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

Rescheduled Rule Development Workshop – Early Intervention Services

Florida Medicaid 

Rule 59G-4.085, Early Intervention Services
Rescheduled Rule Development Workshop
Provider Type(s): 70, 78, 81

The Agency for Health Care Administration has rescheduled a workshop for Rule 59G-4.085, Early Intervention Services and new Rule 59G-4.086, Early Intervention Session Services.

The reschedule workshop will be held on November 13, 2018 from 8:00 a.m. to 8:45 a.m., EST at:

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

There will NOT be a phone call-in number available.

Official notice of the rescheduled workshop was published in Volume 44, Number 211 of the Florida Administrative Register (FAR) on October 29, 2018. A copy of the notice may be found on the FAR website.

Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop on the Agency’s Rules webpage.

Official comments to be entered into the rule record following the publication of a Notice of Rule Development or Notice of Proposed Rule may be e-mailed to MedicaidRuleComments@ahca.myflorida.com. For general inquiries and questions about the rule, please contact Matt Brackett, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: (850)412-4151, e-mail: Matt.Brackett@ahca.myflorida.com.

Webinar: SMMC – Overview of Early Intervention Service

October 26 Webinar: Statewide Medicaid Managed Care (SMMC) Program:  Overview of Early Intervention Service
For All Provider Types

The Agency for Health Care Administration (AHCA) is hosting a public webinar on October 26, 2018, to share information about updates to the Statewide Medicaid Managed Care program.

AHCA contracts with Medicaid health and dental plans to provide services to health plan enrollees in the 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.

In addition, AHCA is focused on fully integrated health care.  As such, under these new contracts, health plans will be responsible for covering services previously paid for through the fee-for-service program.  One of these services includes Early Intervention Services.  This webinar will focus on Early Intervention Services. 

Join the webinar on Friday, October 26, 2018 at 2:00 PM EDT. To register for this webinar, please click the “Register Now” button below:

Register now!

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 AHCA’s website.

In addition, AHCA will be hosting other informative webinars in preparation for the implementation of the new SMMC program contracts. Dates will be forthcoming.

For additional information on the SMMC program please visit AHCA’s website.

DCF Mental Health Program Workshop Notice

Notice of Meeting/Workshop Hearing
Department of Children and Families
Mental Health Program

The purpose of this meeting and webinar of the Florida Children’s System of Care State Advisory Team is to give an update on the progress of the statewide plan and discuss future business.

For more information: http://www.socflorida.com/

Date/Time:
October 31, 2018, 10am-12pm

Webinar:
http://floridadcf.adobeconnect.com/r5lal4bvcfvt/

In Person:
Department of Children and Families Headquarters
1317 Winewood Boulevard
Building 6, Conference Room A
Tallahassee  Florida  32399

Official Notice

Hurricane Michael – Resources for Recovery

During this time of recovery following Hurricane Michael, FCAAP will stay in close communication with the American Academy of Pediatrics Disaster Preparedness Advisory Council (“AAP DPAC”) to secure and provide resources for the families, practices, and patients of Florida’s pediatricians. The AAP DPAC’s connections with federal agencies such as the CDC Children’s Preparedness Unit, the FEMA national children’s advisor, Save the Children, the American Red Cross, and Child Care Aware, will help FCAAP and its members during this recovery period. 

Resources will be posted on this website as they become available. Below are some resources that can be used immediately:   

 

New Resources:

Telemedicine companies staffed by pediatricians and who are already providing pediatric care in partnership with FL based organizations such as Nemours are offering free medical care for simple conditions to all those impacted by Hurricane Michael.  Many of our FCAAP pediatricians provide service to patients through one or more of the following:

  • MDLIVE  888-959-9516 and provide the code MICHAEL18 to schedule their initial consultation.
  • AmWell
  • Doctors on Demand enter the code HURRICANEMICHAEL to redeem a free visit with a medical physician
  • Teladoc

Details are available here.

Additional information on pediatric telehealth care is available from the AAP Section on Telehealth Care.

Additional New Resources:

Hurricane Michael Preparedness

Hurricane Michael is expected to make landfall in the Florida panhandle as a category 2 or 3 hurricane tomorrow afternoon, Wednesday, October 10. Florida Governor Rick Scott has issued an Executive Order declaring a state of emergency for the counties in the panhandle of the state and several areas have been ordered to evacuate.

Visit FloridaDisaster.org to find current evacuation orders and other resources to help prepare your family for the storm. The State of Florida Emergency Response Team recommends that all preparations be completed before tonight.

The AAP’s Healthy Children website provides tips and resources to help prepare families for a hurricane. Visit the site to download a information on how to create a disaster supplies kit, prepare your home and pets, and help children cope.

Remember to listen to emergency officials and follow evacuation orders. FCAAP will continue to monitor Hurricane Michael as the storm approaches Florida’s coast and will remain in communication with the AAP and our members to assist with recovery efforts after the storm passes.

Webinar: SMMC Program: Overview of Early Intervention Services

Statewide Medicaid Managed Care Program:
Overview of Early Intervention Services
October 5, 2018, 9:30am EST – Webinar

Due to Hurricane Michael, the webinar was cancelled. You may review the information about the Program here.

The Agency for Health Care Administration (“Agency”) will be hosting a public webinar on October 5, 2018, to share information about updates to the Statewide Medicaid Managed Care (“SMMC”) program.

The Agency contracts with Medicaid health and dental plans to provide services to health plan enrollees in the SMMC program. The Agency recently entered into new contracts with health and dental plans. As part of those contracts, the Agency achieved program changes that greatly benefit enrollees and providers.

In addition, the Agency is focused on fully integrated health care.  As such, under these new contracts, health plans will be responsible for covering services previously paid for through the fee-for-service program.  These services include:

  • Early Intervention Services
  • Medical Foster Care
  • Nursing Facility Services
  • Child Health Services Targeted Case Management

This webinar will focus on Early Intervention Services.  Additional webinars will be presented at a later date on the three remaining services listed above.

Join the webinar on Friday, October 5, 2018, at 9:30 AM EST. To register for this webinar, please click the “Register Now” button below: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 Agency’s website.In addition, the Agency will be hosting other informative webinars in preparation for the implementation of the new SMMC program contracts. Dates will be forthcoming.

For additional information on the SMMC program please visit the agency’s website at http://ahca.myflorida.com/Medicaid/statewide_mc/