Did you receive this message? Here’s what it means for you: On December 18, 2018, the Florida Department of Health announced its intent to award WellCare with a statewide contract to implement a new service delivery model for the Children’s Medical Services Health Plan (CMS Health Plan). The Florida Department of Health (DOH) will partner with WellCare to offer the CMS Plan as of February 1, 2019. This partnership will bring about positive changes that will greatly benefit children and youth with special health care needs and providers.

The Notice of Termination you received means that your contract with our current partner will end, but you will still be able to provide services to CMS Health Plan members for a continuity of care period. After that, you may continue to serve CMS Health Plan members under contract with WellCare.

Providers should not cancel appointments with current CMS Plan patients. We will honor ongoing treatment that was authorized prior to February 1^st, for up to 180 days.

Providers will be paid. Providers should continue providing services that were previously authorized, regardless of whether the provider is participating in our CMS Health Plan network. We will use information provided by DOH to identify whether a member had services authorized. We will pay for these previously authorized services for up to 180 days.

Providers will be paid promptly. We will follow all timely claims payment contractual requirements.

Prescriptions will be honored. We will allow CMS Health Plan members to continue to receive their prescriptions through their current provider, for up to 180 days, until their prescriptions can be transferred to a provider in our network.

If you have questions about becoming a network provider with CMS Health Plan (operated by WellCare) including credentialing, claims, and navigating our systems, please contact your Provider Relations representative. If you do not know your Provider Relations representative, you may contact FloridaProviderRelations@wellcare.com or call 1-407-551-3200, option 2.

Medicaid 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 or dental 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 which is applicable to CMS Plan:

• 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. Once on the page, click Program Changes, then the Outreach and Presentations link.

Additional questions can be directed to your provider relations liaison for assistance.

SMMC Medicaid Dental

For more information about the SMMC dental plans, call 1-877-711-3662 or visit Florida Medicaid's website.

For Medicaid dental appointments already scheduled or services authorized, the Medicaid dental plan will honor these for up to 90 days after your enrollment in the Medicaid dental plan. For active orthodontic services, the Medicaid dental plans must also honor the entire course of authorized treatment. This is true regardless of whether the provider is in the Medicaid dental plan’s network.

Your CMS Plan (KidCare/Title XXI) dental agreement will remain in effect, there are no changes to CMS Plan (KidCare) coverage benefits and services or authorization and claims processes.

SMMC Health and Dental Plan Roll-out Schedule

The Florida Department of Health’s Children’s Medical Services Plan (CMS Plan) and Specialty Programs is proud to serve Florida’s population of children and youth with special health care needs (CYSHCN). Over the decades, CMS Plan has changed, adapted and grown, always with the goal of providing the best possible care for the children we serve.

The national landscape for health care delivery models continues to change. Florida is well positioned to implement a national model for serving CYSHCN within Medicaid and CHIP and through our Title V initiatives. Rumors have circulated that CMS Plan is “going away” or “closing.” Neither of these is true. While CMS Plan is again in a time of transition, we remain working for the health, safety and quality of life of the children and families we serve.

At this time, there are no immediate changes for providers in our network or for the families we serve. Families do not need to do anything differently, and credentialed providers are still able to see CMS Plan members. Please continue to visit our website for updates (www.CMSPlanFlorida.gov), and rest assured we will contact our members and provider network directly with any changes that will affect them.

Earn up to 1 hour of CME/CE!

Integration of Behavioral Health and Trauma-Informed Care in Patient Centered Medical Homes in the Context of Telepsychiatry
September 25, 2018, 1:00pm – 2:00pm

Presenter: Tommy Schechtman, MD, MSPH, FAAP

Details on the flyer.

Effective Tuesday, September 27, 2016, the Florida Department of Health revised Rule 64C-2.002 of the Florida Administrative Code. Changes include adding certain codes to the clinical eligibility screening from and adding additional options for physicians to utilize a medical review panel to determine clinical eligibility. The rule also clarifies that families may request a re-screening to determine clinical eligibility if clinical eligibility was not previously established. Go to our CMS Plan Physician Attestation Process document to learn more.

If you are a treating physician with questions about the attestation form or process, please call 1-855-901-5390.

All CMS Plan providers must be credentialed and contracted with the Plan. To begin a new application process, please review the CMS Letter of Interest Requirements document for instructions.

Early Steps - Please contact you Local Early Steps Office in the county for which you would like to provide services.

Child Protection Team - Please contact Marceller Hines at the CPT State Office 1-850-558-9553.

If you need assistance with the credentialing or contracting process, please contact your local provider relations liaison.

To renew your contract for CMS Plan Title XIX or Title TXXI, please contact the provider relations liaison serving your area.

Title XIX (MMA) Provider Manual

Risk Management Plan

Utilization Management Plan

Fraud, Waste and Abuse Training

Annual Quality Improvement and Utilization Management Report

Provider Relations Liaisons

Quality Improvement Plan

Cultural competency is one the main ingredients in providing quality health care to our children. It is the way families and providers can come together and talk about health concerns without cultural differences hindering the conversation. Visit the CMS Cultural Competency Plan to learn more.

The CMS Cultural Competency Plan includes provisions for language and communication. This could include language lines, translation services or TTY/TTD services.

According to Title III of the Americans with Disabilities Act (ADA), health care providers are required to provide interpreters for medical visits and other medical-related situations. To learn how health care providers can help meet their patients communication needs, please read the following information regarding ADA requirements.

CMS is contracted with MED3000, a division of McKesson, to serve as the Third Party Administrator to facilitate provider information, client information, service authorizations and claims payment. For more information, please go toMED3000 Enrollment, Authorizations, and Claims.

For questions and technical assistance, providers and CMS staff may contact MED3000 Customer Service at 1-800-664-0146. Families should contact their local CMS Area Office for assistance.

Provider enrollment in the CMS plan consists of a two-step process. First, a provider must be credentialed through the CMS Plan. Next, providers must be contracted through one of our two ICS partners. Ped-I-Care serves provider in the panhandle and central Florida counties, and the Community Care Plan (CCP) serves providers in the southern part of Florida.

Once a provider contracts with one of our two ICSs, their information will be registered in the CMS third party administrator data base (Med3000/McKesson). Providers will then have access to the provider portal, E-InfoSource, which gives the provider the ability to:

• Verify enrollment;
• Verify approval of prior authorization (when required); and,
• Review the status of submitted claims.

Approved and registered CMS providers may submit claims electronically through one of the following two electronic Claims Clearinghouses:

1. Emdeon
2. Availity

Providers wishing to submit paper claims may do so by mailing claims to the following address:

CMS MMA Specialty Plan Title XIX
P. O. Box 981648
El Paso, TX 79998-1648