Statewide Medicaid Managed Care Program
In 2011, the Florida Legislature created Part IV of Chapter 409, Florida Statutes, directing the Agency to create the Statewide Medicaid Managed Care (SMMC) program. The SMMC program has two key components: the Managed Medical Assistance program and the Long-term Care program.
Choose a tab above to view guidance statements and specific information regarding the Long-term Care and Managed Medical Assistance programs.
Choose an arrow below to view general information about the program.
There will be two different components that make up the SMMC program:
If you are interested in learning more about these two programs, overviews and summaries may be accessed through the links below.
Long-term Care program Snapshot [213KB PDF]
Managed Medical Assistance Program Overview [PDF 369KB]
Region Map [105KB PDF]
Updates about the Statewide Medicaid Managed Care program will be posted on this website as they become available.
The “Standards for Independence” document is provided for any plan who intends to participate in the Statewide Medicaid Managed Care program. This document outlines the standards of independence for audits conducted by independent certified public accountants. (See s. 409.967, F.S.) These standards of independence are incorporated by reference in Rule 59G-8.800: Financial Compliance Audits of Medicaid Prepaid Plans. (Rule 59G-8.800 is currently under development.)
Standards for Determining Independence [97KB PDF]
News and Events
Choose an arrow below for information and upcoming events related to the Statewide Medicaid Managed Care program.
Most Recent Webinar
SMMC Provider Webinar: Accessing Patient Responsibility Using "Provider View" from Florida Agency for Health Care Administration
Webinar Presentation: Medicaid Pending - May 9, 2013 [1.58KB PDF]
AHS Presentation: SMMC LTC Overview Partner and Facility Staff Training March 2013 [2.48MB PDF] 3/25/2013
Public Outreach Meetings Regarding 1115 Waiver for the Medically Needy Component of Statewide Medicaid Managed Care
1115 Waiver for the Medically Needy Component of Statewide Medicaid Managed Care
The following outlines the publicly noticed meetings that have occurred. Additional public meetings will be scheduled in the future and all related information will be posted on this page.
You may watch a closed captioned reading of the standard presentation by clicking on the video below. [22.92MB Flash Video]
(Due to the large size of the video it may take longer to download.)
Additionally, the presentation used at the June 2011 meeting in Tallahassee which includes the sign-language interpreters, was video-taped and is available by emailing your request to FLMedicaidManagedCare@ahca.myflorida.com.
From time to time during program development and implementation, the Agency will post guidance statements to provide the public with clarification regarding program components. These statements have no effect on the procurement and the procurement requirements will be based solely on the provisions contained in the ITN and procurement documents.
Clarification: Specialty Plans [51KB PDF]
Specialty Plans [52KB PDF]
409.975(1)(d) Provider Listing [1.49MB MS Excel]
Aging Network Service Providers May 17, 2012 [47KB PDF]
Provision of Case Management Services [52KB PDF]
Reimbursement for Transportation Services [52KB PDF]
HMO Certificate of Authority [44KB PDF]
The Long-term Care component of the Statewide Medicaid Managed Care program will be implemented first.
Choose an arrow below to view more information about the program.
Long-term Care Recipients
Before the Long-term Care program starts in your region, you will get a letter from Medicaid in the mail. The letter will have information about the long-term care plans in your region.
All Medicaid recipients receiving services in a nursing facility, or through the Nursing Home Diversion Waiver, Aged and Disabled Adult Waiver, Assisted Living Waiver, Channeling Waiver, or the Frail Elder Option can receive choice counseling before enrolling in the Long-term Care program.
If you are currently receiving services from a Nursing Home Diversion plan that will also be a long-term care plan in the region where you live, you can choose to stay with the same plan or enroll with a different plan.
A counselor will help you pick the long-term care plan in your region that best meets your needs. When you get the letter that says it is time for you to select a plan, you can contact a choice counselor. Use your computer and go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a choice counselor. You can also request an in person visit from a choice counselor.
Examples of Letters Sent to Recipients:
Pre-Welcome Letter: Sent to recipients four (4) months prior to enrollment
Welcome Letter: Sent to recipients two (2) month prior to enrollment
Reminder Letter: Sent to Recipients one (1) month prior to enrollment
Long-term Care Providers
Choose an arrow below to view more information about the program.
To view upcoming provider training, please go to the News and Events tab above and then select the Calendar of Events and Training dropdown.
To view the previous guidances statements please go to the News and Events tab above and then select the Guidance Statement dropdown.
October 3, 2013 Letter to Consumable Medical Supplies Providers [43KB PDF] 10/16/2013
July 22, 2013 Letter to Nursing Facilities [86KB PDF]
The information below is provided as clarification of the Agency for Health Care Administration letter to nursing facilities dated July 22, 2013.
Nursing facilities do not have to contract with every long-term care plan in their region. However, Florida law requires that nursing facilities must participate with every long-term care plan in their region (see s. 409.982(2), Florida Statutes). This means that if a nursing facility resident chooses a long-term care plan with which the nursing facility does not have a contract, the nursing facility and long-term care plan will need to work together to determine how to handle payment for the nursing facility services provided to that recipient.
If a nursing facility notifies a resident that he or she will have to move because the facility is not contracted with that resident’s plan or cannot reach a payment agreement with that plan, the Agency would consider that the nursing facility is not participating with the long-term care plan. A nursing facility that does not participate, that is, has notified residents that they have to move because of the LTC plan selected by those residents, is subject to termination from the Medicaid program.
To view the FAQs please go to the News and Events tab above and then select the Frequently Asked Questions dropdown.
Long-term Care Plans
Subject to the limitations imposed by Florida Statutes, the Agency anticipates rolling-out the LTC component of the SMMC program on a regional basis in accordance with the following schedule: (See s. 409.966(4), F.S. (2012) i)
TABLE 1 - ANTICIPATED REGIONAL ROLL-OUT SCHEDULE
Prior to enrolling recipients in a LTC Plan in each region in which the LTC Plan receives a resulting Contract, the Agency will conduct a plan-specific readiness review to assess the LTC Plan’s readiness and ability to provide services to recipients. The plan readiness review will include, but is not limited to, desk review of all contract related policies and procedures by the LTC Plan, and corresponding member documents provided by the LTC Plan, the LTC Plan’s provider network and corresponding contracts, and an onsite review including a walk-through of the LTC Plan’s operations, system demonstrations, and interviews with LTC Plan staff, as outlined in Exhibit 5, LTC Plan Readiness Requirements. The scope of the readiness review may include any and all Contract requirements, as determined by the Agency.
Each LTC Plan that receives a resulting Contract must complete and submit the LTC checklists linked below. Along with the LTC checklists, the LTC Plan must submit all policies and procedures and all supporting documents (member correspondence – such as enrollment letters, ID card, handbook, provider directory; provider correspondence, etc.) that correspond to each line item in the LTC Plan Readiness Review Tool. Each plan must note in the LTC Plan Readiness tool the reference number that corresponds with the document or policy being supplied for each line item and specify the page and paragraph number where the elements can be found. This reference number, page and paragraph should be noted in the “Documents reviewed” row that corresponds with the line item for which the policy or document is being provided. The LTC Plan Readiness Review Tool must be submitted to the Agency with this information included, along with the corresponding documents. All materials needing approval must be submitted as they will be viewed in production (including company logo) and be in a WORD format. Readability statistics must accompany each member correspondence submitted.
In addition to the documents above, each LTC plan will be expected to submit provider network files using the specifications outlined in the document below.
The submission due date for all of these files is indicated in the table above under “Documentation Submission Deadline”. Additional submission instructions will be provided to plans upon award. The “Deadline for Enrollment” is the date by which all plan readiness review criteria must be satisfied and the date by which the plan must have met all contract requirements. The Agency will not enroll recipients into a LTC Plan until the Agency has determined that the LTC Plan meets all Contract requirements.
If a LTC Plan does not meet the plan readiness review deadlines for their respective region, as indicated above, the Agency will grant an extension for the LTC Plan to correct deficiencies; however, the LTC Plan will lose the initial enrollment of eligible recipients in their respective region and will lose their transition population, if applicable. After an extension is granted by the Agency, the LTC Plan will have until the penultimate Saturday before the respective region’s enrollment effective date, as indicated above in Table 1 – Anticipated Regional Roll-Out Schedule, to be deemed ready for recipient enrollment. If a LTC Plan is not deemed ready for recipient enrollment by the Agency by the penultimate Saturday before the respective region enrollment effective date, the contract between the LTC Plan and the Agency will be terminated.
If a LTC Plan received an additional contract award and fails to meet plan readiness review criteria in Region 1 or Region 2 by the deadlines as indicated above in Table 1 – Anticipated Regional Roll-Out Schedule, and subsequent paragraphs, the Agency shall terminate the additional awarded region(s) contract(s) immediately if recipients have not been enrolled into the additional region or one-hundred eighty (180) days after the respective Region 1 and/or 2 termination if recipients are already enrolled in the additional awarded region(s). (See s. 409.966(3)(e), F.S.)
The Agency does not guarantee that the LTC Plan will receive any particular enrollment level. The above schedule is subject to change and provided for planning purposes only.
i s. 409.966(4), F.S. (2012), “ADMINISTRATIVE CHALLENGE.—Any eligible plan that participates in an invitation to negotiate in more than one region and is selected in at least one region may not begin serving Medicaid recipients in any region for which it was selected until all administrative challenges to procurements required by this section to which the eligible plan is a party have been finalized. If the number of plans selected is less than the maximum amount of plans permitted in the region, the agency may contract with other selected plans in the region not participating in the administrative challenge before resolution of the administrative challenge. For purposes of this subsection, an administrative challenge is finalized if an order granting voluntary dismissal with prejudice has been entered by any court established under Article V of the State Constitution or by the Division of Administrative Hearings, a final order has been entered into by the agency and the deadline for appeal has expired, a final order has been entered by the First District Court of Appeal and the time to seek any available review by the Florida Supreme Court has expired, or a final order has been entered by the Florida Supreme Court and a warrant has been issued.”
The reporting provisions for reports required through Long-term Care (LTC) Plan Contract are provided in the Statewide Medicaid Managed Care Report Guide (Report Guide). This Report Guide is a companion to each LTC Plan’s contract with the Agency. The Report Guide provides details of LTC Plan reporting requirements, including instructions, templates, and submission directions.
At this time, the Report Guide solely reflects the requirements of the following types of LTC plans:
Note: This Report Guide is NOT for use with the 2012-15 Medicaid Health Plan Contract. The Report Guide for the 2012-15 Medicaid Health Plan Contract is located at http://ahca.myflorida.com/MCHQ/Managed_Health_Care/MHMO/med_prov_0912.shtml
SMMC Report Guide [1.22MB PDF] Effective 4/17/2013
SMMC Report Guide Templates:
PDO Extensive Evaluation [190KB PDF]
PDO General Evaluation [188KB PDF]
PDO Pre-Screening Tool [84KB MS Word 2010]
PDO Manual [135KB MS Word 2010]
PDO Guidelines [357KB MS Word 2010]
PDO Guidelines (Spanish Translation) [352KB MS Word 2010] 7/9/2013
PDO Consent Form [62KB MS Word 2010]
PDO Representative Agreement [52KB MS Word 2010]
PDO Timesheet Attestation Language [24KB MS Word 2010]
PDO Consent Form (Spanish Translation) [52KB MS Word 2010]
PDO Pre-Screening Tool (Spanish Translation) [78KB MS Word 2010]
PDO Representative Agreement (Spanish Translation) [44KB MS Word 2010]
PDO Training Webinar Presentation - 3/14/2013 [490KB PDF]
Long-term Care Archive
The webinar recordings below are hosted on our YouTube channel and may be blocked by your organization’s content filters. If you’re experiencing problems with video playback, please email firstname.lastname@example.org to request a copy of the slideshow presentation(s).
Enrollee and Provider Protections
Recipient Eligibility Verification
Plan of Care
Assisted Living Facilities
March 5, 2012
Audio of March 5, 2012 Meeting [PDF 83.48MB]
February 13, 2012
Audio of February 13, 2012 Meeting [PDF 12.49 MB]
January 20, 2012
Audio of January 20, 2012 Meeting [PDF 24.35MB]
December 12, 2011
Audio of December 12, 2011 Meeting [PDF 26.00MB]
November 10, 2011
Audio of November 10, 2011 Meeting [PDF 29.15MB]
October 14, 2011
Audio of October 14, 2011 Meeting [PDF 27.47MB]
August 26, 2011
July 26, 2011
Managed Medical Assistance
The Managed Medical Assistance component of the Statewide Medicaid Managed Care program will be implemented second.
Choose an arrow below to view more information about the program.
On October 30, 2013, the Agency for Health Care Administration submitted the following implementation plan as required by Special Term and Condition (STC) #35a of Florida’s 1115 Managed Medical Assistance Waiver. Special Term and Condition #35a requires the following:
“MMA Program Implementation Requirements. No earlier than January 1, 2014, the state may implement the MMA program in a region if it meets the following implementation requirements for that region (subject to CMS review and approval).
The state must submit to CMS a schedule indicating its planned start date for mandatory enrollment in the MMA program in each region of the state. The state may not begin mandatory enrollment in any region until CMS has approved the implementation plan. After CMS’ approval of the implementation plan, the state may stagger mandatory enrollment over period beginning no earlier than January 1, 2014. The state will submit an implementation schedule to CMS by October 31, 2013, that specifies the regions to be transitioned in that timeframe with a staggered implementation approach. The state may revise the implementation schedule as needed, and must promptly notify CMS of any changes. The approved implementation plan will become a future attachment to these STCs.
Implementation Plan, October 30, 2013 [826KB PDF]
Managed Medical Assistance Archive
Respondents to Statewide Medicaid Managed Care Managed Medical Assistance (MMA) Invitations to Negotiate
The Agency is directed to select a limited number of eligible plans to participate in the Medicaid program using invitations to negotiate in accordance Florida Statute. This section also requires that separate and simultaneous procurements be conducted in 11 regions of the state. Accordingly, on December 28, 2012 the Agency issued 11 separate and simultaneous invitations to negotiate (ITN’s) in each of the 11 regions. The ITNs may be accessed via the Department of Management Services’ Vendor Bid System (VBS) at: http://myflorida.com/apps/vbs/vbs_www.search.criteria_form. (See c.409.966(2), F.S. and s. 287.057(3)(a), F.S.)
Pursuant to Florida Statute, the Agency shall consider comments submitted in writing by any enrolled Medicaid provider relating to a specifically identified plan participating in the procurement in the same region as the submitting provider. Therefore, the Agency is publishing the following list of respondents to the ITNs: (See s. 409.966(3)(a)8, F.S.)
As published in the March 25, 2013 Florida Administrative Register (FAR), providers may submit comments to the Agency through the online survey tools published below.
Comments must be submitted to the Agency by April 17, 2013, at 5:00 PM, EDT.
The Agency will consider each distinct comment only once. Additionally, the Agency will only consider comments submitted by enrolled Medicaid providers within the same region as the specifically identified plan participating in the procurement.
For each prospective vendor listed in the survey tools included below, the provider shall indicate if its opinion of the named prospective vendor is positive, negative or neutral. The election of the opinions listed below will be considered by the Agency in its decision to award Contracts under the Managed Medical Assistance ITN, pursuant to Section 409.966(3)(a)8, Florida Statutes.
Region 10: https://www.surveymonkey.com/s/MMARegion10
Region 11: https://www.surveymonkey.com/s/MMARegion11
The Agency released the Managed Medical Assistance (MMA) Invitation to Negotiate (ITN) on December 28, 2012. The data book has been included in the ITN. The data book can be found on the Agency for Health for Health Care Administration’s procurement page which can be accessed through the following link:
If you are unable to locate the ITN, please contact us at FLMedicaidManagedCare@ahca.myflorida.com for further assistance.
Choose an arrow below to view more information.
The Agency for Health Care Administration is hosting a public meeting to address questions about the Managed Medical Assistance Data Book released on September 21, 2012. The Data Book provides relevant background information that prospective plans will find useful in the development of their response to the Invitation to Negotiate (ITN). The ITN will be released by January 1, 2013.
The Agency issued eleven (11) separate Invitations to Negotiate (ITN) for the Managed Medical Assistance (MMA) portion of Statewide Medicaid Managed Care on December 28, 2012, through the Department of Management Services Vendor Bid System (VBS).
The MMA ITNs may be viewed through the Vendor Bid System (VBS).
To assist with planning, the Agency is interested in receiving a non-binding Letter of Intent to Bid from interested parties. If you intend to submit a bid, please send a letter to the Agency by August 17, 2012, that identifies your company name and the region(s) for which you intend to submit a response. Such a letter is completely voluntary and the decision not to submit a letter will have no effect on this or any other procurement. Letters should be sent via email to FLMedicaidManagedCare@ahca.myflorida.com.
Choose an arrow below to view more information.
Managed Medical Assistance
The state is seeking federal authority to extend Florida’s Managed Medical Assistance (MMA) Waiver for the period July 1, 2014 to June 30, 2017. The waiver is designed to implement a new statewide managed care delivery system without increasing costs and to re-design the Low Income Pool program. The MMA program will provide primary and acute medical care for certain populations through high quality, competitively selected managed care organizations (MCOs).
Extension Request Submitted November 27, 2013
On November 27, 2013, the Agency submitted a 3-year waiver extension request to the Centers for Medicare and Medicaid Services. The 1115 MMA waiver extension request and cover letter can be viewed at the following links. If you have comments, please submit them to the Agency via mail or email (see ‘Submit Comments’ below).
Public Notice Document Posted October 1, 2013
To view the public notice document posted on this webpage during the public comment period conducted from October 1, 2013 through October 30, 2013, please click the following link:
The following is an historical description of the waiver since authorization in 2005.
Initial 5-Year Period (2006-2011): On October 19, 2005, Florida's 1115 Research and Demonstration Waiver named “Medicaid Reform” was approved by Federal CMS to operate the demonstration for the period from July 1, 2006 to June 30, 2010. The program was implemented in Broward and Duval Counties July 1, 2006 and expanded to Baker, Clay and Nassau Counties July 1, 2007.
Three-Year Extension Period (2011-2014): On June 30, 2010, a three-year waiver extension request was submitted to Federal CMS to maintain and continue operations of Medicaid Reform for the period July 1, 2011 to June 30, 2014. Federal CMS granted temporary extensions of the program until December 15, 2011, when final approval of the waiver extension request was granted for the period December 16, 2011 to June 30, 2014.
MMA Waiver Amendment (June 14, 2013): On June 14, 2013, Federal CMS approved the MMA amendment that allows for the implementation of a new statewide managed care delivery system without increasing costs and to continue the Low Income Pool program. The amendment also changed the name of the waiver to the Florida Managed Medical Assistance program.
To view the June 14, 2013 approval letter, approved Special Terms and Conditions of the waiver, and the Waiver and Expenditure Authorities document, please click on the following links:
During the 2011 legislative session, the Florida Legislature passed and Governor Scott signed legislation to expand managed care the Florida Medicaid program with the creation of the MMA program. Part IV of Chapter 409, Florida Statutes, directs the Agency to submit and obtain approval of any federal waivers or state plan amendments necessary to implement the MMA program no later than October 1, 2014. In accordance with this directive, the Agency is seeking approval to extend the waiver authorization period from July 1, 2014 until June 30, 2017.
To view the law that established the MMA program, please click on the following link:
The Agency must provide for a 30-day public notice and comment period prior to the submission of the waiver extension request to Federal CMS. The 30-day public notice and public comment period began October 1, 2013 and ended October 30, 2013. The Agency considered all public comments received during the 30-day public comment period while developing the waiver extension request.
The following outlines the publicly noticed meetings that have occurred.
To view the video recording of the public meeting held in Tallahassee on October 11, 2013, please click on the picture below. This will direct you to the Florida Channel website and then press the play button to view the video. Video provided by The Florida Channel.
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting Ms. Linda Macdonald at (850) 412-4031 or by email at Linda.Macdonald@ahca.myflorida.com.
If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1 (800) 955-8771 (TDD) or 1 (800) 955-8770 (Voice).
The 30-day public notice and public comment period began October 1, 2013 and ended October 30, 2013. The Agency considered all public comments received during the 30-day public comment period while developing the waiver extension request.
To submit comments by postal service or internet email, please follow the directions outlined below. When providing comments regarding the 1115 MMA Waiver extension request, please have ‘1115 MMA Waiver Extension Request’ referenced in the subject line.
Mail comments and suggestions to:
1115 MMA Waiver Extension Request
You may also e-mail your comments and suggestions to:
If you would like to be added to the Interested Parties List to receive email updates about the 1115 MMA Waiver Extension Request, please provide your information in the box located in the top right hand side of this page named, “Program Updates.” Please note that information will be sent to this list via mass email. Your email server may recognize this as Spam or Junk Mail and, therefore, some action may be required on your part to receive notices.
Public Comments Received 10/1/2013 - 10/30/2013 [1.95MB PDF]
During the 2011 legislative session, the Legislature considered several alternative approaches to the Medically Needy program. In the bills (House Bills 7107 and 7109) that were enacted, the Legislature continued the Medically Needy program and directed the Agency to seek federal waiver authority to change the program to provide additional months of coverage, to implement a premium that would not exceed the share of cost and to provide care coordination and utilization management to achieve more cost-effective services.
Florida Medically Needy 1115 Waiver Application [4.71MB PDF]
The Agency must allow a 30-day public notice and comment period regarding applications for a new demonstration project that the Agency plans to submit to Federal CMS for review and consideration. The Agency will consider the public comments while developing the application for the proposed 1115 Research and Demonstration waiver for Florida’s Medically Needy program. To view a comprehensive description of the proposed 1115 Research and Demonstration for Florida’s Medically Needy program please click the following link to the public notice document. [625KB PDF]
The public workshop locations and times are as follows:
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting Robin Ingram at (850) 412-4017 or by email at Robin.Ingram@ahca.myflorida.com. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1 (800) 955-8771 (TDD) or 1 (800) 955-8770 (Voice).