Agency Communications to SMMC Plans

Applicable ONLY to SMMC Contracts Effective 2014-2018


Discontinuance of PDN Ad Hoc Report PT 17-24 12/14/2017
Revised Case Management File Audit Report Template and New Operational Guidelines PT 17-23 12/13/2017
Update to Encounter Data Reporting Requirements CI 17-02 11/9/2017
Nursing Facility and Hospice Reconciliation Rate File PT 17-22 10/24/2017
Missed Services Report PT 17-21 10/18/2017
Exondys 51 and Spinraza PT 17-20 10/20/2017
MMA Physician Incentive Program (MPIP) Rate Calculation Guidance PT 17-19 9/27/2017
Provision of and Payment for Services During and Outside the Disaster Grace Period for Hurricane Irma PT 17-18 9/21/2017

Ad Hoc Request for Documentation for Annual Validation of Performance Measures

PT 17-17 8/30/2017

Ad Hoc Request for Updated Provider Lists of MMA Physician Incentive Program (MPIP)

PT 17-16 8/24/2017

Provider Complaint Report Template Revision

PT 17-15 7/31/2017

Ad Hoc Request for MMA Physician Incentive Program (MPIP) Data

PT 17-14 7/19/17

Consent for Voluntary Suspension of Authorized Services in the Florida Medicaid Statewide Medicaid Managed Care Program Form

  • Policy Transmittal: 17-13 [252KB PDF]
  • Attachment: Consent for Voluntary Suspension of Authorized Services in the Florida Medicaid Statewide Medicaid Managed Care Program Form; available in:

    English in PDF [219KB] or MS Word [42KB];
    Spanish in PDF [34KB] or MS Word [40KB]; and
    Creole in PDF [129KB] or MS Word [33KB]

PT 17-13 7/18/17

Ad Hoc Report for Encounter Data Validation Study

PT 17-12 5/9/2017

Ad Hoc Report for Private Duty Nursing Services Now Monthly

PT 17-11 4/14/2017

MMA Physician Incentive Program (MPIP) and Ad Hoc Request for 2017 MPIP Plan Proposals

PT 17-10 3/13/2017
Alteration of Encounter Data [184KB] CI 17-01 3/10/2017

Ad Hoc Request for MMA Physician Incentive Program (MPIP) Provider Lists

PT 17-09 3/1/2017

Notices of Adverse Benefit Determination and Notices of Plan Appeal Resolution: New and Revised Templates Effective March 1, 2017

PT 17-08 2/24/2017
Private Duty Nursing Report Template Revision PT 17-07 2/22/2017
Nursing Facility Services for Managed Medical Assistance Enrollees Under the Age of Eighteen (18) Years [614KB] PT 17-06 2/14/2017
Report Guide Revision for Supplemental HIV/AIDS Report [633KB] PT 17-05 2/9/2017

Claims Aging Report Template Revision

PT 17-04 2/9/2017
Ad Hoc Report for Nursing Facility Transition Data PT 17-03 2/7/2017
Ad Hoc Request for Claims Adjudication Accuracy Reports [186KB] PT 17-02 2/7/2017
Healthy Behaviors Report Chapter Revision [180KB] PT 17-01 1/17/2017


Ad Hoc Report Utilizing Revised HIV/AIDS Algorithm PT 16-36 12/20/2016
Revised Performance Measures and Enrollee Satisfaction Survey Requirements for July 1, 2017 Reporting Period PT 16-35 12/16/2016
Ad-Hoc Report Utilizing Revised HIV-AIDS Algorithm [188KB] PT 16-34 11/4/2016
Ad Hoc Request for Select Healthcare Effectiveness Data and Information Set (HEDIS) Measure Details PT 16-33 10/31/2016
MMA Physician Incentive Program (MPIP) Florida Medicaid Cesarean Section Rate Calculation Specifications 2016 PT 16-32 10/26/2016
Training: Ensuring Home Health Agency Eligibility and Staffing Compliance for Medicaid Health Plans [YouTube Video]   10/18/2016
Non-Discrimination Rule Final in Section 1557 of the Affordable Care Act (ACA) [253KB] PT 16-31 10/17/2016
Data Request for Development of Medicaid Capitation Rates for Medicare Special Needs Plans Populations PT 16-30 10/6/2016
Payments to Managed Care Plans for Coverage of Hepatitis C Treatment Drugs Letter PT 16-29 10/6/2016
Ad Hoc Report for Private Duty Nursing Services PT 16-28 10/5/2016
Obstetrical Delivery Kick Payments PT 16-27 10/7/2016
National Standards [254KB] CI 16-02 9/19/2016
Pharmacy Lock-In Program Parameters PT 16-26 9/15/2016
Medicaid Fair Hearing Process-Plan as a Party [231KB] PT 16-25 9/12/2016
Ad Hoc Request for Dental Rate Information due September 21, 2016 PT 16-24 8/21/2016
Supplemental HIV/AIDS Report PT 16-23 8/22/2016
Suspension of Missed Services Report [180KB] PT 16-22 8/22/2016
Ad Hoc Request for Information Related to Dental Providers PT 16-21 8/17/2016
Authorization of Long-term Care Maintenance Therapy Services [421KB] PT 16-20 7/29/2016
Ad Hoc Request for Policies and Procedures Related to Provider Complaints [186KB] PT 16-19 7/1/2016
Policy Transmittal 16-14 Rescinded [179KB] PT 16-18 6/30/2016
Expanded and Other Benefits [271KB] PT 16-17 6/30/2016
Ad hoc Request for Plan-to-Provider Communications on Physician Incentive Programs [182KB] PT 16-16 6/17/2016
Reimbursement of Cochlear Implant Devices [257KB] PT 16-15 6/6/2016
Billing and Reimbursement of Outpatient Hospital Revenue Code 0636 Pharmacy/Coded Drugs [181KB]
  • Rescinded; refer to PT 16-18 issued 6/30/2016.
PT 16-14 6/3/2016
Performance Measures Reporting [183KB] PT 16-13 6/1/2016
Drug Prior Authorization Criteria Change For Treatment of Hepatitis C [183KB] PT 16-12 5/27/2016
Health Plan Privacy Incidents/Breaches Reporting Form PT 16-11 5/26/2016
Coverage and Authorization of Hepatitis C Prescribed Drugs [240KB] CI 16-01 5/5/2016
Ad hoc Report for Preliminary Calendar Year 2015 Performance Measures PT 16-10 5/3/2016
MMA Physician Incentive Program & Ad-hoc Request for Plan Proposals [389KB] PT 16-09 4/21/2016
Ad hoc Report for Notifications to HHS Regarding Breaches of Protected Health Information (PHI) [184KB] PT 16-08 4/12/2016
MMA Physician Incentive Program & Ad-hoc Request for Plan Proposals [897KB] PT 16-07 4/7/2016
Telemedicine Services [182KB] PT 16-06 3/11/2016
Ad hoc Report for Diabetes Disease Management [183KB] PT 16-05 3/4/2016
Revised Rates and Process for Hepatitis C Kick Payments PT 16-04 2/3/2016
Expanded Benefit Ad Hoc Report [181KB] PT 16-03 1/29/2016
Achieved Savings Rebate Audit Requirement PT 16-02 1/27/2016
Third Party Liability Reporting [181KB] PT 16-01 1/25/2016


Ad hoc Report for Residential Psychiatric Treatment Report PT 15-28 12/23/2015
Revised Denial, Reduction, Termination, or Suspension of Services Report PT 15-27 12/18/2015
Performance Measure and Child Health Check-Up Related Requirements [2.40MB PDF] PT 15-26 12/17/2015
Critical and Adverse Incident Report [179KB PDF] PT 15-25 12/10/2015
Nursing Facility Rates and Nursing Facility Retroactive Rate Adjustments PT 15-24 11/20/2015
Express Enrollment [963KB PDF] PT 15-23 11/17/2015
Fair Labor Standards Act (FLSA) [181KB PDF] PT 15-22 11/9/2015
Reporting Most Recent Pre-admission Screening and Resident Review (PASRR) [180KB PDF] PT 15-21 11/3/2015
Community Living Support Plan [183KB PDF] PT 15-20 9/29/15
Mandatory Implementation of ICD-10 [179KB PDF] PT 15-19 9/3/2015
Financial Reporting Requirements [704KB PDF] PT 15-18 7/27/2015
Notice of Action Template for Title XXI MediKids PT 15-17 7/14/2015
Achieved Savings Rebate Financial Report: April 1, 2015 through June 30, 2015 PT 15-16 7/10/2015
Submission of Consumer Assessment of Healthcare Providers and Systems (CAHPS) Survey Report and Action Plan [509KB PDF] CI 15-05 6/29/2015
Emergency Room (ER) Visits for Enrollees without PCP Appointment Report [152KB PDF] PT 15-15 6/22/2015
Claims Payment Provisions in the Statewide Medicaid Managed Care Program [214KB PDF] CI 15-04 6/18/2015
Nursing Facility Rates and Nursing Facility Rate Adjustments PT-15-14 6/10/2015
Medical/Case Record Reviews CI-15-03 6/8/2015
ICD-10 Implementation Activities PT 15-13 6/3/2015
Transitional Care Coordination/Case Management Policies and Procedures [150KB PDF PT 15-12 6/3/2015
Pre-admission Screening and Resident Review (PASRR) CI-15-02 5/22/2015
Ad Hoc Report Request: Case Manager and Direct Service Provider Training Report PT 15-11 5/19/2015
Assisted Living Facility Providers Rendering Adult Day Care Services PT 15-10 5/19/2015
Achieved Savings Rebate Financial Report: January 1, 2015 through March 31, 2015 PT 15-09 4/20/2015
Annual Achieved Savings Rebate Financial Report: Calendar Year 2014 PT 15-08 4/14/2015
Revised Address for Submitting Mandatory and Permissive Exclusions to DHHS OIG [96KB PDF] PT 15-07 2/19/2015
Prescribed Drugs/Pharmacy Services Plan Letter 2/13/2015
Preferred Drug List CI 15-01 2/13/2015
HEDIS 2015 (Calendar Year 2014) Performance Measure Reporting PT 15-06 2/6/2015
Ad Hoc Requests Regarding Provider Network for SIPP Services PT 15-05 1/27/2015
Achieved Savings Rebate Financial Report: December 31, 2014 PT 15-04 1/23/2015
Nursing Facility Retroactive Rate Adjustments PT 15-03 1/21/2015
Affordable Care Act Primary Care Services Rate Increase Audit PT 15-02 1/23/2015
CHCUP (Form CMS-416 ) and FL 80% Screening Report PT 15-01 1/9/2015


Financial Reporting Written Policies and Procedures PT 14-25 12/9/2014
Long-term Care Freedom of Choice PT 14-24 12/8/2014
Notice of Action Template PT 14-23 11/25/2014
Tobacco Cessation Counseling for Pregnant Women and the Affordable Care Act Primary Care Fee Increase [534KB PDF] PT 14-22 11/6/2014
Toll-Free Help Line Performance Standards (MMA_Comp-HMO-PSN-SP-CMSN) [741KB PDF] PT 14-21 11/5/2014
Achieved Savings Rebate Financial Report: September 30, 2014 Quarter PT 14-20 11/3/2014
Achieved Savings Rebate Financial Report: August 2013 through December 2013 PT 14-19 11/3/2014
Newborn Hearing Screening and Newborn Screening Services (Comp-MMA-SP-CMSN) [917KB PDF] CI 14-08 10/3/2014
Primary Payer of Expanded Benefits (Comp-MMA-SP) [529KB PDF] CI 14-07 10/2/2014
Long-term Care (LTC) Outreach and Marketing Materials for LTC Provider Service Network (PSN) Plan Plan Letter 9/17/2014
Comprehensive Long-term Care (LTC) Plan Marketing Materials Plan Letter 9/12/2014
Choice of Primary Care Provider for Full Dual Eligible Enrollees in the Managed Medical Assistance Program [774KB PDF] CI 14-06 9/5/2014
Florida Information Act PT 14-17 8/18/2014
Patient Responsibility Report PT 14-16 8/1/2014
Transportation Services to Medical Managed Assistance Enrollees [539KB PDF] CI 14-05 8/1/2014
Multiple Procedure Payment Reduction for Therapy Services [1.71MB PDF] PT 14-15 8/1/2014
Transplant Kick Payments [335KB PDF] PT 14-14 8/1/2014
Newborn Enrollment and Circumcision Services [616KB PDF] CI 14-04 7/25/2014
Hernandez Settlement Agreement Survey Report [302KB PDF] PT 14-13 7/23/2014
Unable to Locate Enrollee Process PT 14-11 7/22/2014
Utilization Reporting Long-term Care PT 14-12 7/16/2014
Telemedicine Providers [197KB PDF] Plan Letter 7/7/2014
Healthy Behavior Program Requirements [1.24KB PDF] CI 14-03 7/3/2014
Kick Payment for Course of Hepatitis C Treatment Drugs PT 14-10 6/30/2014
Achieved Savings Rebate Financial Report: August 2013 through December 2013 PT 14-09 6/27/2014
Achieved Savings Rebate Financial Report: June 30, 2014 Quarter PT 14-08 6/27/2014
Coverage of Sovaldi [300KB PDF] PT 14-07 6/19/2014
Retroactive Changes to Nursing Facility Per Diem Rates PT 14-06 6/6/2014
Freedom of Choice Ad Hoc Report PT 14-05 5/21/2014
Managed Care Provider Network Performance Measures for Nursing Facilities PT 14-03 5/20/2014
Supplemental HIV/AIDS Report *Replaces Previous PT 14-02 Issued May 6, 2014 [597KB PDF] PT 14-02 5/19/2014
Mobile Vision Providers [257KB PDF] Plan Letter 4/25/2014
Additional Codes to Bill Downward Substitution for Behavioral Health Services [474KB PDF] Plan Letter 4/18/2014
Hospice Concurrent Care Policy [366KB PDF]  PT 14-04 4/10/2014
Guide for Billing Screening, Brief Intervention, and Referral to Treatment (SBIRT) Model [301KB PDF] Plan Letter 4/4/2014
Contracts with Florida Medical School Quality Network [556KB PDF] CI 14-02 4/1/2014
MMA Contracting Requirements for Home Medicaid Equipment and Supplies Providers [745KB PDF] Plan Letter 3/28/2014
Enhanced Standards Related to Claims and Provider Payment [513KB PDF] CI 14-01 3/24/2014
Out of State Providers Located Within 50 Miles of Florida Border [353KB PDF] Plan Letter 3/14/2014
Nursing Facility Type of Bill Codes [63KB PDF] Plan Letter 3/6/2014
Pharmacy Encounter Data Validation Study MMC PT 14-01 2/13/2014
Performance Measures and Other Quality Management-Related Requirements [497KB PDF] PT 14-01 2/20/2014
SMMC Long-Term Care (LTC) Critical Incident Reporting PT 13-06 12/20/2013
Provider Network Requirements PT 13-05 11/12/2013
Public Records Plan Letter 11/7/2013
Case Files Plan Letter 10/25/2013
Participant Direction Option (PDO) Plan Letter 10/16/2013
SMMC Long-term Care (LTC) Program Case Management Caseload Report PT 13-04 8/30/2013
SMMC Long-term Care Utilization Report PT 13-03 8/30/2013
Case Management Ratios PT 7/11/2013
Changes to Hospital ER, Primary Care and Home Health Visits [88 KB, PDF] PT 12-02 HMO and 12-03 PSN 12/20/2012
Updated Paper Claims Submission Information [449 KB, PDF] PT 12-02 PSN 9/6/2012
Requesting an Expansion  [167 KB, PDF] PT 12-01 HMO and 12-01 PSN 1/24/2012