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

RICK SCOTT
GOVERNOR
Better Health Care for all Floridians
Adequate Choice of Managed Care Options
Agency Mission to Ensure Quality Care:
ELIZABETH DUDEK
SECRETARY
The Agency’s mission is to ensure quality care is provided to Florida’s residents. On occasion,
market fluctuations result in a Medicaid health plan reaching its enrollment cap, leaving a county,
terminating its contract, or being purchased by another entity. To ensure recipients in the
demonstration area are provided adequate choice of health plan or provider, recipients are
advised of their choices of health plan/provider. The following is a summary of the processes and
requirements established to enable us to reach this goal.
Policy:
Recipients enrolled in the demonstration are provided 30 days to select a choice of health plans.
If there are fewer than two plans in a demonstration county from which a recipient can choose,
the Agency will allow the recipient to enroll in Florida’s primary care case management program
(MediPass).
Overview of MediPass (PCCM):
MediPass is currently operational in all areas of the state (including the demonstration counties)
and is available to recipients who may voluntarily enroll in the demonstration or where there are
less than two plans in an area. The Agency ensures that MediPass has a sufficient network of
providers through its ongoing credentialing and monitoring. Recipients have access to providers
in accordance with 42 CFR 438.52.
Overview of Choice Counseling Requirements:
The Agency’s enrollment broker works in conjunction with Agency staff to ensure Medicaid
recipients are informed of health plan choices. The Agency notifies the enrollment broker of
changes in plan availability. The enrollment broker processes enrollments, changes and
disenrollments, notifies recipients of required (mandatory) or voluntary participation in a health
plan or MediPass, mails confirmations of enrollment, disenrollment and change requests and
notification of open enrollment and annual change opportunity. The enrollment broker operates
a toll-free helpline to provide choice counseling and enrollment assistance as well as a website
with choice information and online enrollment,
enrollment by mail and in person through face-to-face choice counseling.
Choice Counseling Responsibilities when Choices Change or are Limited:
Several functions are modified or updated when a health plan leaves a county or reaches
enrollment capacity.
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