Continuity of Care
Florida Medicaid Health Care Alert
December 07, 2018
Statewide Medicaid Managed Care: Continuity of Care Provisions
The Agency for Health Care Administration (Agency) contracts with Medicaid health and dental plans to provide services to health plan enrollees in the Statewide Medicaid Managed Care (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.
The Agency will transition to the new contracts through a regional phased roll-out. The first regional roll-out occurred on Saturday, December 1, 2018. Roll-out for phase two will occur Tuesday, January 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. The Agency 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. The Agency 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 the Agency’s website at www.ahca.myflorida.com/smmc. Once on the page, click Program Changes, then the Outreach and Presentations link.
Aetna Better Health of Florida takes great pride in our network of physicians and related professionals who serve our members with the highest level of quality care and service. We’re absolutely committed to making sure our providers receive the best possible and latest information, technology and tools available to ensure their success and their ability to provide for clients.
We will arrange for care and services by specialists, hospitals, and providers including member engagement, which includes outreach and education functions, grievances and appeals.
The goals of Aetna Better Health of Florida’s plan are to:
- Create a person-centered care management approach to improve the quality of care members receive
- Comprehensively manage benefits across the continuum of care, including social and community services
- Integrate services for all physical, behavioral, long-term care, and social needs
We focus on operational excellence, constantly striving to eliminate redundancy and streamline processes for the benefit and value of all of our partners.
Our ability to serve our members well is dependent upon the quality of our provider network. Our providers are the cornerstone of our service delivery approach. By joining our network, you are helping us achieve our goal of providing our members with access to high quality health care services.
Together we can improve health care quality
At Aetna Better Health of Florida, we value our provider partners. We want to work with you to provide timely, safe and effective health care to our members. We are committed to making sure our providers receive the best and latest information, technology and tools available to ensure their success and their ability to provide for our members.
Good communication among our providers and our plan administrators is key to the delivery of quality health care services to our members. Please don’t hesitate to contact us any time with any questions you have.
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