The Florida Medicaid program implemented a new system through which Medicaid enrollees will receive services. This program is called the Statewide Medicaid Managed Care Managed Medical Assistance Program.
The Managed medical Assistance program (hereinafter called “MMA”) is comprised of several types of managed care plans:
- Health Maintenance Organizations (HMOs)
- Provider Service Networks (PSNs)
- Children’s Medical Services Network
Most Medicaid recipients must enroll in the MMA program.
Who is NOT required to Participate?
The following Individuals are NOT required to enroll, although they may enroll if they choose to:
- Medicaid recipients who have other credible health care coverage, excluding Medicare
- Persons eligible for refugee assistance
- Medicaid recipients who are residents of a developmental disability center
- Medicaid recipients enrolled in the developmental disabilities home and community based services waiver or Medicaid recipients waiting for waiver services.
Who is NOT eligible to participate?
The following individuals are NOT eligible to enroll:
- Women who are eligible for only family planning services
- Women who are eligible through the breast and cervical cancer services program
- Persons who are eligible for emergency Medicaid for aliens
- Children receiving services in a prescribed pediatric extended care center
What services are provided under the LTC program?
|LTC Program Minimum Covered Services|
|Adult companion care||Intermittent and skilled nursing|
|Adult day health care||Medical equipment and supplies|
|Assisted living||Medication administration|
|Assistive care services||Medication management|
|Attendant care||Nursing facility|
|Behavioral management||Nutritional assessment/ risk reduction|
|Care coordination/ Case management||Personal care|
|Caregiver training||Personal emergency response system|
|Home accessibility adaptation||Respite care|
|Home-delivered meals||Therapies, occupational, physical, respiratory and speech|
What providers are included in the LTC plans?
LTC plans may limit the providers in their networks based on credentials, quality indicators, and price – But they must include a minimum number of all of the providers listed in the chart below.
In addition, LTC plans must offer initial contracts to certain providers within their region, including: nursing facilities, hospices and aging network services providers in their region.
|LTC Program Minimum Network Providers|
|Adult day care centers||Homemaker and companion services|
|Adult family-care homes||Hospices|
|Assisted living facilities||Community care for the elderly lead agencies|
|Health care service pools||Nurse registries|
|Home health agencies||Nursing home|
Other qualified providers under the LTC program include: Alarm System Contractors, Case Managers and Case Management agencies, Centers for Independent Living, Community Transportation Coordinators, Dietician/ Nutrition Counselors, Homemaker/ Companion Agencies, Durable Medical Equipment and Home Medical Equipment providers, Licensed Practical Nurses, Occupational, Physical, Respiratory and Speech Therapists, and Registered Nurses.
Clinical Social Workers, Community Mental Health Centers, Mental Health Counselors, and Psychologists may contract to provide the behavioral management service.
Plans must have a sufficient provider network to serve the needs of their plan enrollees.
What Regions am I in?
|1||Escambia, Okaloosa, Santa Rosa, and Walton|
|2||Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington|
|3||Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union|
|4||Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia|
|5||Pasco and Pinellas|
|6||Hardee, Highlands, Hillsborough, Manatee, and Polk|
|7||Brevard, Orange, Osceola, and Seminole|
|8||Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota|
|9||Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie|
|11||Miami-Dade and Monroe|
When will the MMA program begin?
The MMA program will be implemented by region.
- Regions 2, 3 & 4 – Enrollment begins May 1, 2014
- Regions 5, 6 & 8 – Enrollment begins June 1, 2014
- Regions 10 & 11 – Enrollment begins July 1, 2014
- Regions 1, 7 & 9 – Enrollment begins August 1, 2014
When will I be notified and be required to enroll?
- Approximately 60 days prior to each region’s start date, eligible Medicaid recipients will receive a letter with information about the managed care plans in the region and information on how to enroll.
- Eligible recipients who must enroll will have a minimum of 30 days from the date they receive their welcome letter to choose from the plans available in their region.
- Enrollees will have 90 days after enrollment to change to a different plan if they so chose.
What do you have to do to choose a LTC plan?
- Choice counselors are available to assist recipients in selecting a plan that best meets their needs. This assistance will be provided by phone. In person visits are also available by request for recipients with special needs.
- Recipients can enroll online at: www.flmedicaidmanagedcare.com.
What MMA Standard (Non-Specialty) plans are available in each region?
|First Coast Advantage||x|
What are MMA Specialty plans?
- Specialty plans will serve populations with a distinct diagnosis or chronic condition. These plans are tailored to meet the specific needs of the specialty population.
- Information on each specialty plan is available through choice counseling website: www.flmedicaidmanagedcare.com.
What MMA Specialty plans are available in each region?
|Clear Health Alliance HIV/AIDS||x||x||x||x||x||x||x||x||x|
|Freedom Health-Duals Chronic Conditions||x||x||x||x||x||x||x|
|Magellan Complete Care-Serious Mental Illness||x||x||x||x||x||x||x||x|
|Positive Healthcare Florida HIV/AIDS||x||x|
|Sunshine Health Plan Child Welfare||x||x||x||x||x||x||x||x||x||x|
|Children’s Medical Services Children with Chronic Conditions||x||x||x||x||x||x||x||x||x||x||x|
Can you change MMA plans once you make a selection?
- Recipients are encouraged to work with their choice counselor to choose the MMA plan that best meets their needs.
- After joining a plan, the recipient has 90 days to change to another plan offered within their region.
- After the 90-day deadline, recipients may only change plans for “good cause” reasons.
- After the initial 12-month period, recipients may change plans during an open enrollment period.
What Medicaid covered services are provided under the MMA program?
Minimum covered services:
|Advanced registered nurse practitioner services||Laboratory and imaging services|
|Ambulatory surgical treatment center services||Medical supply equipment, prostheses & orthoses|
|Assistive care services||Mental health services|
|Birthing center services||Nursing care|
|Chiropractic services||Optical services & supplies|
|Dental services||Optometrist services|
|Early periodic screening diagnosis & treatment services for recipients under age 21||Physical, occupational, respiratory & speech therapy|
|Emergency services||Podiatric services|
|Family planning services & supplies (some exception)||Physician service, including physician assistant services|
|Health start services (some exceptions)||Prescription drugs|
|Hearing services||Renal dialysis services|
|Home health agency services||Respiratory equipment & supplies|
|Hospice services||Rural health clinic services|
|Hospital inpatient services||Substance abuse treatment services|
|Hospital outpatient services||Transportation to access covered services|
What benefits not otherwise covered by Medicaid are available from MMA plans?
|List of Expanded Benefits||Amerigroup||Better||First Coast||Coventry||Humana||Integral||Molina||Preferred||Prestige||SFCCN||Simply||Staywell||Sunshine||United|
|Adult Dental services||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Adult Hearing services||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Adult Vision services||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Home Health care for non-pregnant adults||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Medically related lodging & food||Y||Y||Y||Y||Y||Y||Y|
|Outpatient hospital services||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Over the counter medication & supplies||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Physician home vists||Y||Y||Y||Y||Y||Y||Y||Y||Y|
|Primary care visits for non-pregnant adults||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y||Y|
NOTE: Details regarding scope of covered benefit may vary by managed care plan.
What providers will be included in the MMA plans?
- Managed Medical Assistance plans may limit the providers in their network based on credentials, quality indicators, and price but they must include certain providers sufficient to serve the needs of their plan enrollees.
- In addition, plans must include the following statewide essential providers:
Statewide MMA Program Required Essential Network Providers:
- Faculty Plans of Florida Medical Schools
- Specialty Children’s Hospital
- Regional Perinatal Intensive care Centers (RPICCS)
- Health care providers serving medically Complex Children, as determined by the State
- Plans must have a sufficient provider network to serve the needs of their plan enrollees, as determined by the State.
Additional Qualified Providers Under the MMA Program Include:
|General Surgeons||Infectious Diseases|
|Pathologists||Pediatric Primary Care Providers & Specialists|
|Pharmacies||Board Certified or Board Eligible Psychiatrists|
|Licensed Practitioners of the Healing Arts||Inpatient Substance Abuse Detoxification Units|
|Fully Accredited Psychiatric Community Hospitals or Crisis Stabilization Units (CSU)/Freestanding Psychiatric Specialty Hospitals|
Will my services be interrupted?
To ensure the movement to the new program is a smooth one, the Agency has in place several core program requirements that will allow for seamless continuity of care during the transition period:
- Health care providers should not cancel appointments with current patients. Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the MMA starts in each region.
- Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. Plans must pay for previously authorized services for up to 60 days after MMA starts in each region, and must pay providers at the rate previously received for up to 30 days.
- Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after MMA starts in their respective region, until their prescriptions can be transferred to a provider in the plan’s network.
The material above represents general legal advice. Since the law is continually changing, some provisions may, or may not apply to you. Some provisions may have exceptions you need to be aware of. It is always best to consult an attorney about your legal rights and responsibilities regarding your particular case.
Please contact us to discuss any specific situation or needs you may have to see how we may be able to assist in reaching a resolution. We offer a free thirty (30) minute consultation to see if we can help.