiovascular
Disease
Freedom
Health, Inc.
Freedom Health,
Inc.
Freedom Health,
Inc.
Clear Health
Alliance
Sunshine
Health Plan,
Inc.
Chronic
Obstructive
Pulmonary
Disease
Congestive Heart
Failure
Diabetes
HIV/AIDS
Child Welfare
X
X
X
X
X
X
1
2
X
3
X
X
X
X
4
X
5
X
X
X
X
X
X
X
6
X
X
X
X
X
X
X
7
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
8
9
X
10
X
X
X
X
X
X
X
X
11
X
X
X
X
X
X
X
X
15
Statewide Medicaid Managed Care
Regions Map
Region 2
Holmes
Jackson
Nassau
Gadsden
W alton
Leon
Bay
Hamilton
Madison
Duval
Baker
Liberty
Region 1
Gulf
W akulla
Taylor
Franklin
Clay
Lafayette
Alachua
Dixie
Region 4
Putnam
Flagler
Levy
Marion
Region 3
Volusia
Region 7
Lake
Citrus
Seminole
Hernando
Orange
Pasco
Region 5
Osceola
Polk
Region 6
Manatee
Hardee
St. Lucie
Highlands
Sarasota
Region 1: Escambia, Okaloosa, Santa Rosa, and Walton
Region 2: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon,
Liberty, Madison, Taylor, Wakulla, and Washington
Region 3: Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando,
Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union
Region 4: Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
Region 5: Pasco and Pinellas
Region 6: Hardee, Highlands, Hillsborough, Manatee, and Polk
Region 7: Brevard, Orange, Osceola, and Seminole
Region 8: Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
Region 9: Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
Region 10: Broward
Region 11: Miami-Dade and Monroe
De Soto
Charlotte
Lee
Martin
Glades
Hendry
Region 8
Palm Beach
Broward
Collier
Region 9
Region 10
Dade
Region 11
16
Managed Medical Assistance Program Roll
Out Schedule
Implementation Schedule
Regions
Plans
Enrollment
Date
2, 3 and 4
•
•
Standard Plans
Specialty Plans:
o HIV/AIDS
o Child Welfare
May 1, 2014
5, 6 and 8
•
•
Standard Plans
Specialty Plans:
o HIV/AIDS
o Child Welfare
June 1, 2014
10 and 11
•
•
Standard Plans
Specialty Plans:
o HIV/AIDS
o Child Welfare
o Serious Mental Illness
July 1, 2014
1, 7 and 9
•
•
Standard Plans
Specialty Plans:
o HIV/AIDS
o Child Welfare
August 1, 2014
Statewide
•
Children’s Medical Services Network
August 1, 2014
17
What providers will be included in the
MMA plans?
•
•
Plans must have a sufficient provider network to
serve the needs of their plan enrollees, as
determined by the State.
Managed Medical Assistance plans may limit the
providers in their networks based on credentials,
quality indicators, and price, but they must
include the following statewide essential
providers:
–
–
–
–
Faculty plans of Florida Medical Schools;
Regional Perinatal Intensive Care Centers (RPICCs);
Specialty Children's Hospitals; and
Health care providers serving medically complex children, as determined
by the State.
18
Choice Counseling
19
Choice Counseling Defined
• Choice counseling is a service offered by the Agency
for Health Care Administration (AHCA), through a
contracted enrollment broker, to assist recipients in
understanding:
– managed care
– available plan choices and plan differences
– the enrollment and plan change process.
• Counseling is unbiased and objective.
20
The Choice Counseling Cycle
Recipient determined
eligible for enrollment or
enters open enrollment
Newly eligible recipients
are allowed 90 days to
“try” the plan out, before
becoming locked-in
Enrollment or change is
processed during
monthly processing and
becomes effective the
following month
Recipient receives
communication
informing him of choices
Recipient may enroll or
change via phone, online
or in person
21
Recipient Notification and Enrollment
Region
Pre-Welcome
Letter
Welcome
Letter
Reminder
Letter
Last Day to
Choose a Plan
Before Initial
Enrollment
1
4/1/2014
5/26/2014
6/23/2014
7/17/2014
8/1/2014
2
1/2/2014
2/17/2014
3/24/2014
4/17/2014
5/1/2014
3
1/1/2014
2/17/2014
3/24/2014
4/17/2014
5/1/2014
4
1/2/2014
2/17/2014
3/24/2014
4/17/2014
5/1/2014
5
2/3/2014
3/24/2014
4/21/2014
5/22/2014
6/1/2014
6
2/3/2014
3/24/2014
4/21/2014
5/22/2014
6/1/2014
7
4/1/2014
5/26/2014
6/23/2014
7/17/2014
8/1/2014
8
2/3/2014
3/24/2014
4/21/2014
5/22/2014
6/1/2014
9
4/1/2014
5/26/2014
6/23/2014
7/17/2014
8/1/2014
10
3/3/2014
4/21/2014
5/26/2014
6/19/2014
7/1/2014
11
3/3/2014
4/21/2014
5/26/2014
6/19/2014
7/1/2014
Date Enrolled
in MMA Plans
Note: The dates above are when mailings begin. Due to the volume,
letters are mailed over several days.
22
When will recipients be notified and be
required to enroll?
•
•
Approximately 60 days prior to each region’s
start date, eligible Medicaid recipients will
receive a letter with enrollment information,
including information on how to enroll.
Eligible recipients who must enroll will have a
minimum of 30 days from the date they receive
their welcome letter to choose from the plans
available in their region.
23
How Do Recipients Choose an MMA
Plan?
•
Recipients may enroll in an MMA plan or change plans:
–
–
Online at :www.flmedicaidmanagedcare.com
Or
By calling 1-877-711-3662 (toll free) and
•
speaking with a choice counselor
OR
•
using the Interactive Voice Response system (IVR)
• Choice counselors are available to assist recipients in selecting a plan
that best meets their needs.
• This assistance will be provided by phone, however recipients with
special needs can request a face-to-face meeting.
24
90 days to change plans
• After joining a plan, recipients will have 90
days to choose a different plan in their region.
• After 90 days, recipients will be locked in and
cannot change plans without a state approved
good cause reason or until their annual open
enrollment.
25
Information about making a plan selection
26
Step by Step On-Line Enrollment
27
Choice Counseling
28
Your Address
Medicaid is mailing important information to you
regarding the MMA program to your home. Make sure
we have your current address!
To check,
• Please call the ACCESS Customer Call Center
(866) 762-2237
OR
• Visit http://www.myflorida.com/accessflorida/
29
Auto-Assignment Process
If a Recipient does not
Make a Plan Choice,
how will the Agency
determine which MMA
plan recipients will be
auto assigned to?
• For Recipients who are required to enroll in
an MMA plan:
– Recipient is identified as eligible for a specialty
plan.
– The recipients prior Medicaid managed care
plan is also an MMA plan.
– Recipient is already enrolled (or has asked to
be enrolled) in a long term care plan with a
sister MMA plan.
– The recipient has a family member(s) already
enrolled in, or with a pending enrollment, in
an MMA plan.
30
Specialty Plans
Can recipients choose to be in or identify themselves as eligible
for a specialty plan?
• Yes, recipients can inform their choice counselor during their
choice period that they would like to enroll in a specialty plan
if they believe they are eligible for a specialty plan available in
their region.
• The specialty plan will be responsible for confirming that the
recipient meets the eligibility criteria for the plan.
31
What Specialty Plans are Available?
Managed Medical Assistance Specialty Plans
Region
Clear
Health
Alliance
Positive
Healthcare
Children’s
Medical
Services
Network
Magellan
Complete
Care
Sunshine Health
Plan
Freedom Health
(Dual Eligibles Only)
HIV/AIDS
HIV/AIDS
Children with
Chronic
Conditions
Serious
Mental
Illness
Child Welfare
Cardiovascular Disease; Chronic
Obstructive Pulmonary Disease;
Congestive Heart Failure; &
Diabetes
1
X
X
2
X
X
3
X
X
4
X
X
X
X
X
X
X
X
5
X
X
X
X
X
6
X
X
X
X
X
7
X
X
X
X
X
8
X
X
X
X
9
X
X
X
X
X
10
X
X
X
X
X
X
11
X
X
X
X
X
X
Note:
• Magellan Complete Care will not begin operation until July 1, 2014
• Children’s Medical Services Network plan will not begin operations until August 1, 2014
• Freedom Health will not begin operations until January 1, 2015
32
Specialty Plan Assignment
• The Agency is required by Florida law to automatically
enroll Medicaid recipients into a managed care plan if
they do not voluntarily choose a plan.
• When a specialty plan is available to serve a specific
condition or diagnosis of a recipient, the Agency is
required to assign the recipient to that plan.
• The Agency employs a hierarchy for assignment to
specialty plans in those instances where a recipient
qualifies for enrollment into more than one specialty plan.
33
If a recipient qualifies for enrollment in more than one of the available specialty plan types,
and does not make a voluntary plan choice, they will be assigned to the plan for which
they qualify that appears highest in the chart below:
Child Welfare
Children’s Medical Services
Network
HIV/AIDS
Serious Mental Illness
Dual Eligibles with Chronic
Conditions
34
Who can Enroll in a Specialty Plan?
• Each specialty plan is designed to serve a unique population.
• Each population must have defined specified criteria based on
age, medical condition, or diagnosis, per Florida law.
• A recipient must meet the specified criteria in order to enroll in a
specific specialty plan.
• For the most part, the Agency will identify recipients who are
eligible to enroll in a specialty plan. However, specialty plans may
develop and implement policies and procedures (subject to
Agency approval) to screen recipients meeting the specialty plan
eligibility criteria and who have not been identified by the
Agency.
35
Specialty Plan Enrollment Criteria
Specialty
Plan
Eligibility Criteria
Child Welfare
(Sunshine
Health Plan)
Medicaid recipients under the age of 21 who have an open case for child welfare services in the Department of Children
and Families’ Florida Safe Families Network database.
Serious Mental
Illness
(Magellan
Complete Care)
Medicaid recipients diagnosed with Schizophrenia, Bipolar Disorder, Major Depressive Disorder, or Obsessive
Compulsive Disorder
• The Agency will identify the eligible population using specific diagnosis codes and/or medications used to treat the
diagnoses specified above.
Children’s
Medical
Services
Network
Medicaid recipients under the age of 21 who meet the Department of Health’s clinical screening criteria for chronic
conditions.
HIV/AIDS
(Positive and
Clear Health
Alliance)
Medicaid recipients diagnosed with HIV or AIDS.
•
The Agency will identify the eligible population using specific diagnosis codes, laboratory procedure codes, and/or
medications commonly used to treat HIV or AIDS.
Chronic
Conditions
(Freedom
Health, Inc.)
Medicaid recipients aged 21 and older eligible for both Medicare and full Medicaid benefits with a diagnosis of
Diabetes, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF) or Cardiovascular Disease
(CVD).
NOTE: Will begin operations in January 1, 2015
NOTE: Will begin operations in August 1, 2014
Expanded Benefits
• All managed care plans participating in the SMMC program
have the opportunity to offer expanded benefits to their
enrollees. Expanded benefits are services that are offered in
addition to those available through the Medicaid program.
Plans can:
– Exceed the limits stated in Medicaid policy for certain
services; or
– Offer additional services not covered under the Medicaid
state plan (e.g., art therapy, post discharge meals, etc.).
• Specialty plans can choose to offer expanded benefits tailored
to their unique population.
37
Art therapy
Y
United
Y
Sunshine
Y
Staywell
Adult vision services (Expanded)
Simply
Y
SFCCN
Y
Prestige
Adult hearing services (Expanded)
Preferred
Y
Molina
Y
Integral
Coventry
Y
Humana
Better
Adult dental services (Expanded)
List of Expanded Benefits
First Coast
Amerigroup
Expanded Benefits
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Equine therapy
Y
Home health care for non-pregnant
adults (Expanded)
Influenza vaccine
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Medically related lodging & food
Y
Newborn circumcisions
Y
Y
Nutritional counseling
Y
Outpatient hospital services (Expanded)
Over the counter medication and supplies
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Pet therapy
Physician home visits
Y
Y
Pneumonia vaccine
Y
Y
Post-discharge meals
Y
Prenatal/Perinatal visits (Expanded)
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Primary care visits for non-pregnant
adults (Expanded)
Y
Y
Y
Y
Y
Y
Y
Y
Y
Shingles vaccine
Y
Y
Y
Y
Y
Waived co-payments
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
NOTE: Details regarding scope of covered benefit may vary by managed care plan.
38
HIV/AID
S
(Positive)
SMI
Adult dental services (Expanded)
Adult hearing services (Expanded)
Adult vision services (Expanded)
Art therapy
Home and community-based services
Home health care for non-pregnant adults (Expanded)
Influenza vaccine
Medically related lodging & food
Intensive Outpatient Therapy
Newborn circumcisions
Nutritional counseling
Outpatient hospital services (Expanded)
Over the counter medication and supplies
Physician home visits
Pneumonia vaccine
Post-discharge meals
Prenatal/Perinatal visits (Expanded)
Primary care visits for non-pregnant adults (Expanded)
Shingles vaccine
Waived co-payments

















Child
Welfare
Expanded Benefits
HIV/AID
S (Clear
Health)
Expanded Benefits
















































NOTE: Details regarding scope of covered benefit may vary by managed care plan.
Children’s Medical Services and the specialty plan for dual eligibles with chronic conditions
do not offer Expanded Benefits.
39
Which Plans are Comprehensive?
Region
Comprehensive Plans Available
1
2
3
4
5
6
7
8
9
10
11
None available
None available
Sunshine, United
Sunshine, United
Sunshine
Sunshine
Molina, Sunshine, United
Sunshine
Sunshine
Humana, Sunshine
Amerigroup, Coventry, Humana, Molina, Sunshine, United
40
Partnership
• Choice Counseling wants to partner with the
agencies, organizations and providers that
serve Medicaid recipients.
– Public and Private Enrollment Sessions
– Partner Staff Training
– Educational only presentations
– Health Fairs
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Continuity of Care
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Agency Goals for a Successful MMA Rollout
• Preserve continuity of care, and to greatest extent
possible:
– Recipients keep primary care provider
– Recipients keep current prescriptions
– Ongoing course of treatment will go uninterrupted
• Plans must have the ability to pay providers fully and
promptly to ensure no provider cash flow or payroll
issues.
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Agency Goals for a Successful MMA Rollout
• Plans must have sufficient and accurate provider
networks under contract and taking patients.
– Allows an informed choice of providers for
recipients and the ability to make appointments.
• Choice Counseling call center and website must be
able to handle volume of recipients engaged in plan
choice at any one time.
– Regional roll out to ensure success
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Continuity of Care During the Transition to
MMA
• Heath care providers should not cancel appointments with current
patients. MMA plans must honor any ongoing treatment, for up to 60
days after MMA starts in each Region, that was authorized prior to the
recipient’s enrollment into the plan.
• Providers will be paid. Providers should continue providing any
services that were previously authorized, regardless of whether the
provider is participating in the plan’s network. Plans must pay for
previously authorized services for up to 60 days after MMA starts in
each Region, and must pay providers at the rate previously received for
up to 30 days.
• Prescriptions will be honored. Plans must allow recipients to continue
to receive their prescriptions through their current provider, for up to
60 days after MMA starts in each Region, until their prescriptions can
be transferred to a provider in the plan’s network.
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Resources
• Weekly provider informational calls regarding the rollout
of the Managed Medical Assistance program will be held.
Please refer to our SMMC page,
ahca.myflorida.com/smmc, for dates, times, and calling
instructions.
• Calls will address issues specific to the following provider
groups:
‒
‒
‒
‒
‒
‒
‒
Behavioral Health
Dental
Therapy
Durable Medical Equipment
Physicians / MediPass
Pharmacy
Hospital
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Resources

Questions can be emailed to:
FLMedicaidManagedCare@ahca
.myflorida.com

Updates about the Statewide
Medicaid Managed Care program
are posted at:
www.ahca.myflorida.com/SMMC

Upcoming events and news can
be found on the “News and
Events” link.
 You may sign up for our
mailing list by clicking the red
“Program Updates” box on
the right hand side of the
page.
47
http://apps.ahca.myflorida.com/smmc_cirts/
• If you have a complaint or issue about
Medicaid Managed Care services,
please complete the online form
found at:
http://ahca.myflorida.com/smmc
• Click on the “Report a Complaint”
blue button.
• If you need assistance completing this
form or wish to verbally report your
issue, please contact your local
Medicaid area office.
• Find contact information for the
Medicaid area offices at:
http://www.mymedicaid-florida.com/
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Additional Information
Youtube.com/AHCAFlorida
Facebook.com/AHCAFlorida
Twitter.com/AHCA_FL
SlideShare.net/AHCAFlorida
49
Questions?
50

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