Letter to CMS - Medicaid Managed Care Policies - Agency for ...

All impacted beneficiaries are given 90 days after enrollment into the new health plan to select
another health plan without cause.
Health Plan Detailed Transition Processes:
Regardless of whether the scenario is a withdrawal from a county, a contract termination, or a
health plan acquisition, the Agency carefully plans the transition of the affected enrollees. To
ensure continuity of care to affected enrollees, to minimize any disruption to the enrollees, and
to assist them through the choice process, the Agency follows a multi-layered approach:
• Evaluating the volume and geographic impact of the transition to determine if there is a
need to stagger transitions with the choice counseling/enrollment broker.
• Conducting weekly calls with the impacted Florida Medicaid Area Offices, Medicaid
Contract Management, and the Agency to plan all aspects of the transition and provide a
forum to ensure all issues are resolved quickly.
• Assessing the provider network capacity of the remaining/purchasing plan(s) to ensure
all impacted enrollees have access to quality care.
• In cases of health plan acquisition, comparing the outgoing provider PCP and behavioral
health network to that of the new plan to ensure at least a 90% match in order to
preserve continuity of care.
• In cases of withdrawal or termination, requiring the health plan to provide a listing of
members’ primary care providers (PCPs). Agency then reviews provider networks of
other plans to determine where the same PCPs are available.
• Assisting PCPs unique to the withdrawing/terminating plan through the Medicaid
provider enrollment process to facilitate their enrollment in other health plan networks.
• Confirming the health plan notifies all network providers of the transition effective date at
least 60 days in advance. Notice must include instructions on claims submission after
the transition date.
• In cases of health plan acquisition, reviewing the benefit package of the acquiring entity
to ensure it offers at least the same benefits as the existing health plan.
• Working with the plans, the Agency’s choice counseling/enrollment broker, local area
staff, and advocacy groups to coordinate outreach efforts, such as:
Appropriate and timely notice to enrollees, including developing and releasing
flyers to locations and providers frequented by impacted enrollees to help ensure
beneficiaries understand the changes that are occurring.
Hiring additional choice counselors if needed.
Posting choice counselors in the impacted Medicaid Area Offices and highly
utilized provider locations to offer face-to-face counseling sessions specifically
geared to transition enrollees.
Arranging outbound choice counseling call to enrollees with special needs.
Sharing final enrollee notice templates (60-day and 30-day) with impacted area
offices, current health plan, incoming health plan, and others identified
throughout transition planning.
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