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FLORIDA MEDICAID

Statewide Medicaid Managed Care Program


In 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency to create the Statewide Medicaid Managed Care (SMMC) program.  The SMMC program has two key components:  the Managed Medical Assistance program and the Long-term Care program.

Choose a tab above to view guidance statements and specific information regarding the Long-term Care and Managed Medical Assistance programs.  

Choose an arrow below to view general information about the program.


arrows Program Overview and Summary arrows

There will be two different components that make up the SMMC program:

  • The Florida Long-term Care program and
  • The Florida Managed Medical Assistance program.

If you are interested in learning more about these two programs, overviews and summaries may be accessed through the links below.

Updates about the Statewide Medicaid Managed Care program will be posted on this website as they become available.


arrows Achieved Savings Rebate Rule arrows

The “Standards for Independence” document is provided for any plan who intends to participate in the Statewide Medicaid Managed Care program.  This document outlines the standards of independence for audits conducted by independent certified public accountants. (See s. 409.967, F.S.)  These standards of independence are incorporated by reference in Rule 59G-8.800:  Financial Compliance Audits of Medicaid Prepaid Plans.  (Rule 59G-8.800 is currently under development.)

Standards for Determining Independence [97KB PDF]



Program Updates Report a Complaint Comments or Questions Frequently Asked Questions

News and Events


Choose an arrow below for information and upcoming events related to the Statewide Medicaid Managed Care program.

Calendar of Events and Training


arrows Event and Training Materials arrows

Most Recent Webinar

April

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 21, 2014 [1.27MB PDF]

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 17, 2014 [1.27MB PDF]

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 14, 2014 [1.27MB PDF]

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 11, 2014 [1.27MB PDF]

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 8, 2014 [1.27MB PDF]

Transitioning to Managed Medical Assistance – Selecting a MMA Plan and Continuing Your Services, April 7, 2014 [2.14MB PDF]

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 4, 2014 [1.27MB PDF]

Webinar Presentation: MMA - Specialty Plans, April 3, 2014 [1.23MB PDF]

Webinar Presentation: Long-term Care and Managed Medical Assistance: Putting the Pieces Together, April 1, 2014 [1.27MB PDF]

March

Webinar Presentation: Transitioning to Managed Medical Assistance – Selecting a MMA Plan and Continuing Your Services, March 27, 2014 [2.15MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, March 18, 2014 [1.17MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, March 13, 2014 [955KB PDF]

Webinar Presentation: Transitioning to Managed Medical Assistance – Selecting a MMA Plan and Continuing Your Services, March 12, 2014 [2.15MB PDF]

Webinar Presentation: MMA - Individuals with Intellectual Disabilities, March 11, 2014 [1.32MB PDF]

Webinar Presentation: MMA - Guide for Hospice Providers in Statewide Medicaid Managed Care, March 10, 2014 [935KB PDF]

Webinar Presentation: MMA - Guide for Hospice Providers in Statewide Medicaid Managed Care, March 6, 2014 [974KB PDF]

Webinar Presentation: MMA - Individuals with Intellectual Disabilities, March 5, 2014 [1.33MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, March 4, 2014 [1.17MB PDF]

February

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, February 26, 2014 [1.17MB PDF]

Webinar Presentation: MMA - Individuals with Intellectual Disabilities, February 24, 2014 [1.33MB PDF]

Webinar Presentation: MMA - Choice Counseling and Continuity of Care, February 20, 2014 [2.03MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, February 18, 2014 [1.15MB PDF]

Webinar Presentation: MMA - Individuals with Intellectual Disabilities, February 14, 2014 [1.33MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, February 13, 2014 [1.14MB PDF]

Webinar Presentation: MMA - Individuals with Intellectual Disabilities, February 7, 2014 [1.32MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, February 5, 2014 [1.14MB PDF]

January

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, January 23, 2014 [1.14MB PDF]

Webinar Presentation: MMA - Developmental Disabilities Waiver Services, January 21, 2014 [1.40MB PDF]

Webinar Presentation: Managed Medical Assistance (MMA) Program 101, January 8, 2014 [1.14MB PDF]

December

Webinar Presentation: LTC - Guide for Hospice Providers Statewide Medicaid Managed Care Long-term Care Program, December 18, 2013 [992KB PDF]

Webinar Presentation: MMA - Managed Medical Assistance (MMA) 101, December 10, 2013 [1.16MB PDF]

October

Webinar Presentation: LTC - Recipient Information Data Upload, October 24, 2013 [1.28MB PDF] (Presented May - October)

Webinar Presentation: LTC - Recipient Eligibility Verification, October 22, 2013 [3.03MB PDF] (Presented July - October)

Webinar Presentation: LTC - Assisted Living Facilities & Adult Family Care Homes, October 17, 2013 [2.02MB PDF] (Presented July - October)

Webinar Presentation: LTC - Enrollee and Provider Protections, October 16, 2013 [1.24MB PDF] (Presented July - October)

Webinar Presentation: LTC - Home-Like Environment & Community Integration for Medicaid Recipients in Assisted Living Facilities & Adult Family Care Homes, October 10, 2013 [1.16MB PDF] (Presented March - October)

Webinar Presentation: LTC - Choice Counseling, October 8, 2013 [1.93MB PDF] (Presented June - October)

Webinar Presentation: LTC - Medicaid Provider Enrollment, October 1, 2013 [1.86MB PDF] (Presented April - October)

September

Webinar Presentation: LTC - Long-Term Care 101, September 24, 2013 [1.44MB PDF]

August

Webinar Presentation: LTC - Assisted Living Facilities & Adult Family Care Homes, August 7, 2013 [1.99MB PDF]

July

LTC - Question and Answer Session for Aging Network Providers, July 1, 2013 [1.07MB PDF]

LTC - Aging Network Providers Questions and Agency Responses [65KB PDF]

June

LTC - Webinar Presentation: Participant Direction Options - June 6, 2013 [1.80MB PDF]

May

LTC - Webinar Presentation: Medicaid Pending - May 9, 2013 [1.58KB PDF] (Presented March - May)

March

LTC - Statewide Medicaid Managed Care Long-Term Care Program Presentation – April 9, 2013 [718KB PDF]

LTC - Webinar Presentation:  Welcome Overview for LTC Potential Network Providers (REVISED) – March 6, 2013 [334KB PDF] (Presented February - March)

LTC - Long-term Care Potential Network Provider Webinar: Questions and Answers from March 5 & 6, 2013 [83KB]

LTC - AHS Presentation: SMMC LTC Overview Partner and Facility Staff Training March 2013 [2.48MB PDF] 3/25/2013

February

LTC - Long-term Care Potential Network Provider Webinars: Questions and Answers from February 27, 2013 [83KB PDF]

LTC - Medicaid Joint Training for Nursing Homes ALF, February 2013 [503KB PDF]

LTC - Medicaid Joint Training HCBS Homelike Environment ALF, February 2013 [99KB PDF]


arrows Previous Events Archive arrows

arrows Public Outreach Meetings Regarding 1115 Waiver for the Medically Needy Component of Statewide Medicaid Managed Care arrows

1115 Waiver for the Medically Needy Component of Statewide Medicaid Managed Care

Location Address

Date

Time

Agenda and Presentation

Westin Ft. Lauderdale
400 Corporate Drive
Ft. Lauderdale, FL 33334
Phone:  (954) 772-1331
Fax:  (954) 772-6867

October 19, 2012  2:00 pm - 5:00 pm

FAR Notice [77KB PDF]
Agenda [45KB PDF]
Presentation [109KB PDF]

Medical Care Advisory Committee Meeting

Agency for Health Care Administration
2727 Mahan Drive
Building 3, Conference Room A
Tallahassee, FL 32308

October 23, 2012

Call-In Information (Listen Only): 1-888-670-3525. When prompted, enter the participant pass code: 4265177105

1:00 pm - 4:00 pm

FAR Notice [77KB PDF]
Agenda [45KB PDF]
Presentation [109KB PDF]



arrows June – September 2011 Outreach Meetings arrows

The following outlines the publicly noticed meetings that have occurred.  Additional public meetings will be scheduled in the future and all related information will be posted on this page.

Regions
Counties
Location
Address
Date
Time
Agenda
Presentation
Region 11
Miami-Dade and Monroe

Marathon Government Center - Map It
EOC BOCC Meeting Room 2nd Floor
2798 Overseas Highway, MM 50
Marathon, FL 33050

September 12, 2011 10:00am-1:00pm
Agenda
[109KB PDF]

Presentation
[610KB PDF]
Field House - Map It
(Next to Bank United Center in the University of Miami)
1245 Dauer Drive
Coral Gables, FL 33146
Metro Rail exit: University Station
September 13, 2011 2:30pm-5:30pm
Agenda
[110KB PDF]

Presentation
[610KB PDF]



Regions
Counties
Location
Address
Date
Time
Agenda
Presentation
Region 1
Escambia, Okaloosa, Santa Rosa and Walton
City Hall - Map It
Hagler/Mason Auditorium 2nd floor
222 W. Main Street
Pensacola, FL 32502
June 13, 2011

1:00pm-4:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 2
Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington
Agency for Health Care Administration - Map It
Building 3, Conference Room A
2727 Mahan Drive
Tallahassee, FL 32308
June 10, 2011

1:00pm-4:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 3
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union
Alachua Regional Service Center - Map It
14107 US Highway 441
Conference Room 190-A
Alachua, FL 32615
June 14, 2011

2:30pm-5:30pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 4
Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia
Department of Children and Families Main Auditorium
5920 Arlington Expressway - Map It
Jacksonville, FL 32211
June 14, 2011

9:00am-12:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 5
Pasco and Pinellas
Mary Grizzle Building - Map It
Rooms 136 and 137
11351 Ulmerton Road
Largo, FL 33778-1629
June 15, 2011

9:00am-12:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]

Region 6
Hardee, Highlands, Hillsborough, Manatee and Polk
Florida Department of Transportation Auditorium
11201 N. McKinley Drive - Map It
Tampa, FL 33612
June 16, 2011

9:00am-12:00pm

Agenda
[100KB PDF]

Presentation

[513KB PDF]
Region 7
Brevard, Orange, Osceola  and Seminole
Medicaid Program Office - Map It
Hurston Building
Conference Rooms A and D - 1st Floor
400 West Robinson Street
Orlando, FL 32801
June 16, 2011

2:00pm-5:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 8
Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota
Joseph D’Alessandro Building - Map It
Room 165
2295 Victoria Avenue
Fort Myers, FL 33901
June 17, 2011

2:00pm-5:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]

Region 9
Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
Hilton Palm Beach Airport - Map It
150 Australian Avenue
West Palm Beach, FL 33406
June 14, 2011

9:00am-12:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 10
Broward
Marriott Fort Lauderdale North - Map It
6650 North Andrews Avenue
Ft. Lauderdale, FL 33309
June 16, 2011

9:00am-12:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]
Region 11
Miami-Dade and Monroe
El Palacio - Map It
21485 NW 27th Avenue
Miami Gardens, FL 33056
June 16, 2011

2:00pm-5:00pm

Agenda
[100KB PDF]

Presentation
[513KB PDF]

You may watch a closed captioned reading of the standard presentation by clicking on the video below. [22.92MB Flash Video]

(Due to the large size of the video it may take longer to download.)

Content on this page requires a newer version of Adobe Flash Player.

Get Adobe Flash player

Additionally, the presentation used at the June 2011 meeting in Tallahassee which includes the sign-language interpreters, was video-taped and is available by emailing your request to FLMedicaidManagedCare@ahca.myflorida.com.


arrows Guidance Statements arrows

From time to time during program development and implementation, the Agency will post guidance statements to provide the public with clarification regarding program components. These statements have no effect on the procurement and the procurement requirements will be based solely on the provisions contained in the ITN and procurement documents.

Guidance Statement: Durable Medical Equipment Contracts in the Managed Medical Assistance Program [47KB PDF] 3/28/2014

Updated 409.975(1)(d) Provider Listing, March 2014 [6.08 Microsoft Excel]

Integrated Dual Eligible Plans [45KB PDF]

Respondents to Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Invitations to Negotiate [95KB PDF]

Clarification: Specialty Plans [51KB PDF]

Specialty Plans [52KB PDF]

Contracting Required Pursuant to Section 409.975(1)(d) [38KB PDF]

409.975(1)(d) Provider Listing [1.49MB MS Excel]

Respondents to Statewide Medicaid Managed Care Long-term Care (LTC) Invitations to Negotiate [165KB PDF]

Long-term Care Managed Care Program Application Process for Medicare Advantage Special Needs Plans [63K PDF]

Documentation Accepted for Plan Provider Networks [63KB PDF]

Updated Guidance Statement: Participation of Medicare Advantage SNP plans in the SMMC LTC Component [46KB PDF]

Participation of Provider Service Networks in the LTC Component of the SMMC program [46KB PDF]

Aging Network Service Providers May 17, 2012 [47KB PDF]

Related to Upcoming Public Meeting to Address Questions Regarding the Long-term Care Data Book Released on March 16, 2012 [64KB PDF]

Related to the March 16, 2012, Version of the Long-term Care Managed Care Data Book [66KB PDF]

Provision of Case Management Services [52KB PDF]

Reimbursement for Transportation Services [52KB PDF]

HMO Certificate of Authority [44KB PDF]

Provision of medical care services to Long-term Care plan enrollees after full program implementation [47KB PDF]

Responsibility for the provision of duplicative services to a recipient enrolled in both a Long-term Care plan and a Managed Medical Assistance plan [47KB PDF]

Enrollment in Medicare Advantage plans that are not subject to competitive procurement [44KB PDF]



Program Updates Report a Complaint Comments or Questions Frequently Asked Questions

Long-term Care


The Long-term Care component of the Statewide Medicaid Managed Care program will be implemented first.

  • Long-term Care program Snapshot [214KB PDF]
  • We are currently enrolling recipients in the Long-term Care program, for additional information please see the following brochure.

Choice Counseling Brochure [2.97MB PDF]

  • Eligible recipients can enroll in a long-term care plan by visiting the following website www.flmedicaidmanagedcare.com; or you can call 1-877-711-3662

Choose an arrow below to view more information about the program.


arrows What Plans are Available in My Region? arrows

LTC Plans
Plan Name
Regions of Operation
Contact
American ElderCare

1 through 11

Telephone number: 1-888-998-7732
TDD: English 1-800-955-8770;
TDD: Spanish 1-877-955-8773
www.americaneldercare.com

Amerigroup Florida

10 and 11

Telephone Number: 877-440-3738
TDD: 1-800-855-2880
http://www.myamerigroup.com/fl

Coventry Health Care of Florida

6, 7, 9, and 11

Telephone number: 1-855-219-6671
TDD: 1-866-271-5669
www.coventryflltc.com

Humana Medical Plan

4, 10, and 11

Telephone Number: 888-308-9759
Telephone Number (TDD): 866-842-9285
http://ilshealth.com/humanaportal

Molina Complete care

5, 6, and 11

Telephone Number: 866-472-4585
Telephone Number (TDD): 800-955-8771
LTC Plan Website: www.molinahealthcare.com

Sunshine State Health Plan

1, 3, 4, 5, 6, 7, 8, 9, 10, and 11

Telephone number: 1-877-211-1999
TDD: 1-800-955-8770
www.sunshinestatehealth.com

UnitedHealthcare

2, 3, 4, 5, 6, 7, 8, 9, and 11

Telephone number: 1-800-791-9233
TDD: 711
www.uhccommunityplan.com


arrows Roll-Out Schedule arrows


Region Enrollment Effective Date Total Eligible Population
7 August 1, 2013 Region 7: 9,338
8 & 9 September 1, 2013 Region 8: 5,596
Region 9: 7,854
Total = 13,450
2 & 10 November 1, 2013 Region 2: 4,058;
Region 10: 7,877
Total = 11,935
11 December 1, 2013 Region 11:  17,257
5 & 6 February 1, 2014 Region 5: 9,963
Region 6: 9,575
Total = 19,538
1, 3 , 4 March 1, 2014 Region 1: 2,973
Region 3: 6,911
Region 4: 9,087
Total = 18,971

Program Updates Report a Complaint Comments or Questions Frequently Asked Questions

Long-term Care Recipients


Before the Long-term Care program starts in your region, you will get a letter from Medicaid in the mail. The letter will have information about the long-term care plans in your region.

All Medicaid recipients receiving services in a nursing facility, or through the Nursing Home Diversion Waiver, Aged and Disabled Adult Waiver, Assisted Living Waiver, Channeling Waiver, or the Frail Elder Option can receive choice counseling before enrolling in the Long-term Care program.

If you are currently receiving services from a Nursing Home Diversion plan that will also be a long-term care plan in the region where you live, you can choose to stay with the same plan or enroll with a different plan.

A counselor will help you pick the long-term care plan in your region that best meets your needs. When you get the letter that says it is time for you to select a plan, you can contact a choice counselor. Use your computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a choice counselor. You can also request an in person visit from a choice counselor.

Long-term Care program Snapshot [214KB PDF]


Examples of Letters Sent to Recipients:

Pre-welcome: A short letter to let recipients know that the Medicaid program is changing and that they should watch their mail for more information. This is sent four months prior to the start date of Statewide Medicaid Managed Care in the recipient’s region.

Welcome: A packet of information sent when it is time for the recipient to choose a managed care plan. It contains a letter inviting the recipient to choose a plan, instructions how to choose, the deadline, and the plan to which they will be assigned if they do not choose. It also contains a brochure describing the program and information about the managed care plans in their region. This is sent two month prior to the start date of Statewide Medicaid Managed Care in the recipient’s region.

Reminder: This letter is sent approximately one month before the deadline to choose a plan. It is sent to all recipients who have not yet made a choice of plan. The letter reminds them to pick a plan by the deadline, lists the plan to which they will be assigned if they do not choose, and instructs them how to choose.

arrows When will I be notified and be required to enroll? arrows


Region Pre-Welcome Letter Welcome Letter Reminder Letter Last Day to Choose a Plan Before Initial Enrollment Date Enrolled
in LTC Plans
1 11/1/2013 12/23/2013 1/20/2014 2/13/2014 3/1/2014
2 7/1/2013 8/26/2013 9/16/2013 10/17/2013 11/1/2013
3 11/1/2013 12/23/2013 1/20/2014 2/13/2014 3/1/2014
4 11/1/2013 12/23/2013 1/20/2014 2/13/2014 3/1/2014
5 10/1/2013 11/25/2013 12/16/2013 1/16/2014 2/1/2014
6 10/1/2013 11/25/2013 12/16/2013 1/16/2014 2/1/2014
7 4/1/2013 5/20/2013 6/24/2013 7/18/2013 8/1/2013
8 5/1/2013 6/24/2013 7/22/2013 8/22/2013 9/1/2013
9 5/1/2013 6/24/2013 7/22/2013 8/22/2013 9/1/2013
10 7/1/2013 8/26/2013 9/16/2013 10/17/2013 11/1/2013
11 8/1/2013 9/23/2013 10/21/2013 11/21/2013 12/1/2013


arrows Authorized Representative Form arrows

Below are links to the Designation of Authorized Representative for Selection of Managed Care Plan forms.


Long-term Care Providers


Choose an arrow below to view more information about the program.

arrows Provider Training arrows

To view upcoming provider training, please go to the News and Events tab above and then select the Calendar of Events and Training dropdown.


arrows New Guidance for LTC Providers arrows

To view the previous guidances statements please go to the News and Events tab above and then select the Guidance Statement dropdown.


October 3, 2013 Letter to Consumable Medical Supplies Providers [43KB PDF]


Provision of Assistive Care Services Under the LTC Program [121KB PDF]


July 22, 2013 Letter to Nursing Facilities [86KB PDF]

The information below is provided as clarification of the Agency for Health Care Administration letter to nursing facilities dated July 22, 2013.

Nursing facilities do not have to contract with every long-term care plan in their region. However, Florida law requires that nursing facilities must participate with every long-term care plan in their region (see s. 409.982(2), Florida Statutes). This means that if a nursing facility resident chooses a long-term care plan with which the nursing facility does not have a contract, the nursing facility and long-term care plan will need to work together to determine how to handle payment for the nursing facility services provided to that recipient.

If a nursing facility notifies a resident that he or she will have to move because the facility is not contracted with that resident’s plan or cannot reach a payment agreement with that plan, the Agency would consider that the nursing facility is not participating with the long-term care plan. A nursing facility that does not participate, that is, has notified residents that they have to move because of the LTC plan selected by those residents, is subject to termination from the Medicaid program.


July 22, 2013 Letter to Assisted Living Facilities [110KB PDF]



arrows Plan Contacts for Providers arrows

LTC Plan Contact:  Provider Networks
Plan Name
Regions of Operation
Contact
American ElderCare

1 through 11

Brenda Evans
Phone: 561-496-4440
Email: bevans@americaneldercare.com
Amerigroup Florida

10 and 11

Victoria McMath
Phone: 800-950-7679 ext 77429
Email: Victoria.McMath@amerigroup.com
Coventry Health Care of Florida

6, 7, 9, and 11

Mariangeli  Cataluna
Phone: 305-222-3012
Email: mxcataluna@cvty.com
Humana Medical Plan

4, 10, and 11

Grace Rodriguez
Phone: 888-234-6401
Email: grodriguez@ilshealth.com
Molina Complete Care

5, 6, and 11

Lisa Schwendel
Phone: 1-888-562-5442, ext. 223594
Email: lisa.schwendel@molinahealthcare.com
Sunshine State Health Plan

1, 3, 4, 5, 6, 7, 8, 9, 10, and 11

Tracy Celebrado
Phone: 866-595-8116
Email: sunshinecontracting@centene.com

UnitedHealthcare

2, 3, 4, 5, 6, 7, 8, 9, and 11

Sue Kever
1-850-932-5786
Primary Email: Fl_ltc_network@uhc.com
Secondary Email: sue_a_kever@uhc.com

 


Long-term Care Plans


Choose an arrow below to view more information about the program.

Plan Readiness

arrows Roll-Out Schedule and Plan Readiness Submission Documents arrows

Subject to the limitations imposed by Florida Statutes, the Agency anticipates rolling-out the LTC component of the SMMC program on a regional basis in accordance with the following schedule: (See s. 409.966(4), F.S. (2012) i)

TABLE 1 - ANTICIPATED REGIONAL ROLL-OUT SCHEDULE

Region Documentation
Submission Deadline
Deadline for Enrollment Effective Date
7 January 23, 2013 May 1, 2013 August 1, 2013
8 & 9 February 6, 2013 June 1, 2013 September 1, 2013
2 & 10 February 20, 2013 August 1, 2013 November 1, 2013
11 March 6, 2013 September 1, 2013 December 1, 2013
5 & 6 March 20, 2013 November 1, 2103 February 1, 2014
1, 3 & 4 April 3, 2013 December 1, 2013 March 1, 2014

Prior to enrolling recipients in a LTC Plan in each region in which the LTC Plan receives a resulting Contract, the Agency will conduct a plan-specific readiness review to assess the LTC Plan’s readiness and ability to provide services to recipients. The plan readiness review will include, but is not limited to, desk review of all contract related policies and procedures by the LTC Plan, and corresponding member documents provided by the LTC Plan, the LTC Plan’s provider network and corresponding contracts, and an onsite review including a walk-through of the LTC Plan’s operations, system demonstrations, and interviews with LTC Plan staff, as outlined in Exhibit 5, LTC Plan Readiness Requirements. The scope of the readiness review may include any and all Contract requirements, as determined by the Agency.

Each LTC Plan that receives a resulting Contract must complete and submit the LTC checklists linked below.  Along with the LTC checklists, the LTC Plan must submit all policies and procedures and all supporting documents (member correspondence – such as enrollment letters, ID card, handbook, provider directory; provider correspondence, etc.) that correspond to each line item in the LTC Plan Readiness Review Tool.  Each plan must note in the LTC Plan Readiness tool the reference number that corresponds with the document or policy being supplied for each line item and specify the page and paragraph number where the elements can be found.  This reference number, page and paragraph should be noted in the “Documents reviewed” row that corresponds with the line item for which the policy or document is being provided.  The LTC Plan Readiness Review Tool must be submitted to the Agency with this information included, along with the corresponding documents.  All materials needing approval must be submitted as they will be viewed in production (including company logo) and be in a WORD format. Readability statistics must accompany each member correspondence submitted.

In addition to the documents above, each LTC plan will be expected to submit provider network files using the specifications outlined in the document below.

Provider Network Verification (PNV) File Specification [595 KB PDF]

The submission due date for all of these files is indicated in the table above under “Documentation Submission Deadline”. Additional submission instructions will be provided to plans upon award.  The “Deadline for Enrollment” is the date by which all plan readiness review criteria must be satisfied and the date by which the plan must have met all contract requirements. The Agency will not enroll recipients into a LTC Plan until the Agency has determined that the LTC Plan meets all Contract requirements.

If a LTC Plan does not meet the plan readiness review deadlines for their respective region, as indicated above, the Agency will grant an extension for the LTC Plan to correct deficiencies; however, the LTC Plan will lose the initial enrollment of eligible recipients in their respective region and will lose their transition population, if applicable. After an extension is granted by the Agency, the LTC Plan will have until the penultimate Saturday before the respective region’s enrollment effective date, as indicated above in Table 1 – Anticipated Regional Roll-Out Schedule, to be deemed ready for recipient enrollment. If a LTC Plan is not deemed ready for recipient enrollment by the Agency by the penultimate Saturday before the respective region enrollment effective date, the contract between the LTC Plan and the Agency will be terminated.

If a LTC Plan received an additional contract award and fails to meet plan readiness review criteria in Region 1 or Region 2 by the deadlines as indicated above in Table 1 – Anticipated Regional Roll-Out Schedule, and subsequent paragraphs, the Agency shall terminate the additional awarded region(s) contract(s) immediately if recipients have not been enrolled into the additional region or one-hundred eighty (180) days after the respective Region 1 and/or 2 termination if recipients are already enrolled in the additional awarded region(s). (See s. 409.966(3)(e), F.S.)

The Agency does not guarantee that the LTC Plan will receive any particular enrollment level. The above schedule is subject to change and provided for planning purposes only.

i s. 409.966(4), F.S. (2012), “ADMINISTRATIVE CHALLENGE.—Any eligible plan that participates in an invitation to negotiate in more than one region and is selected in at least one region may not begin serving Medicaid recipients in any region for which it was selected until all administrative challenges to procurements required by this section to which the eligible plan is a party have been finalized. If the number of plans selected is less than the maximum amount of plans permitted in the region, the agency may contract with other selected plans in the region not participating in the administrative challenge before resolution of the administrative challenge. For purposes of this subsection, an administrative challenge is finalized if an order granting voluntary dismissal with prejudice has been entered by any court established under Article V of the State Constitution or by the Division of Administrative Hearings, a final order has been entered into by the agency and the deadline for appeal has expired, a final order has been entered by the First District Court of Appeal and the time to seek any available review by the Florida Supreme Court has expired, or a final order has been entered by the Florida Supreme Court and a warrant has been issued.”


arrows Statewide Medicaid Managed Care Report Guide arrows

The reporting provisions for reports required through the Statewide Medicaid Managed Care (SMMC) Plan Contract are provided in the Statewide Medicaid Managed Care Report Guide (Report Guide). This Report Guide is a companion to each Managed Care Plan’s contract with the Agency. The Report Guide provides details of Managed Care Plan reporting requirements, including instructions, templates, and submission directions.

Beginning June 1, 2014, the Report Guide reflects the requirements for the following types of Managed Care plans:

  • LTC Fee-for-Service Provider Service Networks (LTC FFS PSNs)
  • MMA Health Maintenance Organizations (MMA HMOs)
  • MMA Capitated Provider Service Networks (MMA Capitated PSNs)
  • MMA Specialty Plan
  • MMA Children’s Medical Services Network Managed Care Plan (MMA CMSN MCP)
  • Comprehensive Health Maintenance Organizations (LTC & MMA HMOs)

Note:  This Report Guide is NOT for use with the 2012-15 Medicaid Health Plan Contract.  The Report Guide for the 2012-15 Medicaid Health Plan Contract is located at http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/med_prov_0912.shtml

arrows SMMC Report Guide (Effective 6/1/14) arrows

SMMC Report Guide [849KB PDF] Effective 6/1/2014

SMMC Report Guide Templates:

ACA PCP Payment Increase Encounter Data File Layout - MMA [17KB MS Excel] Effective 6/1/14

ACA PCP Payment Increase MPA SFTP Instructions - MMA[199KB MS Word] Effective 6/1/14

ACA PCP Payment Increase Summary Information - MMA [27KB MS Excel] Effective 6/1/14

Achieved Savings Rebate Financial Report [47KB MS Excel] Effective 6/1/14

Administrative Subcontractors and Affiliates Report [649KB MS Excel] Effective 6/1/14

Annual Fraud and Abuse Activity Report [27KB MS Excel] Effective 6/1/14

Audited Annual and Unaudited Quarterly Financial Reports [437KB Microsoft Excel] Effective 5/15/2014

Case Manager Caseload Report - LTC [66KB MS Excel] Effective 6/1/14

Case Management File Audit Report - LTC [43KB MS Excel] Effective 6/1/14

Case Manager Monitoring and Evaluation Report - LTC [33KB MS Excel]

Child Health Check-Up- MMA [229KB PDF]

Claims Aging Report for SMMC [4.01MB MS Excel] Effective 6/1/14

Claims Supplemental Filing Report for SMMC [4.74MB MS Excel] Effective 6/1/14

Code 15 Report [13KB MS Excel] Effective 6/1/14

Critical Incident Report [13KB MS Excel] Effective 6/1/14

Critical Incident Summary Report [76KB MS Excel] Effective 6/1/14

Denial, Reduction, Termination or Suspension of Services Report - LTC [25KB MS Excel] Effective 6/1/14

Enrollee Complaints, Grievances and Appeals Report [3.67MB MS Excel] Effective 6/1/14

Enrollee Roster and Facility Residence Report - LTC [33KB MS Excel] Effective 6/1/14

Hernandez Settlement Agreement Log - MMA [238KB MS Excel] Effective 6/1/14

Hernandez Settlement Agreement Survey - MMA [31KB MS Excel] Effective 6/1/14

Marketing Agent Termination Report [89KB PDF] Effective 6/1/14

Marketing Outreach Events Notification Logs [278KB PDF] Effective 6/1/14

Missed Services Report - LTC [18KB MS Excel] Effective 6/1/14

Nursing Facility Transfer Report - LTC [41KB MS Excel] Updated 10/1/2013

Patient Responsibility Report - LTC [33KB MS Excel] Effective 6/1/14

Participant Directed Option Roster Report - LTC [19KB MS Excel] Effective 6/1/14

Performance Measures Report LTC & MMA [135KB MS Excel] Effective 6/1/14

Provider Complaint Report [1.14MB MS Excel] Effective 6/1/14

Provider Termination and New Provider Notification Report [123KB MS Excel] Effective 6/1/14

Quarterly and Annual MLR Report - MMA [65KB MS Excel] Effective 6/1/14

Timely Access PCP Wait Times Report - MMA [1.70KB MS Excel] Effective 6/1/14

Utilization Report - LTC [43KB MS Excel] Effective 6/1/14


arrows SMMC Report Guide (Effective 1/1/14) arrows

SMMC Report Guide [1.22MB PDF] Effective 1/1/2014
Summary of SMMC Report Guide Revisions [423KB PDF] Effective 1/1/2014
SMMC Report Guide Transmittal [45KB PDF] Effective 10/1/2013

SMMC Report Guide [1.22MB PDF] Effective 4/17/2013

SMMC Report Guide Templates:

Administrative Subcontractors and Affiliates Report [2.18MB MS Excel] Updated 10/17/2013

Audited Annual and Unaudited Quarterly Financial Reports [267KB MS Excel] Updated 10/31/2013

Case Management File Audit Report [43KB MS Excel]

Case Manager Caseload Report Template [37KB MS Excel] New 10/1/2013

Case Manager Monitoring and Evaluation Report [33KB MS Excel]

Claims Aging Report FFS [2.02MB MS Excel] Updated 10/1/2013

Claims Aging Report & Supplemental Filing Report - Capitated Health Plans [2.45MB MS Excel] Updated 10/1/2013

Critical Incident Report [31KB MS Excel]

Critical Incident Summary Report [32KB MS Excel]

Denial, Reduction, Termination of Services Report [42KB MS Excel] Updated 10/1/2013

Enrollee Complaints, Grievances, and Appeals Report [43KB MS Excel] Updated 10/1/2013

Enrollee & Nursing Facility Residence Report [45KB MS Excel] Updated 10/1/2013

Missed Services Report [32KB MS Excel] Updated 10/1/2013

MPI Annual Fraud and Abuse Activity Report (AFAAR) [65KB MS Excel] Updated 10/1/2013

Multiple Signature Verification Agreement [37KB MS Word]

Nursing Facility Transfer Report [46KB MS Excel] Updated 10/1/2013

Participant Direction Option (PDO) Report [35KB MS Excel]

Patient Responsibility Report [27KB MS Excel]

Provider Complaint Report [34KB MS Excel] Updated 10/1/2013

Provider Network File Specifications [865KB PDF] Updated 10/1/2013

Provider Termination & New Provider Notification Report [74KB MS Excel] Updated 10/31/2013

Utilization Reporting [43KB MS Excel]


arrows SMMC Report Guide Archive arrows

arrows Participant Direction Option (PDO) arrows

PDO Extensive Evaluation [190KB PDF]

PDO General Evaluation [188KB PDF]

PDO Pre-Screening Tool [84KB MS Word 2010]

PDO Manual [135KB MS Word 2010]

PDO Guidelines [357KB MS Word 2010]

PDO Guidelines (Spanish Translation) [352KB MS Word 2010] 7/9/2013

PDO Consent Form [62KB MS Word 2010]

PDO Representative Agreement [52KB MS Word 2010]

PDO Timesheet Attestation Language [24KB MS Word 2010]

PDO Consent Form (Spanish Translation) [52KB MS Word 2010]

PDO Pre-Screening Tool (Spanish Translation) [78KB MS Word 2010]

PDO Representative Agreement (Spanish Translation) [44KB MS Word 2010]

PDO Training Webinar Presentation - 3/14/2013 [490KB PDF]




Long-term Care Archive


Long-term Care Technical Advisory Workgroup Final Report [PDF 102KB]

arrows Past SMMC Provider Webinars arrows

The webinar recordings below are hosted on our YouTube channel and may be blocked by your organization’s content filters.  If you’re experiencing problems with video playback, please email socialmedia@ahca.myflorida.com to request a copy of the slideshow presentation(s).

Hospice Providers

Enrollee and Provider Protections

Recipient Eligibility Verification

Home-Like Environment

Medicaid Pending

Plan of Care

Choice Counseling

Assisted Living Facilities

 


arrows LTC Technical Advisory Workgroup Meeting Information arrows


March 5, 2012


February 13, 2012


January 20, 2012


December 12, 2011


November 10, 2011


October 14, 2011


August 26, 2011


July 26, 2011




Managed Medical Assistance


The Managed Medical Assistance component of the Statewide Medicaid Managed Care program will be implemented between May and August, 2014.

Managed Medical Assistance program Shapshot [318KB PDF]


Choose an arrow below to view more information about the program.


arrows Roll-Out Schedule arrows

MMA Roll-Out Schedule

Regions

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


Program Updates Report a Complaint Comments or Questions Frequently Asked Questions


Managed Medical Assistance Recipients


Before the Managed Medical Assistance program (MMA) starts in your region, you will get a letter from Medicaid in the mail. The letter will have information about the managed medical assistance plans in your region.

All Medicaid recipients receiving services in MediPass, fee-for-service, or a current Medicaid HMO or Provider Service Network (PSN) can receive choice counseling before enrolling in a MMA plan.  

If you are in MediPass now you will have to pick a MMA plan in the region where you live. 

If you are currently receiving services from a Medicaid HMO or PSN plan that will also be a MMA plan in the region where you live, you can choose to stay with the same plan or enroll with a different plan.  If your current plan will not be an MMA plan in the region where you live, then you will have to pick a different plan.

A choice counselor will help you pick the managed medical assistance plan in your region that best meets your needs. When you get the letter that says it is time for you to select a plan, you can contact a choice counselor. Use your computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a choice counselor. You can also request an in person visit from a choice counselor.

Choose an arrow below to view more information about the program.

Examples of Letters Sent to Recipients:

Pre-welcome: A short letter to let recipients know that the Medicaid program is changing and that they should watch their mail for more information. This is sent four months prior to the start date of Statewide Medicaid Managed Care in the recipient’s region.

Welcome: A packet of information sent when it is time for the recipient to choose a managed care plan. It contains a letter inviting the recipient to choose a plan, instructions how to choose, the deadline, and the plan to which they will be assigned if they do not choose. It also contains a brochure describing the program and information about the managed care plans in their region. This is sent two month prior to the start date of Statewide Medicaid Managed Care in the recipient’s region.

Reminder: This letter is sent approximately one month before the deadline to choose a plan. It is sent to all recipients who have not yet made a choice of plan. The letter reminds them to pick a plan by the deadline, lists the plan to which they will be assigned if they do not choose, and instructs them how to choose.

Note: Recipient letters are sent based on the start date of Statewide Medicaid Managed Care in the recipient’s region. Due to the volume, letters are mailed over several days.

arrows When will I be notified and be required to enroll? arrows

Region Pre-Welcome Letter Welcome Letter Reminder Letter Last Day to Choose a Plan Before Initial Enrollment Date Enrolled in MMA Plans
 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 1/2/2014 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

Note: Recipient letters are sent based on the start date of Statewide Medicaid Managed Care in the recipient’s region. Due to the volume, letters are mailed over several days.


Managed Medical Assistance Providers


Choose an arrow below to view more information about the program.

arrows Provider Training arrows

To view upcoming provider training, please go to the News and Events tab above and then select the Calendar of Events and Training dropdown.


arrows Plan Contacts for Providers arrows

MMA Plan Contact:  Provider Networks
Plan Name
Provider Relations Contact

Amerigroup Florida, Inc.

James E. Beermann, Jr. (Jim)
Email: James.beermann@amerigroup.com
Phone: 813-830-6951 (o) / 813-362-9763 (c )
Better Health

Tomas Orozco
Email: torozco@simplyhealthcareplans.com
Phone: 305-921-2645

Coventry Health Care of Florida

Valerie Rodriguez
Email: vmrodriguez@cvty.com
Phone: 305-222-3005

Clear Health Alliance

 

Marianne Finizio
Email: mfinizio@clearhealthalliance.com
Phone: 305-421-1960

First Coast Advantage

Davina Butler
Email: Davina.butler@jax.ufl.edu
Phone: 904-244-9715

Freedom Health

Nancy Gareau
Email: ngareau@freedomh.com
Phone: 813-506-6000 extension 11267

Humana Medical Plan

Mayra Torres
Email: mtorres8@humana.com
Phone: 305-626-5445

Integral

Reginald Martin
Email: Reginald.martin@IntegralQualityCare.com
Phone:

Magellan Complete Care

Robert (Bob) Sonnessa
Email: RASonnessa@magellanhealth.com
Phone: 888-365-9730

Molina Healthcare of Florida

Gus Keriazes
Email: gus.keriazes@molinahealthcare.com
Phone: 1-866-422-2541 ext. 229125

AHF dba Positive Healthcare Florida

Remon Walker
Email: Remon.walker@aidshealth.org
Phone: 954.496.9337

Preferred Medical Plan

 

Teresa Izquierdo
Email: tizquierdo@pmphmo.com
Phone: 305-447-8373, extension 3255

Prestige Health Choice

 

Rosie Stoetzer
Email: RStoetzer@prestigehealthchoice.com
Phone: 305-718-1100 ext 21208

Simply Healthcare Plans

 

Tomas Orozco
Email: torozco@simplyhealthcareplans.com
Phone: 305-921-2645
SFCCN

Alexander Fabano
Email: afabano@sfccn.org
Phone: 305-430-2843

Staywell

 

Mark Metrovich
Email: Mark.Metrovich@wellcare.com
Phone: 813-206-3419

Sunshine State Health Plan

Mark Barrett
Email: sunshinecontracting@centene.com
Phone: 866-595-8116

UnitedHealthcare of Florida

Felix Gonzalez
Email: felix_m_gonzalez@uhc.com
Phone: 407-659-6965

Managed Medical Assistance Plans


Choose an arrow below to view more information about the program.

Plan Readiness


arrows Statewide Medicaid Managed Care Report Guide arrows

The reporting provisions for reports required through the Statewide Medicaid Managed Care (SMMC) Plan Contract are provided in the Statewide Medicaid Managed Care Report Guide (Report Guide). This Report Guide is a companion to each Managed Care Plan’s contract with the Agency. The Report Guide provides details of Managed Care Plan reporting requirements, including instructions, templates, and submission directions. 

Beginning June 1, 2014, the Report Guide reflects the requirements for the following types of Managed Care plans:

  • LTC Fee-for-Service Provider Service Networks (LTC FFS PSNs)
  • MMA Health Maintenance Organizations (MMA HMOs)
  • MMA Capitated Provider Service Networks (MMA Capitated PSNs)
  • MMA Specialty Plan
  • MMA Children’s Medical Services Network Managed Care Plan (MMA CMSN MCP)
  • Comprehensive Health Maintenance Organizations (LTC & MMA HMOs)

Note:  This Report Guide is NOT for use with the 2012-15 Medicaid Health Plan Contract.  The Report Guide for the 2012-15 Medicaid Health Plan Contract is located at http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/med_prov_0912.shtml

arrows SMMC Report Guide (Effective 6/1/14) arrows

SMMC Report Guide [849KB PDF] Effective 6/1/2014

SMMC Report Guide Templates:

ACA PCP Payment Increase Encounter Data File Layout - MMA [17KB MS Excel] Effective 6/1/14

ACA PCP Payment Increase MPA SFTP Instructions - MMA[199KB MS Word] Effective 6/1/14

ACA PCP Payment Increase Summary Information - MMA [27KB MS Excel] Effective 6/1/14

Achieved Savings Rebate Financial Report [47KB MS Excel] Effective 6/1/14

Administrative Subcontractors and Affiliates Report [649KB MS Excel] Effective 6/1/14

Annual Fraud and Abuse Activity Report [27KB MS Excel] Effective 6/1/14

Audited Annual and Unaudited Quarterly Financial Reports [437KB Microsoft Excel] Effective 5/15/2014

Case Manager Caseload Report - LTC [66KB MS Excel] Effective 6/1/14

Case Management File Audit Report - LTC [43KB MS Excel] Effective 6/1/14

Case Manager Monitoring and Evaluation Report - LTC [33KB MS Excel]

Child Health Check-Up- MMA [229KB PDF]

Claims Aging Report for SMMC [4.01MB MS Excel] Effective 6/1/14

Claims Supplemental Filing Report for SMMC [4.74MB MS Excel] Effective 6/1/14

Code 15 Report [13KB MS Excel] Effective 6/1/14

Critical Incident Report [13KB MS Excel] Effective 6/1/14

Critical Incident Summary Report [76KB MS Excel] Effective 6/1/14

Denial, Reduction, Termination or Suspension of Services Report - LTC [25KB MS Excel] Effective 6/1/14

Enrollee Complaints, Grievances and Appeals Report [7.27MB MS Excel] Effective 6/1/14

Enrollee Roster and Facility Residence Report - LTC [33KB MS Excel] Effective 6/1/14

Hernandez Settlement Agreement Log - MMA [238KB MS Excel] Effective 6/1/14

Hernandez Settlement Agreement Survey - MMA [31KB MS Excel] Effective 6/1/14

Marketing Agent Termination Report [89KB PDF] Effective 6/1/14

Marketing Outreach Events Notification Logs [278KB PDF] Effective 6/1/14

Missed Services Report - LTC [18KB MS Excel] Effective 6/1/14

Nursing Facility Transfer Report - LTC [41KB MS Excel] Updated 10/1/2013

Patient Responsibility Report - LTC [33KB MS Excel] Effective 6/1/14

Participant Directed Option Roster Report - LTC [19KB MS Excel] Effective 6/1/14

Performance Measures Report LTC & MMA [135KB MS Excel] Effective 6/1/14

Provider Complaint Report [1.14MB MS Excel] Effective 6/1/14

Provider Termination and New Provider Notification Report [123KB MS Excel] Effective 6/1/14

Quarterly and Annual MLR Report - MMA [65KB MS Excel] Effective 6/1/14

Timely Access PCP Wait Times Report - MMA [1.70KB MS Excel] Effective 6/1/14

Utilization Report - LTC [43KB MS Excel] Effective 6/1/14


arrows SMMC Report Guide (Effective 1/1/14) arrows

SMMC Report Guide [1.22MB PDF] Effective 1/1/2014
Summary of SMMC Report Guide Revisions [423KB PDF] Effective 1/1/2014
SMMC Report Guide Transmittal [45KB PDF] Effective 10/1/2013

SMMC Report Guide [1.22MB PDF] Effective 4/17/2013

SMMC Report Guide Templates:

Administrative Subcontractors and Affiliates Report [2.18MB MS Excel] Updated 10/17/2013

Audited Annual and Unaudited Quarterly Financial Reports [267KB MS Excel] Updated 10/31/2013

Case Management File Audit Report [43KB MS Excel]

Case Manager Caseload Report Template [37KB MS Excel] New 10/1/2013

Case Manager Monitoring and Evaluation Report [33KB MS Excel]

Claims Aging Report FFS [2.02MB MS Excel] Updated 10/1/2013

Claims Aging Report & Supplemental Filing Report - Capitated Health Plans [2.45MB MS Excel] Updated 10/1/2013

Critical Incident Report [31KB MS Excel]

Critical Incident Summary Report [32KB MS Excel]

Denial, Reduction, Termination of Services Report [42KB MS Excel] Updated 10/1/2013

Enrollee Complaints, Grievances, and Appeals Report [43KB MS Excel] Updated 10/1/2013

Enrollee & Nursing Facility Residence Report [45KB MS Excel] Updated 10/1/2013

Missed Services Report [32KB MS Excel] Updated 10/1/2013

MPI Annual Fraud and Abuse Activity Report (AFAAR) [65KB MS Excel] Updated 10/1/2013

Multiple Signature Verification Agreement [37KB MS Word]

Nursing Facility Transfer Report [46KB MS Excel] Updated 10/1/2013

Participant Direction Option (PDO) Report [35KB MS Excel]

Patient Responsibility Report [27KB MS Excel]

Provider Complaint Report [34KB MS Excel] Updated 10/1/2013

Provider Network File Specifications [865KB PDF] Updated 10/1/2013

Provider Termination & New Provider Notification Report [74KB MS Excel] Updated 10/31/2013

Utilization Reporting [43KB MS Excel]


arrows SMMC Report Guide Archive arrows

Managed Medical Assistance Archive


arrows Respondents to Invitation to Negotiate arrows

Respondents to Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Invitations to Negotiate

The Agency is directed to select a limited number of eligible plans to participate in the Medicaid program using invitations to negotiate in accordance Florida Statute.  This section also requires that separate and simultaneous procurements be conducted in 11 regions of the state.  Accordingly, on December 28, 2012 the Agency issued 11 separate and simultaneous invitations to negotiate (ITN’s) in each of the 11 regions.  The ITNs may be accessed via the Department of Management Services’ Vendor Bid System (VBS) at: http://myflorida.com/apps/vbs/vbs_www.search.criteria_form. (See c.409.966(2), F.S. and s. 287.057(3)(a), F.S.)

Pursuant to Florida Statute, the Agency shall consider comments submitted in writing by any enrolled Medicaid provider relating to a specifically identified plan participating in the procurement in the same region as the submitting provider.  Therefore, the Agency is publishing the following list of respondents to the ITNs: (See s. 409.966(3)(a)8, F.S.)

arrows List of Respondents to MMA ITNs arrows

Solicitation Number

Title

Counties

Respondents
(Plan Names)

AHCA ITN 017-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 1

Escambia, Okaloosa, Santa Rosa and Walton

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida True Health, Inc.

Humana Medical Plan, Inc.

Integral Health Plan, Inc. dba Integral Quality Care

Molina Healthcare of Florida, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 018-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 2

Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Humana Medical Plan, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 019-12/13


Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 3

Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union

Coventry Health Care of Florida, Inc.

First Coast Advantage, LLC

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 020-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 4

Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia

Coventry Health Care of Florida, Inc.

First Coast Advantage, LLC

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 021-12/13


Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 5

Pasco and Pinellas

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 022-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 6

Hardee, Highlands, Hillsborough, Manatee and Polk

Amerigroup Florida, Inc.

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Integral Health Plan, Inc. dba Integral Quality Care

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 023-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 7

Brevard, Orange, Osceola, and Seminole

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 024-12/13


Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 8

Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Integral Health Plan, Inc. dba Integral Quality Care

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 025-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 9

Indian River, Martin, Okeechobee, Palm Beach and St. Lucie

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Salubris, LLC

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 026-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 10

Broward County

AHF MCO of Florida, Inc. D.B.A. Positive Healthcare Florida HIV/AIDS Specialty Plan

Amerigroup Florida, Inc.

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Florida True Health, Inc.

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Preferred Medical Plan, Inc.

Salubris, LLC

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

South Florida Community Care Network (SFCCN)

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 027-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 11

Miami-Dade and Monroe

AHF MCO of Florida, Inc. D.B.A. Positive Healthcare Florida HIV/AIDS Specialty Plan

Amerigroup Florida, Inc.

Care Access PSN, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Preferred Medical Plan, Inc.

Prestige Health Choice

Salubris, LLC

Simply Healthcare Plans, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

South Florida Community Care Network (SFCCN)

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

As published in the March 25, 2013 Florida Administrative Register (FAR), providers may submit comments to the Agency through the online survey tools published below.

Comments must be submitted to the Agency by April 17, 2013, at 5:00 PM, EDT.

The Agency will consider each distinct comment only once.  Additionally, the Agency will only consider comments submitted by enrolled Medicaid providers within the same region as the specifically identified plan participating in the procurement.

arrows Survey Tools and Instructions arrows

For each prospective vendor listed in the survey tools included below, the provider shall indicate if its opinion of the named prospective vendor is positive, negative or neutral. The election of the opinions listed below will be considered by the Agency in its decision to award Contracts under the Managed Medical Assistance ITN, pursuant to Section 409.966(3)(a)8, Florida Statutes.

Region 1: https://www.surveymonkey.com/s/MMARegion1

Region 2: https://www.surveymonkey.com/s/MMARegion2

Region 3: https://www.surveymonkey.com/s/MMARegion3

Region 4: https://www.surveymonkey.com/s/MMARegion4

Region 5: https://www.surveymonkey.com/s/MMARegion5

Region 6: https://www.surveymonkey.com/s/MMARegion6

Region 7: https://www.surveymonkey.com/s/MMARegion7

Region 8: https://www.surveymonkey.com/s/MMARegion8

Region 9: https://www.surveymonkey.com/s/MMARegion9

Region 10: https://www.surveymonkey.com/s/MMARegion10

Region 11: https://www.surveymonkey.com/s/MMARegion11


arrows Data Book arrows

The Agency released the Managed Medical Assistance (MMA) Invitation to Negotiate (ITN) on December 28, 2012. The data book has been included in the ITN. The data book can be found on the Agency for Health for Health Care Administration’s procurement page which can be accessed through the following link:

December 28, 2012 Managed Medical Assistance Data Book

If you are unable to locate the ITN, please contact us at FLMedicaidManagedCare@ahca.myflorida.com for further assistance.

Choose an arrow below to view more information.

arrows Public Meetings arrows

The Agency for Health Care Administration is hosting a public meeting to address questions about the Managed Medical Assistance Data Book released on September 21, 2012. The Data Book provides relevant background information that prospective plans will find useful in the development of their response to the Invitation to Negotiate (ITN).  The ITN will be released by January 1, 2013.

Location Address

Date

Time

Agenda and Presentation

Agency for Health Care Administration
2727 Mahan Drive
Building 3, Conference Room A
Tallahassee, FL 32308

A conference number will be available for those unable to attend in person.
Dial In Number: 1 (888) 482-0024
Conference Code: 277-949-69  

November 19, 2012

1:30 pm - 4:30 pm

FAR Notice [77KB PDF]

Agenda [155KB PDF]

Presentations
Data Book Public Meeting [165KB PDF]
Non-LTC Population [446KB PDF]
LTC Population [132KB PDF]


arrows Procurement arrows

Due to the competitive procurement, we are in a statutorily imposed “Blackout Period” until 72 hours after the award and cannot provide interpretation or additional information not included in the MMA ITN documents.

As stated in s. 287.057(23), F.S., “Respondents to this solicitation or persons acting on their behalf may not contact, between the release of the solicitation and the end of the 72-hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the procurement officer or as provided in the solicitation documents. Violation of this provision may be grounds for rejecting a response."

The Agency issued eleven (11) separate Invitations to Negotiate (ITN) for the Managed Medical Assistance (MMA) portion of Statewide Medicaid Managed Care on December 28, 2012, through the Department of Management Services Vendor Bid System (VBS).

The MMA ITNs may be viewed through the Vendor Bid System (VBS).


arrows Agency Requests Non-binding Letter of Intent from Potential Managed Medical Assistance Plans arrows

To assist with planning, the Agency is interested in receiving a non-binding Letter of Intent to Bid from interested parties. If you intend to submit a bid, please send a letter to the Agency by August 17, 2012, that identifies your company name and the region(s) for which you intend to submit a response. Such a letter is completely voluntary and the decision not to submit a letter will have no effect on this or any other procurement. Letters should be sent via email to FLMedicaidManagedCare@ahca.myflorida.com.


arrows List of Respondents to MMA ITNs arrows

Solicitation Number

Title

Counties

Respondents
(Plan Names)

AHCA ITN 017-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 1

Escambia, Okaloosa, Santa Rosa and Walton

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida True Health, Inc.

Humana Medical Plan, Inc.

Integral Health Plan, Inc. dba Integral Quality Care

Molina Healthcare of Florida, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 018-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 2

Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Humana Medical Plan, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 019-12/13


Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 3

Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union

Coventry Health Care of Florida, Inc.

First Coast Advantage, LLC

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 020-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 4

Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia

Coventry Health Care of Florida, Inc.

First Coast Advantage, LLC

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 021-12/13


Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 5

Pasco and Pinellas

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 022-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 6

Hardee, Highlands, Hillsborough, Manatee and Polk

Amerigroup Florida, Inc.

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Integral Health Plan, Inc. dba Integral Quality Care

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 023-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 7

Brevard, Orange, Osceola, and Seminole

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 024-12/13


Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 8

Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Integral Health Plan, Inc. dba Integral Quality Care

Prestige Health Choice

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 025-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 9

Indian River, Martin, Okeechobee, Palm Beach and St. Lucie

Amerigroup Florida, Inc.

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Prestige Health Choice

Salubris, LLC

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 026-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 10

Broward County

AHF MCO of Florida, Inc. D.B.A. Positive Healthcare Florida HIV/AIDS Specialty Plan

Amerigroup Florida, Inc.

Better Health, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Florida True Health, Inc.

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Preferred Medical Plan, Inc.

Salubris, LLC

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

South Florida Community Care Network (SFCCN)

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

AHCA ITN 027-12/13

Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 11

Miami-Dade and Monroe

AHF MCO of Florida, Inc. D.B.A. Positive Healthcare Florida HIV/AIDS Specialty Plan

Amerigroup Florida, Inc.

Care Access PSN, LLC

Coventry Health Care of Florida, Inc.

Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan

Freedom Health, Inc.

Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan

Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan

Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan

Freedom Health, Inc. Diabetes Specialty Plan

Humana Medical Plan, Inc.

Molina Healthcare of Florida, Inc.

Preferred Medical Plan, Inc.

Prestige Health Choice

Salubris, LLC

Simply Healthcare Plans, Inc.

Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan

South Florida Community Care Network (SFCCN)

Sunshine State Health Plan, Inc.

Sunshine State Health Plan, Inc. Child Welfare Specialty Plan

UnitedHealthcare of Florida, Inc.

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida

Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan

 

Federal Authorities



Choose an arrow below to view more information.


Managed Medical Assistance


arrows Request for Extension of the 1115 MMA Waiver and Public Input arrows

The state is seeking federal authority to extend Florida’s Managed Medical Assistance (MMA) Waiver for the period July 1, 2014 to June 30, 2017. The waiver is designed to implement a new statewide managed care delivery system without increasing costs and to re-design the Low Income Pool program. The MMA program will provide primary and acute medical care for certain populations through high quality, competitively selected managed care organizations (MCOs).

Extension Request Submitted November 27, 2013

On November 27, 2013, the Agency submitted a 3-year waiver extension request to the Centers for Medicare and Medicaid Services.  The 1115 MMA waiver extension request and cover letter can be viewed at the following links. If you have comments, please submit them to the Agency via mail or email (see ‘Submit Comments’ below).

Public Notice Document Posted October 1, 2013

To view the public notice document posted on this webpage during the public comment period conducted from October 1, 2013 through October 30, 2013, please click the following link:

arrows Waiver History (2006-2013) arrows

The following is an historical description of the waiver since authorization in 2005.

Initial 5-Year Period (2006-2011):  On October 19, 2005, Florida's 1115 Research and Demonstration Waiver named “Medicaid Reform” was approved by Federal CMS to operate the demonstration for the period from July 1, 2006 to June 30, 2010.  The program was implemented in Broward and Duval Counties July 1, 2006 and expanded to Baker, Clay and Nassau Counties July 1, 2007. 

Three-Year Extension Period (2011-2014):  On June 30, 2010, a three-year waiver extension request was submitted to Federal CMS to maintain and continue operations of Medicaid Reform for the period July 1, 2011 to June 30, 2014.  Federal CMS granted temporary extensions of the program until December 15, 2011, when final approval of the waiver extension request was granted for the period December 16, 2011 to June 30, 2014.

MMA Waiver Amendment (June 14, 2013):  On June 14, 2013, Federal CMS approved the MMA amendment that allows for the implementation of a new statewide managed care delivery system without increasing costs and to continue the Low Income Pool program. The amendment also changed the name of the waiver to the Florida Managed Medical Assistance program. 

To view the June 14, 2013 approval letter, approved Special Terms and Conditions of the waiver, and the Waiver and Expenditure Authorities document, please click on the following links:


arrows Legislative Authority to Seek Waiver Extension (2014-2017) arrows

During the 2011 legislative session, the Florida Legislature passed and Governor Scott signed legislation to expand managed care the Florida Medicaid program with the creation of the MMA program.  Part IV of Chapter 409, Florida Statutes, directs the Agency to submit and obtain approval of any federal waivers or state plan amendments necessary to implement the MMA program no later than October 1, 2014.  In accordance with this directive, the Agency is seeking approval to extend the waiver authorization period from July 1, 2014 until June 30, 2017.

To view the law that established the MMA program, please click on the following link:


arrows Public Notice and Public Comment Period Held October 1 – October 30, 2013 arrows

The Agency must provide for a 30-day public notice and comment period prior to the submission of the waiver extension request to Federal CMS. The 30-day public notice and public comment period began October 1, 2013 and ended October 30, 2013.  The Agency considered all public comments received during the 30-day public comment period while developing the waiver extension request.


arrows Public Meetings/Workshops arrows

The following outlines the publicly noticed meetings that have occurred.

Schedule of Public Meetings

Location Address

Date

Time

FAR Notice

Agenda/
Presentation

Tampa
Egypt Shriners
4050 Dana Shores Drive
Tampa, FL 33634
Map It

October 8, 2013

1:00p.m. – 3:30p.m.

FAR
[24KB PDF]

Agenda
[78KB PDF]

Presentation
[509KB PDF]

Miami
Florida International University (FIU)
Kovens Center
3000 N.E. 151 Street
North Miami, FL 33181-3000
Map It

October 9, 2013

1:00p.m. – 3:30p.m.

FAR
[24KB PDF]

Agenda
[79KB PDF]

Presentation
[509KB PDF]

Tallahassee
Agency for Health Care Administration
2727 Mahan Drive,
Building 3, 1st Floor
Conference Room A
Tallahassee, FL 32308
Map It

October 11, 2013

1:00p.m. – 3:30p.m.

FAR
[24KB PDF]

Agenda
[78KB PDF]

Presentation
[509KB PDF]

To view the video recording of the public meeting held in Tallahassee on October 11, 2013, please click on the picture below. This will direct you to the Florida Channel website and then press the play button to view the video. Video provided by The Florida Channel.

Click to view video of public meeting Tallahassee October 11, 2013 re Extenion Request for Florida 1115 Managed Medical Assistance Waiver

 

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting Ms. Linda Macdonald at (850) 412-4031 or by email at Linda.Macdonald@ahca.myflorida.com.

If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1 (800) 955-8771 (TDD) or 1 (800) 955-8770 (Voice).


arrows Submit Comments arrows

The 30-day public notice and public comment period began October 1, 2013 and ended October 30, 2013.  The Agency considered all public comments received during the 30-day public comment period while developing the waiver extension request.

To submit comments by postal service or internet email, please follow the directions outlined below.  When providing comments regarding the 1115 MMA Waiver extension request, please have ‘1115 MMA Waiver Extension Request’ referenced in the subject line.

Mail comments and suggestions to:

1115 MMA Waiver Extension Request
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308

You may also e-mail your comments and suggestions to:

FLMedicaidWaivers@ahca.myflorida.com

If you would like to be added to the Interested Parties List to receive email updates about the 1115 MMA Waiver Extension Request, please provide your information in the box located in the top right hand side of this page named, “Program Updates.” Please note that information will be sent to this list via mass email. Your email server may recognize this as Spam or Junk Mail and, therefore, some action may be required on your part to receive notices.

  • If you are interested in learning more about the Managed Medical Assistance program, please click on the following links to view an overview and frequently asked questions about the program:


arrows Request for 1115 Waiver / Medically Needy Component arrows

During the 2011 legislative session, the Legislature considered several alternative approaches to the Medically Needy program.  In the bills (House Bills 7107 and 7109) that were enacted, the Legislature continued the Medically Needy program and directed the Agency to seek federal waiver authority to change the program to provide additional months of coverage, to implement a premium that would not exceed the share of cost and to provide care coordination and utilization management to achieve more cost-effective services.

Florida Medically Needy 1115 Waiver Application [4.71MB PDF]

arrows Public Input arrows

The Agency must allow a 30-day public notice and comment period regarding applications for a new demonstration project that the Agency plans to submit to Federal CMS for review and consideration. The Agency will consider the public comments while developing the application for the proposed 1115 Research and Demonstration waiver for Florida’s Medically Needy program. To view a comprehensive description of the proposed 1115 Research and Demonstration for Florida’s Medically Needy program please click the following link to the public notice document. [625KB PDF]


arrows Public Workshops arrows

The public workshop locations and times are as follows:

Location Address

Date

Time

Agenda and Presentation

Westin Ft. Lauderdale
400 Corporate Drive
Ft. Lauderdale, FL 33334
Phone:  (954) 772-1331
Fax:  (954) 772-6867

October 19, 2012 

2:00 pm -
5:00 pm

FAR Notice [77KB PDF]
Agenda [45KB PDF]
Presentation [109KB PDF]
Video of Meeting

Medical Care Advisory Committee Meeting

Agency for Health Care Administration
2727 Mahan Drive
Building 3, Conference Room A
Tallahassee, FL 32308

October 23, 2012

Call-In Information (Listen Only): 1-888-670-3525. When prompted, enter the participant pass code: 4265177105

1:00 pm - 4:00 pm

FAR Notice [77KB PDF]
Agenda [45KB PDF]
Presentation [109KB PDF]

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting Robin Ingram at (850) 412-4017 or by email at Robin.Ingram@ahca.myflorida.com. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1 (800) 955-8771 (TDD) or 1 (800) 955-8770 (Voice).


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  • To comment by postal service or internet, please follow directions outlined in the “Comments or Questions” informational box located on the top right hand side of page. When providing comments regarding the Medically Needy program, please have ‘Medically Needy’ referenced in the subject line.
  • For more information on 1115 Research and Demonstration waivers you may visit Federal CMS website at the following link http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html.
  • The Agency will post all public comments here periodically throughout the 30-day public notice and comment period.
  • The 1115 waiver application 30-day public comment period began October 12, 2012. Public comment was received via the public meetings held in Ft. Lauderdale 10/19 and Tallahassee 10/23. Public comment will continue to be received via FLMedicaidManagedCare@ahca.myflorida.com email, and U.S. Postal service mail to 2727 Mahan Drive, Tallahassee, FL 32308. The following is a collection of public comments that will be updated as received.

    Medically Needy Comments [2.91MB PDF]






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