Statewide Medicaid Managed Care ProgramIn 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency to create the Statewide Medicaid Managed Care (SMMC) program. The SMMC program has two key components: the Managed Medical Assistance program and the Long-term Care program. Choose a tab above to view guidance statements and specific information regarding the Long-term Care and Managed Medical Assistance programs. Choose an arrow below to view general information about the program.
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Due to the competitive procurement, we are in a statutorily imposed “Blackout Period” until 72 hours after the award and cannot provide interpretation or additional information not included in the LTC or MMA ITN documents.As stated in s.287.057(23), F.S., “Respondents to this solicitation or persons acting on their behalf may not contact, between the release of the solicitation and the end of the 72-hour period following the agency posting the notice of intended award, excluding Saturdays, Sundays, and state holidays, any employee or officer of the executive or legislative branch concerning any aspect of this solicitation, except in writing to the procurement officer or as provided in the solicitation documents. Violation of this provision may be grounds for rejecting a response."
Comments and Questions?Members of the media should contact the Members of the public can email comments and suggestions about the Statewide Medicaid Managed Care program to FLMedicaidManagedCare@ahca.myflorida.com or mail them to: Statewide Medicaid Managed Care program
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News and Events |
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Choose an arrow below for information and upcoming events related to the Statewide Medicaid Managed Care program.
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Location Address |
Date |
Time |
Agenda and Presentation |
Westin Ft. Lauderdale |
October 19, 2012 | 2:00 pm - 5:00 pm | FAR Notice [77KB PDF] |
Medical Care Advisory Committee Meeting Agency for Health Care Administration |
October 23, 2012 Call-In Information (Listen Only): 1-888-670-3525. When prompted, enter the participant pass code: 4265177105 |
1:00 pm - 4:00 pm |
FAR Notice [77KB PDF] Agenda [45KB PDF] Presentation [109KB PDF] |
Long-term Care Technical Advisory Workgroup Final Report [PDF 102KB]
June – September 2011 Outreach Meetings
The following outlines the publicly noticed meetings that have occurred. Additional public meetings will be scheduled in the future and all related information will be posted on this page.
Statewide Medicaid Managed Care Program: FAQs on the Public Input Process [96KB PDF]
Perspectiva General de Cuidado Administrados de Medicaid, Junio 2011 [386KB PDF]
Perspectiva General de Cuidado Administrados de Medicaid, Septiembre 2011 [383KB PDF]
Regions Counties |
Location Address |
Date |
Time |
Agenda Presentation |
| Region 11 Miami-Dade and Monroe |
Marathon Government Center - Map It |
September 12, 2011 | 10:00am-1:00pm | |
| Field House - Map It (Next to Bank United Center in the University of Miami) 1245 Dauer Drive Coral Gables, FL 33146 Metro Rail exit: University Station |
September 13, 2011 | 2:30pm-5:30pm |
Regions Counties |
Location Address |
Date |
Time |
Agenda Presentation |
| Region 1 Escambia, Okaloosa, Santa Rosa and Walton |
City Hall - Map It Hagler/Mason Auditorium 2nd floor 222 W. Main Street Pensacola, FL 32502 |
June 13, 2011 | 1:00pm-4:00pm |
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| Region 2 Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla and Washington |
Agency for Health Care Administration - Map It Building 3, Conference Room A 2727 Mahan Drive Tallahassee, FL 32308 |
June 10, 2011 | 1:00pm-4:00pm |
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| Region 3 Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee and Union |
Alachua Regional Service Center
- Map It 14107 US Highway 441 Conference Room 190-A Alachua, FL 32615 |
June 14, 2011 | 2:30pm-5:30pm |
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| Region 4 Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia |
Department of Children and Families
Main Auditorium 5920 Arlington Expressway - Map It Jacksonville, FL 32211 |
June 14, 2011 | 9:00am-12:00pm |
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| Region 5 Pasco and Pinellas |
Mary Grizzle Building - Map It Rooms 136 and 137 11351 Ulmerton Road Largo, FL 33778-1629 |
June 15, 2011 | 9:00am-12:00pm |
Agenda Presentation |
| Region 6 Hardee, Highlands, Hillsborough, Manatee and Polk |
Florida Department of Transportation Auditorium 11201 N. McKinley Drive - Map It Tampa, FL 33612 |
June 16, 2011 | 9:00am-12:00pm |
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| Region 7 Brevard, Orange, Osceola and Seminole |
Medicaid Program Office - Map It Hurston Building Conference Rooms A and D - 1st Floor 400 West Robinson Street Orlando, FL 32801 |
June 16, 2011 | 2:00pm-5:00pm |
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| Region 8 Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota |
Joseph D’Alessandro Building - Map It Room 165 2295 Victoria Avenue Fort Myers, FL 33901 |
June 17, 2011 | 2:00pm-5:00pm |
Agenda Presentation |
| Region 9 Indian River, Martin, Okeechobee, Palm Beach and St. Lucie |
Hilton Palm Beach Airport - Map It 150 Australian Avenue West Palm Beach, FL 33406 |
June 14, 2011 | 9:00am-12:00pm |
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| Region 10 Broward |
Marriott Fort Lauderdale North - Map It 6650 North Andrews Avenue Ft. Lauderdale, FL 33309 |
June 16, 2011 | 9:00am-12:00pm |
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| Region 11 Miami-Dade and Monroe |
El Palacio - Map It 21485 NW 27th Avenue Miami Gardens, FL 33056 |
June 16, 2011 | 2:00pm-5:00pm |
You may watch a closed captioned reading of the standard presentation by clicking on the video below. [22.92MB Flash Video]
(Due to the large size of the video it may take longer to download.)
Additionally, the presentation used at the June 2011 meeting in Tallahassee which includes the sign-language interpreters, was video-taped and is available by emailing your request to FLMedicaidManagedCare@ahca.myflorida.com.
Guidance Statements
From time to time during program development and implementation, the Agency will post guidance statements to provide the public with clarification regarding program components. These statements have no effect on the procurement and the procurement requirements will be based solely on the provisions contained in the ITN and procurement documents.
Clarification: Specialty Plans [51KB PDF]
Specialty Plans [52KB PDF]
Contracting Required Pursuant to Section 409.975(1)(d) [38KB PDF]
409.975(1)(d) Provider Listing [1.49MB MS Excel]
Respondents to Statewide Medicaid Managed Care Long-term Care (LTC) Invitations to Negotiate [165KB PDF]
Long-term Care Managed Care Program Application Process for Medicare Advantage Special Needs Plans [63K PDF]
Documentation Accepted for Plan Provider Networks [63KB PDF]
Updated Guidance Statement: Participation of Medicare Advantage SNP plans in the SMMC LTC Component [46KB PDF]
Participation of Provider Service Networks in the LTC Component of the SMMC program [46KB PDF]
Aging Network Service Providers May 17, 2012 [47KB PDF]
Related to the March 16, 2012, Version of the Long-term Care Managed Care Data Book [66KB PDF]
Provision of Case Management Services [52KB PDF]
Reimbursement for Transportation Services [52KB PDF]
HMO Certificate of Authority [44KB PDF]
Enrollment in Medicare Advantage plans that are not subject to competitive procurement [44KB PDF]
Comments and Questions?
Members of the public can email comments and suggestions about the Statewide Medicaid Managed Care program to FLMedicaidManagedCare@ahca.myflorida.com or mail them to:
Statewide Medicaid Managed Care program
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308
Long-term Care | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
The Long-term Care component of the Statewide Medicaid Managed Care program will be implemented first.
Choose an arrow below to view more information about the program.
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| Region | Healthcare Plans | ||||||
| American Eldercare, Inc. | Amerigroup Florida, Inc. | Coventry Health Plan | Humana Medical Plan, Inc. | Molina Healthcare of Florida, Inc. | Sunshine State Health Plan | United Healthcare of Florida, Inc. | |
| 1 | X | X | |||||
| 2 | X | X | |||||
| 3 | X | X | X | ||||
| 4 | X | X | X | X | |||
| 5 | X | X | X | X | |||
| 6 | X | X | X | X | X | ||
| 7 | X | X | X | X | |||
| 8 | X | X | X | ||||
| 9 | X | X | X | X | |||
| 10 | X | X | X | X | |||
| 11 | X | X | X | X | X | X | X |
Roll-Out Schedule
| Region | Enrollment Effective Date | Total Eligible Population |
| 7 | August 1, 2013 | Region 7: 9,338 |
| 8 & 9 | September 1, 2013 |
Region 8: 5,596 Region 9: 7,854 Total = 13,450 |
| 2 & 10 | November 1, 2013 |
Region 2: 4,058; Region 10: 7,877 Total = 11,935 |
| 11 | December 1, 2013 | Region 11: 17,257 |
| 5 & 6 | February 1, 2014 |
Region 5: 9,963 Region 6: 9,575 Total = 19,538 |
| 1, 3 , 4 | March 1, 2014 | Region 1: 2,973 Region 3: 6,911 Region 4: 9,087 Total = 18,971 |
Long-term Care Recipients | ||||||||||||||||||||||||||||||||||||||||||||||||
| Prior to implementation in your region, you will receive plan selection materials from the choice counselor by mail. All Medicaid recipients receiving services in a nursing facility, or through the Nursing Home Diversion Waiver, Aged and Disabled Adult Waiver, Assisted Living Waiver, Channeling Waiver, or the Frail Elder Option will have the opportunity to receive choice counseling prior to enrollment into the Long-term Care program. If a recipient is currently receiving services from a LTC health plan that will also be a long-term care health plan in the region where the recipient resides, the recipient can choose to remain with the original plan, or the recipient can choose to enroll with a different plan. A counselor will assist you in selecting the plan in your region that best meets your needs. When you have been notified that you can select a plan, you can contact a choice counselor by using your computer and go to www.flmedicaidmanagedcare.com; or you can call 1-877-711-3662 to talk to a Choice Counselor. You can request an in person visit from a Choice Counselor as well. For additional information please click on the Medicaid snapshot document below:
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| Region | First Notification letter | Final Notification Letter | Date Enrolled in LTC Plans |
| 1 | 11/1/2013 | 1/20/2014 | 3/1/2014 |
| 2 | 7/1/2013 | 9/16/2013 | 11/1/2013 |
| 3 | 11/1/2013 | 1/20/2014 | 3/1/2014 |
| 4 | 11/1/2013 | 1/20/2014 | 3/1/2014 |
| 5 | 10/1/2013 | 12/16/2013 | 2/1/2014 |
| 6 | 10/1/2013 | 12/16/2013 | 2/1/2014 |
| 7 | 4/1/2013 | 6/24/2013 | 8/1/2013 |
| 8 | 5/1/2013 | 7/22/2013 | 9/1/2013 |
| 9 | 5/1/2013 | 7/22/2013 | 9/1/2013 |
| 10 | 7/1/2013 | 9/16/2013 | 11/1/2013 |
| 11 | 8/1/2013 | 10/21/2013 | 12/1/2013 |
Long-term Care Providers | ||||||||||||||||
Choose an arrow below to view more information about the program.
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| LTC Plan Contact: Provider Networks | |
| American ElderCare | Brenda Evans 561-496-4440 bevans@americaneldercare.com |
| Amerigroup | Victoria McMath 800-950-7679 ext 77429 Victoria.McMath@amerigroup.com |
| Coventry | Mariangeli Cataluna 305-222-3012 mxcataluna@cvty.com |
| Humana | Grace Rodriguez 888-234-6401 grodriguez@ilshealth.com |
| Molina Healthcare | Lisa Schwendel Phone: 1-888-562-5442, ext. 223594 Email: lisa.schwendel@molinahealthcare.com |
| Sunshine State Heath Plan | Susan McCurry, Manager, Provider Relations 866-769-1158, ext 41344 smccurry@centene.com |
| United Healthcare | George Rodriguez 407-659-7029 Primary email: Fl_ltc_network@uhc.com Secondary email: george_rodriguez@uhc.com |
Long-term Care Plans | ||||||||||||||||||||||||||||
Plan Readiness
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| Region | Documentation Submission Deadline |
Deadline for Enrollment | Effective Date |
| 7 | January 23, 2013 | May 1, 2013 | August 1, 2013 |
| 8 & 9 | February 6, 2013 | June 1, 2013 | September 1, 2013 |
| 2 & 10 | February 20, 2013 | August 1, 2013 | November 1, 2013 |
| 11 | March 6, 2013 | September 1, 2013 | December 1, 2013 |
| 5 & 6 | March 20, 2013 | November 1, 2103 | February 1, 2014 |
| 1, 3 & 4 | April 3, 2013 | December 1, 2013 | March 1, 2014 |
Prior to enrolling recipients in a Managed Care Plan in each region in which the Managed Care Plan receives a resulting Contract, the Agency will conduct a plan-specific readiness review to assess the Managed Care Plan’s readiness and ability to provide services to recipients. The plan readiness review will include, but is not limited to, desk review of all contract related policies and procedures by the Managed Care Plan, and corresponding member documents provided by the Managed Care Plan, the Managed Care Plan’s provider network and corresponding contracts, and an onsite review including a walk-through of the Managed Care Plan’s operations, system demonstrations, and interviews with Managed Care Plan staff, as outlined in Exhibit 5, Managed Care Plan Readiness Requirements. The scope of the readiness review may include any and all Contract requirements, as determined by the Agency.
Each managed care plan that receives a resulting Contract must complete and submit the LTC checklists linked below. Along with the LTC checklists, the Managed Care Plan must submit all policies and procedures and all supporting documents (member correspondence – such as enrollment letters, ID card, handbook, provider directory; provider correspondence, etc.) that correspond to each line item in the LTC Plan Readiness Review Tool. Each plan must note in the LTC Plan Readiness tool the reference number that corresponds with the document or policy being supplied for each line item and specify the page and paragraph number where the elements can be found. This reference number, page and paragraph should be noted in the “Documents reviewed” row that corresponds with the line item for which the policy or document is being provided. The LTC Plan Readiness Review Tool must be submitted to the Agency with this information included, along with the corresponding documents. All materials needing approval must be submitted as they will be viewed in production (including company logo) and be in a WORD format. Readability statistics must accompany each member correspondence submitted.
- LTC Administrative Staff Checklist [119KB Microsoft Word]
- LTC Enrollee Handbook Checklist [83KB Microsoft Excel]
- LTC Provider Contract Checklist [60KB Microsoft Excel]
- LTC Provider Directory Checklist [56KB Microsoft Excel]
- LTC Readiness Review Tool [2.05MB Microsoft Excel]
- LTC Subcontract Checklist [59KB Microsoft Excel]
In addition to the documents above, each managed care plan will be expected to submit provider network files using the specifications outlined in the document below.
Provider Network Verification (PNV) File Specification [595 KB PDF]
The submission due date for all of these files is indicated in the table above under “Documentation Submission Deadline”. Additional submission instructions will be provided to plans upon award. The “Deadline for Enrollment” is the date by which all plan readiness review criteria must be satisfied and the date by which the plan must have met all contract requirements. The Agency will not enroll recipients into a Managed Care Plan until the Agency has determined that the Managed Care Plan meets all Contract requirements.
If a Managed Care Plan does not meet the plan readiness review deadlines for their respective region, as indicated above, the Agency will grant an extension for the Managed Care Plan to correct deficiencies; however, the Managed Care Plan will lose the initial enrollment of eligible recipients in their respective region and will lose their transition population, if applicable. After an extension is granted by the Agency, the Managed Care Plan will have until the penultimate Saturday before the respective region’s enrollment effective date, as indicated above in Table 1 – Anticipated Regional Roll-Out Schedule, to be deemed ready for recipient enrollment. If a Managed Care Plan is not deemed ready for recipient enrollment by the Agency by the penultimate Saturday before the respective region enrollment effective date, the contract between the Managed Care Plan and the Agency will be terminated.
If a Managed Care Plan received an additional contract award pursuant to s. 409.966(3)(e), F.S., and fails to meet plan readiness review criteria in Region 1 or Region 2 by the deadlines as indicated above in Table 1 – Anticipated Regional Roll-Out Schedule, and subsequent paragraphs, the Agency shall terminate the additional awarded region(s) contract(s) immediately if recipients have not been enrolled into the additional region or one-hundred eighty (180) days after the respective Region 1 and/or 2 termination if recipients are already enrolled in the additional awarded region(s).
The Agency does not guarantee that the Managed Care Plan will receive any particular enrollment level. The above schedule is subject to change and provided for planning purposes only.
i s. 409.966(4), F.S. (2012), “ADMINISTRATIVE CHALLENGE.—Any eligible plan that participates in an invitation to negotiate in more than one region and is selected in at least one region may not begin serving Medicaid recipients in any region for which it was selected until all administrative challenges to procurements required by this section to which the eligible plan is a party have been finalized. If the number of plans selected is less than the maximum amount of plans permitted in the region, the agency may contract with other selected plans in the region not participating in the administrative challenge before resolution of the administrative challenge. For purposes of this subsection, an administrative challenge is finalized if an order granting voluntary dismissal with prejudice has been entered by any court established under Article V of the State Constitution or by the Division of Administrative Hearings, a final order has been entered into by the agency and the deadline for appeal has expired, a final order has been entered by the First District Court of Appeal and the time to seek any available review by the Florida Supreme Court has expired, or a final order has been entered by the Florida Supreme Court and a warrant has been issued.”
Statewide Medicaid Managed Care Report Guide
The reporting provisions for reports required through Long-Term Care (LTC) Managed Care Plan Contract are provided in the Statewide Medicaid Managed Care Report Guide (Report Guide). This Report Guide is a companion to each LTC managed care plan’s contract with the Agency. The Report Guide provides details of LTC managed care plan reporting requirements, including instructions, templates, and submission directions.
At this time, the Report Guide solely reflects the requirements of the following types of LTC managed care plans:
- LTC Health Maintenance Organizations (LTC HMOs)
- LTC Capitated Provider Service Networks (LTC Capitated PSNs)
- LTC Fee-for-Service Provider Service Networks (LTC FFS PSNs)
Note: This Report Guide is NOT for use with the 2012-15 Medicaid Health Plan Contract. The Report Guide for the 2012-15 Medicaid Health Plan Contract is located at http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/med_prov_0912.shtml
SMMC Report Guide [1.22MB PDF]
SMMC Report Guide Templates:
Administrative Subcontractors and Affiliates Report [2.18MB Microsoft Excel]
Audited Annual and Unaudited Quarterly Financial Reports [267KB Microsoft Excel]
Case Management File Audit Report [43KB Microsoft Excel]
Case Manager Monitoring and Evaluation Report [33KB Microsfot Excel]
Claims Aging Report FFS [2.02MB Microsoft Excel]
Claims Aging Report & Supplemental Filing Report - Capitated Health Plans [2.45MB Microsoft Excel]
Community Outreach Health Fairs Public Events Notification [147KB Microsoft Excel]
Community Outreach Representative Report [50KB Microsoft Excel]
Critical Incident Report [31KB Microsoft Excel]
Critical Incident Summary Report [32KB Microsoft Excel]
Denial, Reduction, Termination of Services Report [56KB Microsfot Excel]
Enrollee Complaints, Grievances, and Appeals Report [43KB Microsoft Excel]
Enrollee & Nursing Facility Residence Report [45KB Microsoft Excel]
Missed Services Report [32KB Microsoft Excel]
MPI Annual Fraud and Abuse Activity Report (AFAAR) [65KB Microsoft Excel]
MPI Quarterly Fraud Abuse Activity Report [213KB Microsoft Word]
MPI Suspected Confirmed Fraud and Abuse Report [60KB Microsoft Word]
Multiple Signature Verification Agreement [37KB Microsoft Word]
Nursing Facility Transfer Report [46KB Microsoft Excel]
Participant Direction Option (PDO) Report [35KB Microsoft Excel]
Patient Responsibility Report [27KB Microsfot Excel]
Performance Measure Specifications [43KB Microsoft Word]
Performance Measures Report [35KB Microsoft Excel]
Provider Complaint Report [34KB Microsoft Excel]
Provider Network File Specifications [292KB Microsoft Word]
Provider Termination & New Provider Notification Report [74KB Microsoft Excel]
Utilization Reporting [43KB Microsoft Excel]
Participant Direction Option (PDO)
PDO Extensive Evaluation [190KB PDF] 5/9/2013
PDO General Evaluation [188KB PDF] 5/9/2013
PDO Pre-Screening Tool [84KB MS Word 2010]
PDO Manual [135KB MS Word 2010] 5/9/2013
PDO Guidelines [357KB MS Word 2010]
PDO Consent Form [62KB MS Word 2010]
PDO Representative Agreement [52KB MS Word 2010]
PDO Timesheet Attestation Language [24KB MS Word 2010]
PDO Consent Form (Spanish Translation) [52KB MS Word 2010]
PDO Pre-Screening Tool (Spanish Translation) [78KB MS Word 2010]
PDO Representative Agreement (Spanish Translation) [44KB MS Word 2010]
Managed Medical Assistance |
The Managed Medical Assistance component of the Statewide Medicaid Managed Care program will be implemented second. Choose an arrow below to view more information about the program.
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Managed Medical Assistance Data Book |
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The Agency released the Managed Medical Assistance (MMA) Invitation to Negotiate (ITN) on December 28, 2012. The data book has been included in the ITN. The data book can be found on the Agency for Health for Health Care Administration’s procurement page which can be accessed through the following link: December 28, 2012 Managed Medical Assistance Data Book If you are unable to locate the ITN, please contact us at FLMedicaidManagedCare@ahca.myflorida.com for further assistance. Choose an arrow below to view more information.
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Location Address |
Date |
Time |
Agenda and Presentation |
Agency for Health Care Administration A conference number will be available for those unable to attend in person. |
November 19, 2012 |
1:30 pm - 4:30 pm |
FAR Notice [77KB PDF] Agenda [155KB PDF] Presentations |
Federal AuthoritiesManaged Medical AssistanceChoose an arrow below to view more information.
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Location Address |
Date |
Time |
Agenda and Presentation |
Westin Ft. Lauderdale |
October 19, 2012 |
2:00 pm - |
FAR Notice [77KB PDF] |
Medical Care Advisory Committee Meeting Agency for Health Care Administration |
October 23, 2012 Call-In Information (Listen Only): 1-888-670-3525. When prompted, enter the participant pass code: 4265177105 |
1:00 pm - 4:00 pm |
FAR Notice [77KB PDF] Agenda [45KB PDF] Presentation [109KB PDF] |
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting Robin Ingram at (850) 412-4017 or by email at Robin.Ingram@ahca.myflorida.com. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1 (800) 955-8771 (TDD) or 1 (800) 955-8770 (Voice).
Submit Comments
- To comment by postal service or internet, please follow directions outlined in the “Comments or Questions” informational box located on the top right hand side of page. When providing comments regarding the Medically Needy program, please have ‘Medically Needy’ referenced in the subject line.
- For more information on 1115 Research and Demonstration waivers you may visit Federal CMS website at the following link http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/Section-1115-Demonstrations.html.
- The Agency will post all public comments here periodically throughout the 30-day public notice and comment period.
- The 1115 waiver application 30-day public comment period began October 12, 2012. Public comment was received via the public meetings held in Ft. Lauderdale 10/19 and Tallahassee 10/23. Public comment will continue to be received via FLMedicaidManagedCare@ahca.myflorida.com email, and U.S. Postal service mail to 2727 Mahan Drive, Tallahassee, FL 32308. The following is a collection of public comments that will be updated as received.
Medically Needy Comments [2.91MB PDF] 1/10/13
Request(s) for Amendment of the 1115 MEDS AD Waiver
- Link to Amendment to 1115 MEDS AD Waiver [1.48MB PDF]
- Link to Florida Medically Needy Waiver Amendment Request [659KB PDF]
Request(s) for Amendment of the 1115 Medicaid Reform Waiver
- Link to Amendment #1 to Medicaid Reform Waiver [1.55MB PDF]
- Link to Amendment #2 to Medicaid Reform Waiver [1.55MB PDF]
- Link to Amendment #3 to Medicaid Reform Waiver [1.61MB PDF]
Long-term Care
Approved Long-term Care Waivers
February 1, 2013 Approval Letter [295KB PDF]
Final 1915(b) Waiver Application [4.07MB PDF]
Final 1915(b) Cost Effectiveness [2.99MB PDF]
Final 1915(c) Waiver Application [11.68MB PDF]
Comments and Questions?
Members of the media should contact the
Office of Communications at AHCACommunications@ahca.myflorida.com or by calling 850-412-3623.
Members of the public can email comments and suggestions about the Statewide Medicaid Managed Care program to FLMedicaidManagedCare@ahca.myflorida.com or mail them to:
Statewide Medicaid Managed Care program
Office of the Deputy Secretary for Medicaid
Agency for Health Care Administration
2727 Mahan Drive, MS #8
Tallahassee, Florida 32308
Managed Medical Assistance Provider Comments
April 3, 2012
Respondents to Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Invitations to Negotiate
Section 409.966(2) directs the Agency to select a limited number of eligible plans to participate in the Medicaid program using invitations to negotiate in accordance with s. 287.057(3)(a). This section also requires that separate and simultaneous procurements be conducted in 11 regions of the state. Accordingly, on December 28, 2012 the Agency issued 11 separate and simultaneous invitations to negotiate (ITN’s) in each of the 11 regions. The ITNs may be accessed via the Department of Management Services’ Vendor Bid System (VBS) at: http://www.myflorida.com/apps/vbs/vbs_www.main_menu.
Pursuant to s. 409.966(3)(a)8, the Agency shall consider comments submitted in writing by any enrolled Medicaid provider relating to a specifically identified plan participating in the procurement in the same region as the submitting provider. Therefore, the Agency is publishing the following list of respondents to the ITNs:
Solicitation Number
Title
Counties
Respondents
(Plan Names)
AHCA ITN 017-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 1
Escambia, Okaloosa, Santa Rosa and Walton
Better Health, LLC
Coventry Health Care of Florida, Inc.
Florida True Health, Inc.
Humana Medical Plan, Inc.
Integral Health Plan, Inc. dba Integral Quality Care
Molina Healthcare of Florida, Inc.
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 018-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 2
Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington
Better Health, LLC
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Humana Medical Plan, Inc.
Prestige Health Choice
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 019-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 3
Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union
Coventry Health Care of Florida, Inc.
First Coast Advantage, LLC
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Prestige Health Choice
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 020-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 4
Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
Coventry Health Care of Florida, Inc.
First Coast Advantage, LLC
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Humana Medical Plan, Inc.
Molina Healthcare of Florida, Inc.
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 021-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 5
Pasco and Pinellas
Amerigroup Florida, Inc.
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Molina Healthcare of Florida, Inc.
Prestige Health Choice
Simply Healthcare Plans, Inc.
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 022-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 6
Hardee, Highlands, Hillsborough, Manatee and Polk
Amerigroup Florida, Inc.
Better Health, LLC
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Integral Health Plan, Inc. dba Integral Quality Care
Molina Healthcare of Florida, Inc.
Prestige Health Choice
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 023-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 7
Brevard, Orange, Osceola, and Seminole
Amerigroup Florida, Inc.
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Molina Healthcare of Florida, Inc.
Prestige Health Choice
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 024-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 8
Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
Amerigroup Florida, Inc.
Coventry Health Care of Florida, Inc.
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Integral Health Plan, Inc. dba Integral Quality Care
Prestige Health Choice
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 025-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 9
Indian River, Martin, Okeechobee, Palm Beach and St. Lucie
Amerigroup Florida, Inc.
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Molina Healthcare of Florida, Inc.
Prestige Health Choice
Salubris, LLC
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 026-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 10
Broward County
AHF MCO of Florida, Inc. D.B.A. Positive Healthcare Florida HIV/AIDS Specialty Plan
Amerigroup Florida, Inc.
Better Health, LLC
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Florida True Health, Inc.
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Molina Healthcare of Florida, Inc.
Preferred Medical Plan, Inc.
Salubris, LLC
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
South Florida Community Care Network (SFCCN)
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
AHCA ITN 027-12/13
Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)-Region 11
Miami-Dade and Monroe
AHF MCO of Florida, Inc. D.B.A. Positive Healthcare Florida HIV/AIDS Specialty Plan
Amerigroup Florida, Inc.
Care Access PSN, LLC
Coventry Health Care of Florida, Inc.
Florida MHS, Inc. d/b/a Magellan Complete Care Serious Mental Illness Specialty Plan
Freedom Health, Inc.
Freedom Health, Inc. Cardiovascular Disease (CVD) Specialty Plan
Freedom Health, Inc. Chronic Obstructive Pulmonary Disease (COPD) Specialty Plan
Freedom Health, Inc. Congestive Heart Failure (CHF) Specialty Plan
Freedom Health, Inc. Diabetes Specialty Plan
Humana Medical Plan, Inc.
Molina Healthcare of Florida, Inc.
Preferred Medical Plan, Inc.
Prestige Health Choice
Salubris, LLC
Simply Healthcare Plans, Inc.
Simply Healthcare Plans, Inc. d.b.a. Clear Health Alliance HIV/AIDS Specialty Plan
South Florida Community Care Network (SFCCN)
Sunshine State Health Plan, Inc.
Sunshine State Health Plan, Inc. Child Welfare Specialty Plan
UnitedHealthcare of Florida, Inc.
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida
Wellcare of Florida, Inc. d/b/a Staywell Health Plan of Florida Child Welfare Specialty Plan
As published in the March 25, 2013 Florida Administrative Register (FAR), providers may submit comments to the Agency through the online survey tools published below.
Comments must be submitted to the Agency by April 17, 2013, at 5:00 PM, EDT.
The Agency will consider each distinct comment only once. Additionally, the Agency will only consider comments submitted by enrolled Medicaid providers within the same region as the specifically identified plan participating in the procurement.
For each prospective vendor listed in the survey tools included below, the provider shall indicate if its opinion of the named prospective vendor is positive, negative or neutral. The election of the opinions listed below will be considered by the Agency in its decision to award Contracts under the Managed Medical Assistance ITN, pursuant to Section 409.966(3)(a)8, Florida Statutes.
Region 1: https://www.surveymonkey.com/s/MMARegion1
Region 2: https://www.surveymonkey.com/s/MMARegion2
Region 3: https://www.surveymonkey.com/s/MMARegion3
Region 4: https://www.surveymonkey.com/s/MMARegion4
Region 5: https://www.surveymonkey.com/s/MMARegion5
Region 6: https://www.surveymonkey.com/s/MMARegion6
Region 7: https://www.surveymonkey.com/s/MMARegion7
Region 8: https://www.surveymonkey.com/s/MMARegion8
Region 9: https://www.surveymonkey.com/s/MMARegion9
Region 10: https://www.surveymonkey.com/s/MMARegion10
Region 11: https://www.surveymonkey.com/s/MMARegion11