Updates and Events

The continuity of care period for CMS Health Plan (operated by WellCare) ends on July 31, 2019. CMS Health Plan has been honoring ongoing treatment and prescriptions authorized prior to February 1st for up to 180 days. After July 31, 2019, services and prescriptions must be transferred to a provider in our network.If an authorization is required for services provided on or after August 1, 2019, one must be obtained in order for claims to pay.

Providers who delivered services and prescriptions during the continuity of care period did not have to contract with WellCare during this period. Providers who wish to contract with WellCare as a network provider for CMS Health Plan should contact FloridaProviderRelations@wellcare.com or call 407-551-3200, option 2.

 Requesting Authorizations

For services that require authorization, network providers may obtain authorizations through our portal with a secure login. Web submissions are faster and if the procedure requested meets clinical criteria, you will be provided an approval that can be printed for easy reference. 

Providers may also request authorization via fax using the numbers listed below:

• Durable Medical Equipment Services Fax1-855-657-8641 or 1-855-481-0606
• Home Health Services Fax1-855-657-8641 or 1-855-481-0606
• Inpatient Discharge Planning Requests Fax1-813-283-9285
• Outpatient Services Fax1-800-935-5752
• Physical and Occupational Therapy Services 1-888-333-8641
• Speech Therapy Services Fax1-877-709-1698 or 1-855-481-0606
• Transplant Services Fax1-813-283-5320
• Pharmacy Medical Requests Fax1-855-677-3915   

What if you have questions?

If you have any questions, please contact your WellCare Provider Relations representative or call Provider Services toll-free: CMS Health Plan 1-866-799-5321 (TTY 711). Please call us Monday–Friday, 8 a.m. to 7 p.m. You can also access additional information on our website.

Payment Schedule Change - CMS Plan will experience some changes in the payment batch that will be released the week of May 27th. This payment batch will include claims that have been fully adjudicated as of May 22nd. This change is in anticipation of the Memorial Day holiday such that there will be no change in the timing of when payments in this batch will be released to providers.

Member Transition Notice

Provider Transition Notice

CMS ID Card Template

Continuity of Care Notice

Provider Communication:  Retro Authorizations

On Dec. 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.

If you are a CMS Plan provider, you may have received this message. The 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. For more information about how what this change means for you, visit our Providers page.

Provider with questions about becoming a network provider with CMS Health Plan (operated by WellCare) including credentialing, claims, and navigating our systems, should contact their 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 wesite.

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

As of December 1, 2018, CMS Plan will not cover Medicaid dental benefits. Your Medicaid dental services will be covered by a dental plan.

You were sent a letter about changes in the Statewide Medicaid Managed Care (SMMC) program.

You will receive an ID card from your new dental plan in the mail. Please keep this with your CMS Plan ID card.  Both cards have important contact phone numbers.

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

For dental appointments already scheduled or services authorized, the dental plan will honor these for up to 90 days after your enrollment.

Call Member Services at 1-866-209-5022 (TTY/TDD 1-855-655-5303) if you have questions about this process.

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.

The summer member newsletter of 2018 is available online.

The CMS Plan and Specialty Programs welcomes Jeffrey P. Brosco, MD, PhD, who has been named Deputy Secretary for Children’s Medical Services (CMS). As Deputy Secretary, Dr. Brosco will oversee the Division of Children’s Medical Services. He also joins the executive leadership team of the Office of the CMS Managed Care Plan and Specialty Programs, Cheryl Young, Director, Andrea Gary, Director of Operations and Kelli Stannard, Director of Clinical Operations, to oversee the CMS Managed Care Plan and Specialty Programs and the CMS area offices.

Dr. Brosco currently serves as the Title V (Maternal and Child Health) statewide consultant for CMS, is professor of clinical pediatrics at the University Of Miami Miller School Of Medicine (UM) and served as a regional medical director for CMS from 2012-2015.  For the past 21 years, he has served at UM’s School Of Medicine in several capacities, most recently as the associate director of UM’s Mailman Center for Child Development, director of faculty education development in the Department of Pediatrics and director of the Leadership Education Neurodevelopmental Disabilities Program. He is also the chair of the Pediatric Bioethics Committee at Jackson Memorial Hospital.

Miami's WLRN recently interviewed Dr. Brosco to find out more. Read the interview here.

Starting in August 2017, the Payment Error Rate Measurement (PERM) program contractor will contact all Medicaid and CHIP providers. If you are contacted you must comply with the medical records request. For more information you can read AHCA'S notice.

The Florida Department of Health Children's Medical Services has a statewide initiative to assist pediatric practices with Patient Centered Medical Home (PCMH) practice transformation and recognition.  The PCMH model has become a widely accepted standard with a variety of tools and processes that enable providers to more effectively deliver better care and achieve improved outcomes.

We have partnered with HealthARCH - a division of the University of Central Florida College of Medicine to assist us with this program.  A survey of pediatric practices is the first step in the process and will assist us with determining who among Florida pediatric practices is interested and ready to begin the medical home journey.

Your results will be kept confidential. The survey should take approximately 20 minutes. Educational content on PCMH is provided throughout the survey to help explain concepts and standards. We appreciate your time and assistance with this program.

Begin the survey:  PCMH Survey