Florida Medicaid’s TBI/SCI and ACF Waiver Changes

The 2017 Legislature amended the law to transition individuals enrolled in the TBI/SCI and ACF waivers into the Statewide Medicaid Managed Care Long-term Care (LTC) program to continue receiving home and community-based services. The LTC program provides services and supports through LTC health plans to eligible individuals with disabilities ages 18-64 and elderly individuals age 65 or older. This transition is anticipated to occur on January 1, 2018.

Individuals enrolled in the TBI/SCI Waiver are currently eligible for the LTC program. Individuals age 18 or older with Cystic Fibrosis will be eligible to enroll in the LTC program under the same criteria as the ACF Waiver. This means there will be no loss in services – both groups will continue to have access to Medicaid services.      

The LTC program offers services consistent with those currently available through the TBI/SCI and ACF Waivers.  The Agency will provide these individuals with an opportunity to choose an LTC plan that can best meet their needs. The LTC program offers a more robust benefit package than the TBI/SCI and ACF waivers, including enhanced case management standards and expanded benefits. The LTC program also offers recipients an opportunity to receive care/services through a program with enhanced quality outcome measures.

Most individuals enrolled in the TBI/SCI and ACF Waivers currently receive their medical, pharmaceutical, and acute care services from MMA health plans. There will be no change to how these individuals receive MMA services unless they choose to change plans. 

The Agency will use a number of different methods to maintain open lines of communication throughout the transition. Individuals enrolled in these waivers will begin to receive written notification approximately 90 days before the transition date of January 1, 2018. In addition, the Agency is hosting monthly web-based meetings for interested stakeholders (TBI/SCI and ACF providers, recipients, etc.) to share information on the transition efforts.

Pre-Welcome Letters

ACF - ENGLISH [87KB]

ACF - SPANISH [88KB]

ACF - CREOLE [19KB]

TBISCI - ENGLISH [87KB]

TBISCI - SPANISH [87KB]

TBISCI - CREOLE [19KB]

Welcome and Reminder Letters

The Long-term Care program welcome and reminder letters can be viewed at: https://flmedicaidmanagedcare.com/LettersAndBrochures.aspx.  Additionally, you can view brochures that provide additional information related to the Long-term Care program.

Webinar Dates

Date Time Presentation
July 26, 2017 11:00 – 11:50 am, ET July TBI/SCI-ACF Presentation [774KB]
August 15, 2017 3:30 - 4:30 pm, ET August TBI/SCI-ACF Presentation [632KB]
September 19, 2017 3:30 - 4:30 pm, ET *Cancelled due to post Hurricane Irma recovery efforts
October 17, 2017 3:30 - 4:30 pm, ET October TBI/SCI-ACF Presentation [499KB]
November 14, 2017 3:30 - 4:30 pm, ET November TBI/SCI-ACF Presentation [846KB]
December 12, 2017 3:30 - 4:30 pm, ET December TBI/SCI-ACF Presentation [492KB]
Post-Transition Stakeholder Webinar: PAC, ACF, TBI/SCI
January 23, 2018 2:00 – 3:00 pm, ET  

All presentations will be made available following the scheduled webinar date. To register for the post-transition stakeholder webinars, please visit:   https://register.gotowebinar.com/register/4777463072459764481.

Waiver Services

The Agency conducted a review of the LTC program to ensure that it offers services consistent with those received through the TBI/SCI and ACF Waivers. Below are the TBI/SCI and ACF Waiver and LTC Services comparison.

TBI/SCI Waiver Services Crosswalk

Current TBI Waiver Services Current TBI Waiver Procedure Code SMMC Services SMMC Service Titles SMMC Procedure Code(s) Modifier
1
Assistive Technologies E1399 LTC Medical Equipment and Supplies E1399
S5199
AU
Attendant Care S5125 LTC Attendant Care S5125  
Behavior Programming 96152 LTC Behavioral Management H2020
H2019
 
Community Support Coordination G9012 LTC Care Coordination/ Case Management G9002  
Companion Care S5135 LTC Adult Companion Care S5135  
Consumable Medical Supplies S5199 LTC Medical Equipment and Supplies E1399
S5199
AU
Emergency Alert Response System Installation S5160 LTC Personal Emergency Response System, Installation S5160  
Emergency Alert Response System Monitoring and Maintenance S5161 LTC Personal Emergency Response System, Monthly Maintenance S5161  
Environmental Accessibility Adaptations S5165 LTC Home Accessibility Adaptations Services S5165  
Life Skills Training H2014 LTC Occupational and Physical Therapy 97003
97110
 
Occupational Therapy 97530 LTC Occupational Therapy 97003  
Personal Adjustment Counseling H2019 LTC Behavioral Management H2020
H2019
 
Physical Therapy 97110 LTC Physical Therapy 97110  
Personal Care Services T1019 LTC Personal Care T1019  
Rehabilitation Engineering Evaluation T1028 LTC Home Accessibility Adaptations Services S5165  
Residential Habilitation T2020 LTC Assisted Living Service T2030  
Transition Case Management T2024 LTC Care Coordination/ Case Management G9002  
Transition Environmental Accessibility Adaptations T2038 LTC Home Accessibility Adaptations Services S5165  

ACF Waiver Services Crosswalk

Current ACF Waiver Services Current ACF Waiver Procedure Code SMMC Services SMMC Service Titles SMMC Procedure Code(s) Modifier
1
Community Support Coordination T1016 LTC Care Coordination/ Case Management G9002  
Chore Services S5120 LTC Homemaker S5130  
Counseling 98152 LTC Behavioral Management H2020
H2019
 
Dental (Adult) D1110 LTC Dental (Adult) Expanded Benefit  
Home Delivered Meals S5170 LTC Home Delivered Meals S5170  
Homemaker Services S5130 LTC Homemaker S5130  
Massage Therapy* 97124 LTC Physical Therapy 97110  
Nutritional Supplements A9150 MMA Prescribed Drug** See PDL weekly file  
Personal Care T1004 LTC Personal Care T1019  
Personal Emergency Response (initial installation) S5160 LTC Personal Emergency Response System, Installation S5160  
Personal Emergency Response System Maintenance and Monitoring S5161 LTC Personal Emergency Response System, Monthly Maintenance S5161  
Physical Therapy (initial) 97001 LTC Physical Therapy 97110  
Physical Therapy (regular) 97110 LTC Physical Therapy 97110  
Prescribed Drugs J8499 MMA Prescribed Drug See PDL weekly file  
Respiratory Therapy (initial) S5180 LTC Respiratory Therapy, evaluation, age 21 and older S5180  
Respiratory Therapy (regular) 99503 LTC Respiratory therapy, treatment regular, age 21
and older
99503  
Respiratory therapy, treatment mechanical vent
care
99504  
Respite Care S5150 LTC Respite in Facility T1005  
Respite in Home S5150  
Skilled Nursing G0154 LTC Intermittent and Skilled Nursing, RN T1002 HN
Intermittent and Skilled Nursing, LPN T1003  
Specialized Medical Equipment and Supplies T1999 LTC Medical Equipment and Supplies E1399
S5199
AU
*This will only be applicable to the transition population
**These recipients have been receiving OTC/vitamins