Professional Documents
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FL Medicaid Managed Care FAQ
FL Medicaid Managed Care FAQ
Questions
Table of Contents
Click a chapter title to go directly to that chapter.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Services .............................................................................................................................. 61
11.
Other .................................................................................................................................... 85
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Amerigroup
Coventry
Humana
Molina
Sunshine
United
LTC
LTC
COMP
COMP
COMP
COMP
LTC
COMP
LTC
LTC
COMP
LTC
MMA
COMP
COMP
COMP
LTC
COMP
LTC
MMA
2
3
4
LTC
MMA
LTC
MMA
LTC
MMA
MMA
8
9
LTC
10
LTC
11
COMP
MMA
MMA
COMP
COMP
COMP
COMP
COMP
COMP
COMP
Question:
Can you please clarify if managed care plans are now the only plans available
under Florida Medicaid?
Answer:
Upon implementation of the Managed Medical Assistance component of the
Statewide Medicaid Managed Care program, MMA and Long-term Care (LTC)
plans will be responsible for providing services to most Medicaid recipients.
Recipients who are not required to participate or who are excluded from
participation in the SMMC program will continue to receive their services
through fee-for-service Medicaid.
Question:
Will existing health plans be going away?
Answer:
Once the MMA program is implemented in a region, current health plans that
were not awarded contracts under the Managed Medical Assistance program
will no longer cover services. To view a list of all MMA plans and their regions
of operation, please review the MMA Snapshot, located at
http://ahca.myflorida.com/SMMC. Select the Managed Medical Assistance tab,
and then the Managed Medical Assistance program Snapshot.
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For new plan enrollees (i.e., enrolled after the implementation), MMA
plans must meet continuity of care requirements for prescription drug
benefits, but are not required to do so through an open pharmacy
network.
Question:
Will claims for MMA participants enrolled in the Childrens Medical Services
Network continue to be submitted as fee for service or will CMS handle claims
similar to the commercial MMA plans?
8. Provider Enrollment
Question:
Will all providers be required to be credentialed individually or will a Medicaid
provider number be sufficient to be a participating provider?
Answer:
The managed care plans are responsible for the credentialing and recredentialing of their provider network. The plans must establish credentialing
and re-credentialing criteria for all providers that, at a minimum, meet the
Agency's Medicaid participation standards. Each provider that wishes to
participate in a plans network must work directly with the plan to meet their
credentialing requirements.
Question:
When Medicaid goes to Managed Care will physicians dispensing still have to
get a dispensing number even though they have a Medicaid Provider Number?
Answer:
Yes. The dispensing physician must be enrolled or registered in Medicaid for
physician services, then the physician must apply as a pharmacy and is
assigned a second ID to use when billing for the drugs they dispense. Please
reference the excerpt below from the Florida Medicaid Prescribed Drug
Services Coverage, Limitations and Reimbursement Handbook:
The Medicaid prescribed drug program may reimburse physicians and other
practitioners for dispensing drugs to Medicaid recipients if the practitioner
meets all of the following conditions:
1. Is registered with his or her professional licensing board as a
dispensing practitioner.
2. Enrolls in the Medicaid program as a pharmacy provider and complies
with all other requirements of the prescribed drug services program.
3. Maintains a current Florida Medicaid Medical Provider agreement.
The Florida Medicaid Prescribed Drug Services Coverage, Limitations and
Reimbursement Handbook is available on the Florida Medicaid Web Portal:
http://www.mymedicaid-florida.com/. Select Public Information for Providers,
then click Provider Support, followed by Provider Handbooks and select the
handbook.
Question:
Regarding the Child welfare plan, will all foster care children be enrolled in the
specialty plan or will other plans in the regions also be serving this population?
Answer:
Children in foster care can choose to enroll in the Child Welfare specialty plan
or in any standard non-specialty Managed Medical Assistance plan operating
in their region. All standard plans are required to provide the full array of
services, including special services that are only available to children in the
child welfare system.
Question:
For comprehensive plans are both LTC and MMA membership going to come
on the same 834 file?
Answer:
Plans will get a separate 834 file for each provider ID unless they choose to
link their provider IDs using a function available to them for one large 834 file.
Question:
During the 60 day continuity of care period, who will notify providers when
there is a change of service provision, PCP or plan or who?
Answer:
The Managed Care Plan will notify both the recipient and their primary care
provider if there is any change in services.
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Enrollment Date
2, 3 and 4
May 1, 2014
5, 6 and 8
June 1, 2014
10 and 11
July 1, 2014
1, 7 and 9
August 1, 2014
Clinic services
Chiropractic services
Dental services
Immunizations
Emergency services
Hearing services
Hospice services
Hospital services
Podiatric services
Practitioner Services
Therapy services
Transportation services
During the competitive procurement process, the State negotiated additional
expanded benefits with the selected MMA plans such as additional primary
care provider visits, adult dental, waived co-payments and several other
benefits that are not currently state plan covered services.
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