Issues with Medicaid?

The new Statewide Medicaid Managed Care (SMMC) contracts were rolled out in December 2018, January 2019, and February 2019. Providers experiencing issues with proper payments from plans or other issues related to the roll out are encouraged to first attempt to resolve the issue with the SMMC plan directly. SMMC plan contacts can be located here. Should the SMMC plan fail to correct the error in payment or otherwise resolve the issue in a timely manner, a formal complaint should be submitted to the Agency for Health Care Administration (AHCA). Filing a formal complaint is the only way AHCA can track complaints to identify a pattern of behavior by a plan. Information on filing a formal complaint with AHCA is available here. Complaints may be submitted online or by calling 1-877-254-1055 Monday through Friday, 8am-5pm EST.

Resilience

Resilience
The Biology of Stress & The Science of Hope

ACEs Documentary RESILIENCE Will Broadcast Throughout the State of Florida On Public TV

KPJR Films & PBS Stations will broadcast the award-winning documentary in Honor of the
Marjory Stoneman Douglas High School Victims and to Support the Healing of the Community

RESILIENCE: The Biology of Stress and the Science of Hope will air on public TV Station throughout Florida on February 15th at 9:00 pm ET. The broadcast will commemorate the victims and
survivors of Marjory Stoneman Douglas High School shooting which happened in Parkland, FL one year ago. Following the broadcast KPJR Films will host a RESILIENCE National Twitter Town Hall with discussion of aspects of trauma, toxic stress and resilience with professionals and subject matter experts including: James Redford, Director of Resilience; Alice Forrester, PhD CEO Clifford Beers Foundation, Jane Stevens, ACES Connection and other experts from Florida. Join the Twitter Town Hall at @DocResilience using #ResilienceFL.

RESILIENCE shows us, through science and the stories of our young people, how adults are stepping up to help children who are exposed to adverse experiences,” said James Redford, Director, KPJR Films. “We hope the stories of children, educators and scientists grappling with the results of trauma help raise awareness, foster conversation and inspire action. We so appreciate the PBS stations who are broadcasting this timely information into their communities.” “We are thrilled that RESILIENCE will be broadcast throughout the state of Florida on Public TV. The broadcast works to meet our goal of helping our states and communities build resilience and change the trajectory of that child and families’ lives. We believe that many of Florida’s most costly, intractable social problems, including our opioid and substance abuse crisis, our growing public health costs, tragic school failures, and the multigenerational cycle of families in our criminal justice and child welfare systems, can be decreased by addressing early trauma and building resilience,” said MiMi Graham, Director, Florida State University Center for Prevention & Early Intervention Policy.

The following stations will be airing this film:
WGCU Naples area          WUCF Orlando                WSRE Pensacola        WJCT Jacksonville
WEDU Tampa                  WUFT Gainesville            WPBT Miami              WFSU Tallahassee/North Florida

We see the film Resilience as an advocacy tool that our community can use to help explain toxic stress and its impact on students and how they function in schools,” said Katherine C. Cowan, Communications Director, National Association of School Psychologists (NASP). “This is a problem we can solve, but it will take expertise and support from educators, school psychologists, health experts and elected officials.”

KPJR Films, a producer of independent films about pressing social issues, offers documentary films Paper Tigers and Resilience for screening in local communities. There are additional resources available on the KPJRfilms.co website, including a Resilience Facilitator’s Guide and a One Caring Adult Resource portal.

Learn more about Resilience here.

Register Now – FPP2019!

Registration for The Future of Pediatric Practice 2019 is now open! With a new venue and expanded educational sessions, this year’s conference is not to be missed!

After the Pediatric Resident Forum and Brain Bowl competition on Friday, attendees and their families are invited to enjoy live entertainment in the Exhibit Hall before eating, dancing, and meeting Disney characters at the Family Reception. Saturday and Sunday both start with an optional yoga session and hot breakfast before some of the top pediatric experts take the stage. Saturday includes 8 hours of CME/CEU and a full, complimentary lunch. Sunday offers 6 hours of CME/CEU with two new tracks tailored to your practice and educational needs! “Big Thunder Mountain” is the Community Pediatrics Track which includes topics that have been tailored to the primary care general pediatrician, whether in solo or group practice. “Carousel of Progress” is the Hospital Pediatrics Track which includes topics that hospital-based pediatricians, such as hospitalists, specialists, and acute care pediatricians would find beneficial. View the full conference agenda here.

Back by popular demand, an optional bonus track is available on Sunday afternoon. “Stay Independent! Running a Successful & Profitable Pediatric Practice.” will provide a complimentary lunch and additional 4 hours of CME/CEU. Industry experts will discuss ways to retain patients, increase revenues, and effectively manage a pediatric practice. The afternoon will end with an open panel, allowing you to ask the questions you’ve always wanted answered! This bonus track, which can be included with full conference registration or registered for separately, is perfect for providers practicing in an independent practice, providers considering a move to independent practice, and practice administrators/office managers working in a pediatric practice.

Attendees and their families will enjoy beautiful accommodations at Disney’s Yacht & Beach Club Resorts. Specially priced rooms are available to conference attendees and their guests during the conference and for three days before and three days after the conference, allowing you to participate in educational sessions during the day and enjoy the amenities at night. Specially priced tickets to Disney theme parks are available to conference attendees, including tickets to attend the Food and Wine Festival at Epcot – a short walk from the resort.

See the full conference agenda and details here. Register early to take advantage of discounted registration rates!

 

New CMS Health Plan

A message from Deputy Secretary of Children’s Medical Services, Dr. Jeffrey Brosco:

Dear Colleagues,

You are likely well aware of the exciting changes to our CMS Health Plan starting this Friday, February 1st.  By partnering with Wellcare, we believe that the CMS Health Plan will be able to better serve children with special health care needs, their families, and pediatric providers.  This “Frequently Asked Questions” document that you should have received already by email.

Some key messages:

Families should be getting calls and letters (such as this one) with the message that they do not need to do anything to continue with CMS Health Plan coverage.  Families should continue to make and go to appointments just as they always have.  If a family has questions, they should call CMS Health Member services operated by WellCare at 866-799-5321.

More than 90% of current CMS health care providers are already part of the new CMS Health Plan operated by Wellcare, so most families will not see any disruptions in their child’s care.  There is also a 180 day continuity of care provision, so there is still a lot of time for signing on providers and ensuring smooth transitions when there has to be a change in providers.

Many of our current CMS care coordinators, as well as leaders in the current CMS Health Plan, have been hired by Wellcare.  We are committed to making this transition as seamless as possible for families and health care providers.

The Florida Department of Health will continue to have close oversight of all aspects of the CMS Health Plan, including clinical eligibility, to help ensure that children receive the care they need.

Additional information will be available on our website: 

http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/

We appreciate all the work that you do to improve the health of children with special health care needs, and we hope that you will help disseminate this information to families and your colleagues.

There are bound to be difficulties in a transition of this magnitude.  Please do not hesitate to let us know what’s working and what’s not.

We all want the best for Florida’s children and families.

Thank you,

Jeffrey P. Brosco MD PhD
Deputy Secretary
Children’s Medical Services
Florida Department of Health
4052 Bald Cypress Way, Bin A06
Tallahassee, Florida 32399-1707
Phone: 850.245.4213

 
 
 
 
The Mission of the Florida Department of Health:
To protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

Controlled Substance Prescribing Course

Do Not Forget – January 31, 2019, Deadline!

Section 456.0301, Florida Statutes, requires each prescribing practitioner registered with the United States Drug Enforcement Administration and approved to prescribe controlled substances to complete a board approved course on prescribing controlled substances by January 31, 2019.  The current law does not allow the Department of Health to renew a license if the licensee does not complete the course by January 31, 2019. 

As of last week, only 55.2% of Medical Doctors have completed the approved course or notified the Department of Health that they are not registered with the United States Drug Enforcement Administration. 

As a reminder, the Department of Health must receive from each licensed physician either:

  • Confirmation that s/he has completed the required controlled substance prescribing course; or
  • Confirmation that s/he is not individually registered with the DEA to prescribe controlled substances

Providers will not be able to renew their license if they do not complete a Florida approved course by January 31, 2019.

If you have not done so already, please follow the steps below to ensure compliance:

  1. Visit our secure “Online Services” website: http://www.flhealthsource.gov/mqa-services
  2. Do you already have an account?
    1. Click “Yes” and log in using your MQA Online Services user ID and password
    2. Click “No” and follow the instructions provided to complete your one-time account registration
  3. Once logged in:
    1. Go to the “Manage My License” section
    2. Select “Add/Change DEA Registration” in the drop-down list and follow the instructions to indicate if you hold a current registration with the U.S. Drug Enforcement Administration
      1. If you hold a current individual DEA Registration
        1. You may provide your DEA number
        2. You MUST complete the CE/CME course by January 31, 2019
      2. If you are using the DEA registration of an institution or supervisor and do not have an individual DEA registration
        1. Indicate that you are not registered with the DEA
        2. You do not have to take the CE/CME course by January 31, 2019
      3. If you do not have a current individual DEA registration
        1. Indicate that you are not registered with the DEA
        2. You do not have to take the CE/CME course by January 31, 2019

After indicating you are not registered with the DEA then you DO NOT have to take a course on controlled substance prescribing.

Please email Takecontrol@FLhealth.gov if you have any questions.

The Florida Pediatrician, Winter 2019

The Winter 2019 edition of The Florida Pediatrician is now available! Articles include:

  • Health Care Transition 101: Bridging the Gaps for Youth and Young Adults with Special Health Care Needs
  • The Care of Transgender Youth
  • Acute Fever, Rash, Headache and Vomiting in a 13-Year-Old Male
  • Pediatric Raynaud Phenomenon Workup and Treatment: A Case Report

Read the Winter 2019 edition here (use presentation mode for the best viewing)!

CMS Plan Transition to WellCare

Information about CMS Plan Transition to WellCare

In December, several practices/health systems received a notice of termination of their contracts with the University of Florida for participation in the Ped-I-Care provider network. Additional information from CMS that may answer some common questions from providers and families is provided below.

The “Ped-I-Care” members always were and will continue to be members of the Children’s Medical Services Managed Care Plan a/k/a the CMS Plan for both Title 19 and for Title 21. Ped-I-Care, a program of the University of Florida, was an administrator for the CMS Plan. Ped-I-Care provided utilization management services, provider compliance services, member services for the CMS children, and contracted for network providers, so, as an administrator for the CMS Plan, Ped-I-Care interacted with practices on many different levels and in many different areas over the years.

  1. No, the Children’s Medical Services Managed Care Plan (CMS Plan) is not going away. See CMS website: http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/for-health-care-providers/index.html (CMS: WE’RE HERE TO STAY) “Rumors have circulated that CMS Plan is “going away” or “closing.” Neither of these is true. While CMS Plan is again in a time of transition, we remain working for the health, safety and quality of life of the children and families we serve.”
  2. Yes, both the Title 19 (Medicaid) and the Title 21 (CHIP/KidCare) populations of children with special health care needs (members) will continue to be enrolled in the CMS Plan. See CMS website: http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/for-health-care-providers/index.html (CMS: WE’RE HERE TO STAY) “At this time, there are no immediate changes for providers in our network or for the families we serve. Families do not need to do anything differently, and credentialed providers are still able to see CMS Plan members. Please continue to visit our website for updates (www.CMSPlanFlorida.gov), and rest assured we will contact our members and provider network directly with any changes that will affect them.”
  3. Yes, the Ped-I-Care program at the University of Florida will cease operations. The University’s contract with the Department of Health to provide administration services for the CMS Plan ends on February 6, 2019.
  4. Yes, there will be another administrator for the CMS Plan. CMS announced on 12/18/18 that WellCare will be the new administrator of the CMS Plan (Title 19 and Title 21) as of 2/1/19. See CMS website: http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/updates-events/index.html: (NOTICE OF TERMINATION) “On Dec. 18, 2018, the Florida Department of Health announced its intent to award WellCare with a statewide contract to implement a new service delivery model for the Children’s Medical Services Health Plan (CMS Health Plan). The Florida Department of Health (DOH) will partner with WellCare to offer the CMS Plan as of February 1, 2019.”
  5. No, please do not cancel upcoming or future appointments with CMS members. See CMS website: http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/for-health-care-providers/index.html (DID YOU RECEIVE A NOTICE) “We will honor ongoing treatment that was authorized prior to February 1st, for up to 180 days.”
  6. Yes, you will be able to continue to see CMS members. There is a continuity of care period. See CMS website: http://www.floridahealth.gov/programs-and-services/childrens-health/cms-plan/updates-events/index.html (CONTINUITY OF CARE PROVISIONS) “Medicaid health and dental plans are required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that when enrollees transition from one health or dental plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition.”
  7. Yes, CMS members should receive new CMS ID cards in the near future. If a member does not receive a card, please have them reach out to their Nurse Care Coordinator or to WellCare.
  8. Yes, to continue to provide services to CMS children after the continuity of care time period, please contact WellCare at FloridaProviderRelations@wellcare.com or call 1-407-551-3200, option 2.
  9. No, the changes currently taking place between AHCA and other ‘big’ MMA Plans does not affect the CMS Plan’s change of administrators from Ped-I-Care to WellCare.  These are unrelated events.
  10. Yes, Ped-I-Care will be here until 2/6/19 to serve our children and our providers.

Thank you for providing services to children enrolled in the CMS Plan assigned to Ped-I-Care.  Your dedication to children with special health care needs is so valuable!

 

SMMC: Continuity of Care

The Agency for Health Care Administration (“AHCA”) contracts with Medicaid health and dental plans to provide services to health plan enrollees in the Statewide Medicaid Managed Care (“SMMC”) program. AHCA recently entered into new contracts with health and dental plans. As part of those contracts, AHCA achieved program changes that greatly benefit enrollees and providers. AHCA will transition to the new contracts through a regional phased roll-out. The first regional roll out will occur this Saturday, December 1, 2018.

Health and dental plans are required to ensure continuity of care (“COC”) during the transition period for Medicaid recipients enrolled in the SMMC program.  COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition.  AHCA has instituted the following COC provisions:

  • 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 roll-out date 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 the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.
  • Providers will be paid promptly.  During the continuity of care period, plans are required to follow all timely claims payment contractual requirements.  AHCA will monitor complaints to ensure that any issues with delays in payment are resolved.
  • Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.

More information about COC provisions can be referenced on the COC program highlight document, which is posted on AHCA’s website at www.ahca.myflorida.com/smmc. Once on the page, click Program Changes, then the Outreach and Presentations link.

For a full overview of the SMMC Program Changes and links to additional resources please visit this post on the FCAAP website: SMMC Program Changes

Ate too much at Thanksgiving? Lose the “wait” and save 8%!

Ate too much at Thanksgiving? Lose the “wait” and save 8% when you pre-register for
The Future of Pediatric Practice 2019!

With a NEW venue and exciting new CME topics, FCAAP’s Annual Conference is going to be bigger and better than ever in 2019! We know you’re excited to attend, so we want to help you lose the “wait” this holiday weekend. For a limited time, take 8% off registration rates for FCAAP’s Annual Conference: The Future of Pediatric Practice 2019!

Labor Day Weekend – August 30 – September 1, 2019

Why attend The Future of Pediatric Practice 2019?

  • NEW Location at Disney’s Yacht & Beach Club Resorts
  • Network with fellow Florida providers and FCAAP Leaders
  • Earn CME/CEU credits while learning from top pediatric experts
  • Cheer on Florida’s top pediatric residency programs during the Brain Bowl
  • Enjoy food, fun, dancing, and meet Disney characters at the Family Reception
  • Special hotel rates and discounted tickets to Disney theme parks, valid for the Epcot International Food & Wine Festival

Discounted rates start at 12:00am EST on Friday, Nov. 23 and run through 11:59pm EST on Monday, Nov. 26.

Click here to download the pre-registration form. Send completed forms to aadams@fcaap.org by the deadline to reserve your spot at the discounted rate!

Statewide Medicaid Managed Care Program Overview & Dental Overview

FLORIDA MEDICAID

Webinar Schedule: Statewide Medicaid Managed Care Program Overview & Dental Overview

The Agency for Health Care Administration (“AHCA”) contracts with Medicaid health and dental plans to provide services to health plan enrollees in the Statewide Medicaid Managed Care (“SMMC”) program. AHCA recently entered into new contracts with health and dental plans. As part of those contracts, AHCA achieved program changes that greatly benefit enrollees and providers.

AHCA will be hosting public webinars over the course of the next few months to share information about updates to the SMMC program.

Join AHCA for webinars relating to SMMC Overview and Dental Overview every Wednesday afternoon. These webinars will consist of a pre-recorded presentation with the same information each webinar followed by a live question and answer session. To register for any of these webinars, please click the registration links below:

Wednesday, November 14th, 2:00 – 3:00pm EST: Dental Overview – Register
Wednesday, November 21st, 2:00 – 3:30pm EST: SMMC Overview – Register
Wednesday, November 28th, 2:00 – 3:00pm EST: Dental Overview – Register
Wednesday, December 5th, 2:00 – 3:30pm EST: SMMC Overview – Register
Wednesday, December 12th, 2:00 – 3:00pm EST: Dental Overview – Register
Wednesday, December 19th, 2:00 – 3:30pm EST: SMMC Overview – Register
Wednesday, December 26th, 2:00 – 3:00pm EST: Dental Overview – Register
Wednesday, January 2nd, 2:00 – 3:30pm EST: SMMC Overview – Register
Wednesday, January 9th, 2:00 – 3:00pm EST: Dental Overview – Register
Wednesday, January 16th, 2:00 – 3:30pm EST: SMMC Overview – Register
Wednesday, January 23rd, 2:00 – 3:00pm EST: Dental Overview – Register
Wednesday, January 30th, 2:00 – 3:30pm EST: SMMC Overview – Register

In order to accommodate as many participants as possible, please try to consolidate participation within organizations. Please note that if you are unable to attend due to scheduling conflicts or the webinar has reached the webinar capacity limit, the information will be posted on the AHCA website.

For additional information on the SMMC program, please visit http://ahca.myflorida.com/SMMC.

QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com

COMPLAINTS OR ISSUES? ONLINE: http://ahca.myflorida.com/Medicaid/complaints/|  PHONE:  1-877-254-1055