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!