Florida
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 January 1, 2019.

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(link opens in new window). Once on the page, click Program Changes, then the Outreach and Presentations link.

Hurricane Michael Alert

Members

Your health and safety are important to us. We have people available to help you get the care you need – whether it’s getting a refill for your medications or finding a doctor, hospital, clinic, or other healthcare provider.

Disaster planning: For information about general disaster relief organizations that can help in Florida and making a disaster plan, visit:

http://www.floridadisaster.org (link opens in new window)

Disaster Declaration: The disaster grace period for Hurricane Michael has been extended from 10/7/18 through 11/9/18 for the following counties: Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Leon, Liberty, Taylor, Wakulla, and Washington

Prior Authorizations: We are working with providers to ensure care is not disrupted. Prior authorizations have been lifted and service limitations have been waived for critical Medicaid services that are life sustaining in order to maintain the health and safety of recipients for dates of service during the disaster grace period in the 12 affected counties.

Medication Refills: For areas declared as a disaster, your pharmacy can override the edit on your medication refill if you are without your normal medications and it is not yet time to refill them.

Providers

Prior Authorizations/Claims Payment: Humana will reimburse for services furnished within the disaster grace period without prior authorization and without regard to service limitations for critical Medicaid services that are life sustaining or whether such services are provided by a participating provider in those instances where the provider and/or enrollee could not comply with policy requirements because of storm-related impacts.

  • Authorizations
    Services will be approved without any form of authorization.
  • Unit/Service limitations
    Limitations will be suspended during the Disaster Grace Period critical Medicaid services that are life sustaining.

Providers not Known to Florida Medicaid that Rendered Services During the Disaster Grace Period

Providers without a Florida Medicaid ID that rendered services during the disaster grace period may refer to the FL Medicaid Web Portal (link opens in new window) to obtain a provisional provider identification number. You may also review Emergent enrollment guidelines (link opens in new window).

Requirements for Humana expedited enrollment is delineated below:

For Medicaid providers within the State of Florida that are not enrolled with Florida Medicaid, along with out-of-state providers who are providing services to our displaced Florida residents, Florida Medicaid is waiving the requirements to submit documentation showing the nature of the treatment, as well as other normally-required information. Until further notice, Humana Medicaid will accept claims with only the following requirements:

  • A fully completed claim form containing the provider’s active National Provider Identifier (NPI), along with the provider’s SSN/FEIN should be submitted via email to ContractAdministration@humana.com.

Member Services

Call the number on the back of your Humana member ID card Monday – Friday 8am to 8pm and a Humana representative can help you:

  • Connect with doctors and specialists to get the care you need
  • Replace durable medical equipment and medical supplies
  • Replace your Humana member ID card

For areas declared as a disaster, your pharmacy can override the edit on your medication refill if you are without your normal medications and it is not yet time to refill them.

If you have online access, you can find additional information, including a copy of your Humana member ID card and important documents, when you sign in to MyHumana.com.

We serve Florida residents who are eligible for Medicaid Medical, Long-Term Care and Comprehensive plans

If you live in certain counties in Florida, and are eligible to receive Medicaid Medical, Long-Term Care, and/or a Comprehensive plan, we can help you easily manage your benefits.

We will also help you learn more about your eligibility and explore your plan options.

Managing Medicaid coverage in Florida

Our Medicaid Medical plans are available in certain counties in Florida. Eligible residents in those areas can keep all the benefits of Medicaid Medical, plus many extras. Our members enjoy more choices for high-quality care, as well as access to programs and resources to help them stay healthy.

Humana Medical plan

The Humana Medicaid Managed Medical Assistance (MMA) program in Florida provides access to affordable healthcare for low-income families and individuals, as well as people with disabilities.
MMA is available in these Florida counties:

  • Escambia, Okaloosa, Santa Rosa, and Walton
  • Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington (effective 2/1/2019)
  • Alachua, Bradford, Citrus, Columbia, Dixie, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Putnam, Sumter, Suwannee, and Union (effective 2/1/2019)
  • Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia (effective 2/1/2019)
  • Pasco and Pinellas
  • Hardee, Highlands, Hillsborough, Manatee, and Polk
  • Brevard, Orange, Osceola, and Seminole
  • Charlotte, Collier, Desoto, Glades, Hendry, Lee, and Sarasota
  • Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
  • Broward
  • Miami-Dade and Monroe

Humana Long-Term Care

We offer Long-Term Care plans if you are eligible and enrolled in the Medicaid Managed Medical Assistance (MMA) program. Eligible individuals may qualify for management of chronic conditions, including benefits for institutional care and community- and/or home-based care options.

This coverage is available in all Florida counties.

Humana Comprehensive plans

We also provide Comprehensive coverage that combines the benefits of Medicaid Medical and Long-Term Care if you are eligible and enrolled in the Medicaid Managed Medical Assistance (MMA) program.

This plan provides coverage for treatment of chronic health conditions for people with low-incomes and disabilities.