This webinar defines the "Medicaid Pending" status and serves to educate providers on the needs of individuals in this situation as it relates to the SMMC Long-term Care Program.
This presentation covers protections afforded to enrollees and providers participating in the Long-term Care aspect of Florida's Statewide Medicaid Managed Care program.
FAQs chronic care management medicare reimbursement billingGaryRichards30
Care providers across the United States of America are monetizing Medicare chronic care management billing reimbursement codes to increase revenue from their practice. Read on to find answers to all the most commonly asked questions about patient eligibility, the scope of services, CPT codes and payment reimbursement for Medicare CCM.
Medicare 101 - 2021 Update from Erin HartMary Hagan
Medicare 101 – 2019 Update
Medicare Benefit Education Topics
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Medicare and Medicaid benefits
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This presentation covers protections afforded to enrollees and providers participating in the Long-term Care aspect of Florida's Statewide Medicaid Managed Care program.
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Care providers across the United States of America are monetizing Medicare chronic care management billing reimbursement codes to increase revenue from their practice. Read on to find answers to all the most commonly asked questions about patient eligibility, the scope of services, CPT codes and payment reimbursement for Medicare CCM.
Medicare 101 - 2021 Update from Erin HartMary Hagan
Medicare 101 – 2019 Update
Medicare Benefit Education Topics
Health benefits options for retirees and people over 65
Medicare and Medicaid benefits
Structuring an Eldercare program for your employees
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This presentation includes a detailed review of changes and updates discussed to the MDS 3.0 item set effective October 1, 2013. The presentation provides an overview of the most recent MDS 3.0 User’s Manual updates and reviews key elements for MDS coding, which will impact reimbursement based on the Federal Regulations in the FY 2014 Final Rule.
Medicare 101: The A,B,C, and D\’s of MedicareMark Lane
A overview of the basic components of Medicare, how they work, and what financial exposure exists under Basic Medicare coverage. Highlights supplemental or alternative coverage options within the Medicare framework.
This presentation is designed to provide an overview of the choice counseling process and how it can benefit long-term care recipients in the State of Florida.
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This SMMC provider webinar talks about specialty plans involved in the SMMC program. These plans are designed to provide services tailored for individuals with a particular diagnosis, such at HIV/AIDS, Mental Illness, CHF, COPD, or Diabetes.
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This presentation includes a detailed review of changes and updates discussed to the MDS 3.0 item set effective October 1, 2013. The presentation provides an overview of the most recent MDS 3.0 User’s Manual updates and reviews key elements for MDS coding, which will impact reimbursement based on the Federal Regulations in the FY 2014 Final Rule.
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This provider webinar has been customized to inform hospice providers about how they can participate in the Statewide Medicaid Managed Care Managed Medical Assistance (MMA) program.
This presentation outlines the specific requirements for Hospice providers with respect to the Statewide Medicaid Managed Care (SMMC) Long-term Care program in Florida.
This presentation shows providers how to verify a patient's Medicaid eligibility before providing services to them as part of the Managed Medical Assistance program.
This SMMC provider webinar talks about specialty plans involved in the SMMC program. These plans are designed to provide services tailored for individuals with a particular diagnosis, such at HIV/AIDS, Mental Illness, CHF, COPD, or Diabetes.
This SMMC provider webinar talks about the implications for recipients who are eligible for both the Long-term Care and Managed Medical Assistance programs.
This presentation discusses Assisted Living Faciltiies (ALFs) and Adult Family Care Homes (AFCHs) and how they fit in to the new Long-term Care program under Statewide Medicaid Managed Care.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Next Generation ACO Model team hosted an open door forum on Tuesday, March 28, 2017. The Next Generation Model features three payment rule waivers, referred to as benefit enhancements. This open door forum provided an overview of the Model’s three benefit enhancements.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Planning for healthcare needs via Medicare is also not a quick task. Understanding the length of time involved when considering which insurance is right reduces unrealistic expectations and disappointment. It also helps to understand what Medicare is and who it benefits before getting in to the finer details.
This episode continues our COVID-19 COVID-19 Insights Webinar discussing CMS changes, available grants and loans, existing opportunities in telehealth, and more state openings for elective surgeries.
MA Appeals Overturn 75% Of Claims Denialsbrennaljan
The name of the company that made the redetermination (the company that handled the Medicare claim in Level 1). You can find this information on the Medicare Summary Notice or the redetermination notice.
During this webinar, the Primary Care First Model Options team reviewed information necessary to submit an application for Primary Care First. The team discussed details on various parts of the application and answered frequently asked questions. Attendees also could submit questions live.
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CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
On Tuesday, April 9 from 2:00 p.m. - 3:00 p.m. EDT the Medicare Advantage Value-Based Insurance Design Model team provided an overview of the model’s main goals and guiding principles, provided a brief review of Medicare Advantage and the Medicare Hospice Benefit, introduced the key model design considerations, and provided a general timeline for the coming months.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Medicaid Planning and the Caregiver Crisis
https://www.thehalelawfirm.com/practice-areas/elder-law/medicaid-planning/
If you or someone you love is at risk of spending down their life savings to pay for the ever-growing cost of long-term care, then we invite you to call today for your free initial consultation. We look forward to exploring the opportunities our long-term care and asset protection planning can provide. The risk of needing long-term care and its related expenses is too great to ignore.
Call today to speak with a Dallas Medicaid planning attorney at the Hale Law Firm, P.C.
The Hale Law Firm, P.C.
417 W Main St
Waxahachie, TX 75165
(214) 446-5080
https://www.thehalelawfirm.com/
This webinar continues the COVID-19 Insights webinar series. Topics include the loans and grants being offered by the government, how they differ, and how they may benefit your practice, including SBA Loans and Grants, HHS Grants, Medicare Advance/Accelerated Payments, and Telehealth Funding. The webinar also goes over the CareOptimize technology developed to assist with streamlining COVID-19 monitoring and reporting.
Learn how to maximize the Medicare enrollment period and gain valuable insights into the Medicare provider enrollment process in our informative blog!
Understanding the Medicare enrollment period is crucial for anyone approaching Medicare eligibility or currently enrolled in the program. This period offers a window of opportunity to make important decisions regarding your healthcare coverage. Whether you're a newcomer to Medicare or a current beneficiary looking to make changes, it's essential to grasp the ins and outs of this enrollment period.
Our blog provides comprehensive information on navigating the Medicare enrollment period effectively. We guide you through the process of enrolling in Medicare, explain different parts of Medicare, and help you make informed choices about your coverage. You'll find tips on how to ensure that you're getting the most out of your Medicare benefits during this critical time.
If you're a Medicare provider, our blog also offers valuable insights into the Medicare provider enrollment process. We break down the steps and requirements involved in becoming a Medicare provider, ensuring you have a clear understanding of the process. Whether you're a medical professional, a healthcare facility, or an organization looking to participate in the Medicare program, our blog equips you with the knowledge to navigate the enrollment process seamlessly.
Stay informed, make well-informed decisions about your Medicare coverage, and gain insights into becoming a Medicare provider by exploring our blog. We're dedicated to providing you with the information you need to make the most of Medicare and enhance your understanding of the enrollment process.
Understanding the ObamaCare North Carolina Health Insurance Plans
As a result of the Affordable Care Act (a.k.a. ObamaCare) the following provisions are now in place for health insurance policies with an effective date January 1, 2014 or after:Individuals cannot be declined for health insurance or charged more due to their health status or gender.
Insurance premiums are based on age, your zip code and tobacco usage.
Coverage limitations or exclusions based on pre-existing conditions are not allowed.
Elimination of annual and lifetime coverage limits.
Prohibition of declining an individual for coverage based on their participation in an approved clinical trial.
Maternity and mental health are included on all policies.
Preventative dental is covered with a $25 copay for members up to age 19. There is also some vision coverage for this age group.
Whether or not your children are students they can stay on your policy until age 26.
Introduction of the Medical Loss Ratio (MLR) which ensures that 80% of the premium dollars paid to the health insurance issuer are spend on providing health care. An insurance company that does not do this must provide rebates to their policyholders
http://www.hisonc.com/obamacare-north-carolina
Understanding User Needs and Satisfying ThemAggregage
https://www.productmanagementtoday.com/frs/26903918/understanding-user-needs-and-satisfying-them
We know we want to create products which our customers find to be valuable. Whether we label it as customer-centric or product-led depends on how long we've been doing product management. There are three challenges we face when doing this. The obvious challenge is figuring out what our users need; the non-obvious challenges are in creating a shared understanding of those needs and in sensing if what we're doing is meeting those needs.
In this webinar, we won't focus on the research methods for discovering user-needs. We will focus on synthesis of the needs we discover, communication and alignment tools, and how we operationalize addressing those needs.
Industry expert Scott Sehlhorst will:
• Introduce a taxonomy for user goals with real world examples
• Present the Onion Diagram, a tool for contextualizing task-level goals
• Illustrate how customer journey maps capture activity-level and task-level goals
• Demonstrate the best approach to selection and prioritization of user-goals to address
• Highlight the crucial benchmarks, observable changes, in ensuring fulfillment of customer needs
LA HUG - Video Testimonials with Chynna Morgan - June 2024Lital Barkan
Have you ever heard that user-generated content or video testimonials can take your brand to the next level? We will explore how you can effectively use video testimonials to leverage and boost your sales, content strategy, and increase your CRM data.🤯
We will dig deeper into:
1. How to capture video testimonials that convert from your audience 🎥
2. How to leverage your testimonials to boost your sales 💲
3. How you can capture more CRM data to understand your audience better through video testimonials. 📊
Recruiting in the Digital Age: A Social Media MasterclassLuanWise
In this masterclass, presented at the Global HR Summit on 5th June 2024, Luan Wise explored the essential features of social media platforms that support talent acquisition, including LinkedIn, Facebook, Instagram, X (formerly Twitter) and TikTok.
Building Your Employer Brand with Social MediaLuanWise
Presented at The Global HR Summit, 6th June 2024
In this keynote, Luan Wise will provide invaluable insights to elevate your employer brand on social media platforms including LinkedIn, Facebook, Instagram, X (formerly Twitter) and TikTok. You'll learn how compelling content can authentically showcase your company culture, values, and employee experiences to support your talent acquisition and retention objectives. Additionally, you'll understand the power of employee advocacy to amplify reach and engagement – helping to position your organization as an employer of choice in today's competitive talent landscape.
Event Report - SAP Sapphire 2024 Orlando - lots of innovation and old challengesHolger Mueller
Holger Mueller of Constellation Research shares his key takeaways from SAP's Sapphire confernece, held in Orlando, June 3rd till 5th 2024, in the Orange Convention Center.
Company Valuation webinar series - Tuesday, 4 June 2024FelixPerez547899
This session provided an update as to the latest valuation data in the UK and then delved into a discussion on the upcoming election and the impacts on valuation. We finished, as always with a Q&A
Personal Brand Statement:
As an Army veteran dedicated to lifelong learning, I bring a disciplined, strategic mindset to my pursuits. I am constantly expanding my knowledge to innovate and lead effectively. My journey is driven by a commitment to excellence, and to make a meaningful impact in the world.
Top mailing list providers in the USA.pptxJeremyPeirce1
Discover the top mailing list providers in the USA, offering targeted lists, segmentation, and analytics to optimize your marketing campaigns and drive engagement.
Premium MEAN Stack Development Solutions for Modern BusinessesSynapseIndia
Stay ahead of the curve with our premium MEAN Stack Development Solutions. Our expert developers utilize MongoDB, Express.js, AngularJS, and Node.js to create modern and responsive web applications. Trust us for cutting-edge solutions that drive your business growth and success.
Know more: https://www.synapseindia.com/technology/mean-stack-development-company.html
Kseniya Leshchenko: Shared development support service model as the way to ma...Lviv Startup Club
Kseniya Leshchenko: Shared development support service model as the way to make small projects with small budgets profitable for the company (UA)
Kyiv PMDay 2024 Summer
Website – www.pmday.org
Youtube – https://www.youtube.com/startuplviv
FB – https://www.facebook.com/pmdayconference
Kseniya Leshchenko: Shared development support service model as the way to ma...
SMMC Long-term Care Provider Webinar: Medicaid Pending
1. Welcome to the Agency for Health
Care Administration Training
Presentation for Potential
Long-term Care Providers.
The presentation will begin momentarily.
Please dial in ahead of time to:
1-888-670-3525
Passcode: 771 963 1696
4. 4
3. Select “Event Materials”
to download today’s
presentation.
Note: You may also view
details regarding future
SMMC events using the
“Upcoming Events” tab.
5. 5
4. Choose the file(s) you
would like to save.
Note: You may also view
files from past events and
AHCA guidance statements
or submit questions to be
answered in future
presentations.
6. Today’s Presenters
Cheryl Young
• Bureau Chief of Long-Term Care & Support
Services
• Department of Elder Affairs
Damon Rich
• Manager, Choice Counseling Unit
• Agency for Health Care Administration
6
7. Objectives
Define/explain Medicaid Pending
Explain how Medicaid Pending will affect
SMMC long-term care applicants in nursing
facilities vs. community settings
Clarify the differences between Medicaid
Pending under the Nursing Home Diversion
waiver and the Long-term Care (LTC) program
7
8. Legislative and Technical Advisory
Workgroup Direction
409.9841(e), Florida Statutes, directs the Agency
for Health Care Administration (AHCA) to
develop a process for the “enrollment of and
payment for individuals pending determination
of Medicaid eligibility.”
8
9. Workgroup Recommendation
Nursing Facility Care
The Agency shall ensure nursing facilities receive payment (the
state will maintain a separate fee-for-service payment system for
nursing facilities) for individuals whose Medicaid eligibility is
determined retroactively prior to their enrollment with a managed
care organization.
Home and Community Based Care
The Agency shall develop and incorporate a retroactive eligibility
and payment process that allows individuals access to home and
community based care as quickly as possible even if their financial
eligibility for Medicaid has not yet been determined.
9
10. What is Medicaid Pending?
Medicaid Pending is when recipients elect
to enroll and receive services before their
application for financial eligibility is
approved.
10
11. Reasons for Medicaid Pending
Individuals that qualify for a Long-term Care plan
may be elders or disabled individuals that have
chronic illnesses and require long-term care services
right away.
Individuals are given the option to either receive
services without verified Medicaid financial eligibility
or wait for Medicaid financial eligibility to be verified
to start receiving services.
11
12. Medicaid Pending Process
After the Medicaid application has been completed (no eligibility
yet), the DCF application information will be sent to HealthTrack, a
system that is used to complete enrollments.
HealthTrack will store the information until the CARES assessment is
received stating the member is clinically eligible for the Long-term
Care program.
Therefore, HealthTrack will be receiving the Department of Children
and Families (DCF) application information stating the individual has
applied for Medicaid and the CARES assessment indicating the
individual is clinically eligible for long-term care services.
In order to enroll with an SMMC Long-term Care managed care plan
(MCP) as “Medicaid Pending,” applicants must have completed the
following steps:
Filed a Medicaid application with DCF
Received clinical eligibility (met “Level of Care” requirement).
12
13. Once an SMMC Long-term Care applicant has completed these two
steps, they have two options:
1. Now: Clients can choose to enroll with a managed care plan in a
“Medicaid Pending” status. This will allow the recipient to receive
services immediately, but puts them at risk for the cost of services
received if their application for Medicaid is later denied.
OR
2. Later: Clients can choose a managed care plan, but have the
Enrollment Broker hold the choice until their Medicaid application
has been approved by DCF. They are not formally enrolled in a
health plan and do not receive services until Medicaid is approved.
There is also the option to “Wait” when choosing to receive
services “Later.” Choosing to “Wait” means you opt to wait until
you receive approval of eligibility to both choose a plan and
receive services.
13
Medicaid Pending Process
14. What does the choice “Now” mean?
If the individual chooses to get LTC services “Now,” they will be
enrolled into the plan of their choice for the next enrollment cycle.
The plan choice will be sent to the managed care plan and the
member will receive a confirmation letter stating the plan
choice, effective date and another reminder about getting services
“Now” without approved Medicaid eligibility.
During this Medicaid Pending period, the managed care plan cannot
deny or delay services based on the individuals pending Medicaid
eligibility status.
There is a financial risk to the Medicaid recipient associated with
receiving services prior to receiving verification of Medicaid
eligibility.
14
15. What does the choice “Later” mean?
If the recipient decides to receive long-term care services
“Later,” their services will not start until Medicaid eligibility
has been approved.
Although the recipient chooses to get services “Later,” they
may still choose a managed care plan.
The managed care plan choice will be saved in the system as a
pending enrollment until Medicaid eligibility is approved.
A confirmation letter with the managed care plan will be sent;
however, since there is no eligibility yet, it will not indicate an
effective date.
15
16. Enrollment Timeframe Examples
Example 1
If a recipient begins enrollment with the plan effective 9/1/13, but
Medicaid eligibility is approved effective 10/1/13, then the recipient is
responsible for paying the plan for services rendered for the month of
September.
Example 2
If a recipient begins enrollment with the plan effective 9/1/13, Medicaid
eligibility is approved effective 8/1/13, then the plan will only be paid for
services rendered September forward.
16
17. What does the choice to “Wait” for
eligibility to enroll mean?
Recipients can also choose to get services later and wait to
make their managed care selection when eligibility is
verified.
When eligibility is granted, these recipients will receive a
letter that lets them know that they have 30 days to choose a
plan and informs them of the health plan they will be
automatically enrolled in if they do not make this choice
within that timeframe.
They will have 90 days from the initial effective date indicated
in this letter to try out either their chosen or automatically-
assigned plan and change it for any reason.
17
18. Managed Care Plan
“Medicaid Pending” Protocol
Managed care plans (MCPs) are not allowed to
delay or limit services provided to Medicaid
Pending members.
If a member is denied Medicaid eligibility (for some or
all of the enrollment months spent in Medicaid
Pending status), the MCP can seek reimbursement of
the cost of services from the member for the ineligible
time period.
If a member gains Medicaid eligibility, the MCP will be
reimbursed for the months in which the enrollee
received services in a Medicaid Pending status
pursuant to the rates established in the Long-term
Care program contract.
18
19. “Medicaid Pending” Recipient Protocol
Medicaid Pending recipients are not allowed to
change plans while in a Medicaid Pending status.
Members can choose to opt out of Medicaid
Pending, and stop receiving services until Medicaid is
approved.
Once a member receives Medicaid eligibility, he/she
will have a 90 day change period to switch MCPs, if
desired.
After the change period is over, members are locked in for
the rest of the year and can only change MCPs with an
approved “just cause” request.
19
20. LTC vs. Nursing Home Diversion
Medicaid Pending under SMMC LTC differs from Nursing
Home Diversion’s version of Medicaid Pending in the
following ways:
SMMC LTC applicants must file a Medicaid Application before
they are enrolled with an MCP.
SMMC LTC MCPs will only receive Medicaid Pending members
who wish to receive services, and have filed their application
with DCF.
The “606” vs. “608” process under Nursing Home Diversion will end.
SMMC LTC MCPs will not assist with initial DCF applications. MCPs will
only assist if they are providing services and also assist with financial
eligibility completion as a part of case management.
Medicaid Pending members will show up as enrolled with their
MCP in FMMIS while Medicaid Pending.
20
21. Medicaid Pending & Nursing Facilities
LTC applicants who reside in nursing facilities will be subject
to the same retroactive eligibility process under LTC that
they were under Institutional Care Program (ICP) Medicaid.
This is technically different from the SMMC LTC Medicaid
Pending process, which only applies to recipients in community
settings.
Individuals in nursing homes will not have the option to enroll in
a managed care plan until their eligibility for Medicaid has been
approved by DCF.
According to the Medicaid Nursing Facility
Handbook, Medicaid eligibility can be granted retroactively
by DCF for up to three months before the date of Medicaid
application if the applicant meets all eligibility
criteria, including level of care.
21
22. Resources
Questions can be emailed to:
FLMedicaidManagedCare@ahca.
myflorida.com
Updates about the Statewide
Medicaid Managed Care program
are posted at:
http://ahca.myflorida.com/Medicaid
/statewide_mc
Upcoming events and news can be
found on the “News and Events” tab.
You may sign up for our mailing list by
clicking the red “Sign Up for Program
Updates” box on the right hand side of
the page.
22