Health Care for Florida Children Cheat Sheet
|
|
- Morgan Morrison
- 5 years ago
- Views:
Transcription
1 Health Care for Florida Children Cheat Sheet MEDICAID a/k/a State Plan Medicaid Eligibility by DCF Administered by AHCA Federal (about 58%); State (about 42%) Mandatory (every state must cover): Inpatient & Outpatient Hospital, Physician and Nurse Practitioner, Labs & X-rays, Prenatal care & Family Planning, EPSDT for under 21*, Nursing Homes, Rural Health Clinics, Federally Qualified Health Centers, Transportation. *EPDST has been interpreted to require states to offer ALL services, whether optional or mandatory, to children if they are medically necessary. Optional (states can chose to cover): HCBA, Pediatric Nursing Facilities, Inpatient Psychiatric for under 21, ICF/DD, Prescription meds, personal care services, Therapies (PT/OT/ST/RT), vision & dental services, durable medical equipment Eligibility: Age: Depends on category Categories of eligible individuals: Children (under age 21), Pregnant women, Adults with dependent children, Anyone getting SSI, Elderly, Blind or Disabled Financial: It s complicated, but a child will qualify for any of these reasons: 1. Gets SSI, which requires a finding of disability and very low household income and assets 2. Birth to 1 with household income less than or equal to 200% FPL 3. Age 1 to 21 with household income less than or equal to 138% FPL 4. Is a dependent of the state; (also, if under 26 and aged out of foster care, and getting Medicaid when aged out; no income/asset test) 5. Is covered as part of an adoption assistance subsidy; 6. Is enrolled in a Waiver program (child is treated as a household of one for income and asset criteria.) Enrollment Process: Apply through DCF Service Center (online ACCESS), KidCare (including MediKids and HealthyKids), or the ACA Insurance Exchange Statutory Authority: Federal: Title XIX of the SSA (42 USC 1396 et seq.) State: Chapter 409, Fla. Stat. Rules: Federal: 42 CFR 430 et seq. See 42 C.F.R for EPSDT State: Chapter 65A, F.A.C.
2 Handbooks: Handbooks are adopted as rules through AHCA for Medicaid services, provider requirements, and most Medicaid Waiver programs.they can be found online at AHCA s website under Provider Support/Provider Handbooks: erhandbooks/tabid/42/default.aspx Useful examples include: Medicaid Summary of Services, Medicaid Home Health Services, Child Health Check-Up (formerly EPSDT). Waiting List: None. Medicaid is an entitlement for anyone who is eligible. MEDICALLY NEEDY MEDICAID Eligibility by DCF Administered by AHCA Same as State Plan Medicaid Same as State Plan Medicaid, except not nursing home care. Also not applicable to Waivers Eligibility: Clinical: Individual is eligible for Medicaid under any eligibility category but does not meet financial criteria. Enrollment is determined monthly based on Share of Cost. Financial: Share of Cost is determined based on household Modified Adjusted Gross Income, less about $250 per dependent. For Medicaid to kick in, bills from Medicaid providers must be submitted to DCF in an amount equal to or greater than the Share of Cost. For the remainder of the month, the eligible individuals are covered by Medicaid. Enrollment Process: Same as Medicaid. Plus, DCF is supposed to determine eligibility any time another type of Medicaid is terminated. Statutory Authority: State: (2), F.S. Rules: Federal: 42 CFR 435, Subpart D State: See F.A.C. Rules 65A-1.702, 1,713 Handbook: See Medicaid Provider Reimbursement Handbook CMS-1500 Claim Form (Special billing for Medically Needy Recipients) Waiting List: None
3 MEDIKIDS (A KidCare CHIP Program) Eligibility through KidCare/HealthyKids Administered by AHCA Federal (about 70%); State (about 30%), but there is a federal cap Same as State Plan Medicaid, including EPSDT. This program is, essentially, an extension of Medicaid. Eligibility: Age: 1 through 4 Other: Uninsured, citizen or qualified non-citizen, not eligible for Medicaid, not in an institution Financial: Modified Adjusted Gross Income of household less than 200% of FPL. Requires small premium payment of $15 or $20 per month. MediKids is available for a full pay premium (under $200/month) either for uninsured or underinsured children. Enrollment Process: Same as Medicaid. Also, DCF is supposed to submit a KidCare application if Medicaid is terminated. Statutory Authority: Federal: Title XXI of SSA State: KidCare , et seq ; MediKids , F.S. Rules: Federal: 42 C.F.R. Chapter IV, Subchapter D State: KidCare Grievance Process at Chapter 59G-14 Handbook: Same service requirements as Medicaid, so look at Medicaid Handbooks Waiting List: None currently, but CHIP is not an entitlement like Medicaid. The state can stop enrollment or modify benefits. HEALTHYKIDS (A KidCare CHIP Program) Eligibility through KidCare/HealthyKids Administered by HealthyKids Federal (about 70%); State (about 30%), but there is a federal cap
4 Benefit package similar to insurance, with minimum benefits set out in (2), F.S. Not as extensive as MediKids/Medicaid. Availability of home health services is unclear. Eligibility: Age: 5 through 18 Other: Uninsured, citizen or qualified non-citizen, not eligible for Medicaid, not in an institution Financial: Modified Adjusted Gross Income of household less than 200% of FPL. Requires small premium payment of $15 or $20 per month. HealthyKids is available for a full pay premium (under $200/month) either for uninsured or underinsured children. Enrollment Process: Same as Medicaid. Also, DCF is supposed to submit a KidCare application if Medicaid is terminated. Statutory Authority: Federal: Title XXI of SSA State: KidCare , et seq.; Benefits , F.S. Rules: Federal: 42 C.F.R. Chapter IV, Subchapter D State: KidCare Grievance Process at Chapter 59G-14 Handbook: Member handbook of organization administering claims, like United Healthcare Waiting List: None currently, but CHIP is not an entitlement like Medicaid. The state can stop enrollment or modify benefits. CHILDREN S MEDICAL SERVICES Clinical eligibility through Department of Health Financial eligibility through either DCF or HealthyKids CMS Network (both Medicaid and SCHIP enrollees) administered by Department of Health Medicaid, CHIP, and federal Title V Maternal & Child Health Block Grant Same as State Plan Medicaid, along with case management services and an expanded provider network of medical, therapeutic and support services. Moving to Managed Care in August of Eligibility: Age: Birth to 21
5 Clinical: Medically complex Financial: Same as Medicaid or CHIP programs, but no full pay option (Note: the lack of a full pay option is under court challenge.) Enrollment Process: Same as Medicaid and CHIP, but requires a clinical assessment by CMS nurses. Statutory Authority: Federal: See funding State: Chapter 391 Rules: Federal: Depends on program eligibility State: F.A.C. Chapter 64C Handbook: CMS Provider Handbooks for Physicians & Dentists, Licensed Non-Physician Healthcare Professionals, Non-Licensed Healthcare Professionals at CMS website. Waiting List: None currently, but if CHIP is the eligible program, it is not an entitlement like Medicaid. The state can stop enrollment or modify benefits for CHIP. BIRTH-RELATED NEUROLOGICAL INJURY COMPENSATION ASSOCIATION PROGRAM (NICA) Department of Financial Services State, but may be offset by other insurance sources, including Medicaid Wide range of medical, therapy and care benefits, but waiver of any other malpractice compensation Eligibility: Age: Lifetime coverage if eligible, but claim must be filed by child s 5 th birthday Clinical: Oxygen deprived or mechanical injury in labor or delivery or resuscitation immediately post-delivery; Permanent, substantial mental and physical impairment Financial: None Enrollment Process: Must file petition with DOAH for an eligibility determination by an Administrative Law Judge. Statute of limitations for medical malpractice applies but is tolled by administrative claim.
6 Statutory Authority: State: , F.S. Handbook: Benefit Handbook at NICA website EARLY STEPS Department of Health/CMS Federal (through IDEA and Medicaid) and State Intervention to address developmental delays and promote learning; developed through an Individual Family Support Plan Eligibility: Age: Birth to 36 months Clinical: in delays Significant delay or established medical condition likely to result Financial: None, but can receive services under Medicaid, if eligible Enrollment Process: Referral to contracted regional Early Steps office, usually by a health care provider, but parent can call as well. Statutory Authority: Federal: Title XIX of SSA (Medicaid) and Part C of IDEA State: et seq. and Ch Rules: Federal: 42 CFR 430 et seq. See 42 C.F.R for EPSDT and 34 CFR 300, et seq. State: 59G (Handbook); 6A (ESE Eligibility for Infants or Toddlers Birth Through Two Years Old who have Established Conditions); 6A (ESE Eligibility for Infants and Toddlers Birth Through Two Years Old who are Developmentally Delayed); 6A (Contractual Agreements With Nonpublic Schools and Residential Facilities); 6A (General Education Intervention Procedures, Evaluation, Determination of Eligibility, Reevaluation and the Provision of ESE Services); 64F Healthy Start Care Coordination System. Handbook: Medicaid Early Intervention Services Waiting List: None
7 MEDICAL FOSTER CARE Coordination with AHCA, CMS (DOH), DCF Child Welfare and Community- Based Care Program Federal and State. DCF reimburses for room, board, and living expenses. Medicaid reimburses for medically necessary care, such as assisting with activities of daily living, administering medication, changing dressing. Foster home with trained providers, oversight by social worker, nurse, training of family if re-unification. Services will depend on the level of need. Eligibility: Age: Birth to 21 Clinical: Financial: Medically complex, but medically stable in home setting In custody of DCF Enrollment Process: Placement recommended by CMS (CMAT); Placement approval by DCF and CMS physician; Authorization from service authorization nurse at AHCA Area Office Statutory Authority: Federal: Title XIX and V of SSA State: Chapter 409, F.S. (related to foster care, generally) Rules: State: F.A.C. Chapters 65C-12 (Emergency Shelter); 65C-13 (Substitute Care of Children), Rule 59G (Medicaid Summary of Services Handbook) Waiting List: Depends on availability of Medical Foster Care home THE MEDICAID WAIVER PROGRAMS DEVELOPMENTAL DISABILITIES ibudget WAIVER Clinical eligibility determined by Agency for Persons with Disability Financial eligibility determined by DCF Administered by APD. AHCA is the designated single-state agency for Medicaid Same as Medicaid Home and community-based services, including personal support and respite, services that provide a meaningful day activity (e.g., adult day training),
8 consumable medical supplies (e.g., diapers), durable medical equipment (e.g., a wheelchair), behavioral and mental health services, OT, PT, ST, RT, and environmental modifications, among others. Eligibility: Age: 3 and up Clinical: 1. Diagnosed with one of six different developmental disabilities that occurred before the age of 18: mental retardation (IQ of 59 or less, or between 60 and 69 with a handicapping condition), cerebral palsy, autism (not Asperger s or PDD-NOS), spina bifida, Prader- Willi Syndrome or Down Syndrome; and 2. Has substantial limitations in at least three life activities: self-care, learning, mobility, self-direction, understanding and use of language, and capacity for independent living. Financial: The individual with developmental disability is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Apply for eligibility through Regional APD Office Statutory Authority: Federal: 1915(c) of SSA (42 U.S.C. 1396n) State: Chapter 393, F.S. Rules: Federal: 42 C.F.R et seq. State: F.A.C. Chapter 65G Handbook: Developmental Disabilities Home and Community-Based Services Coverage and Limitations Handbook. (A new Handbook for APD s ibudget Program has been proposed.) Enrollment: 29,082 Waiting List: 22,069* [Footnote: all figures for enrollment and waitlist based on 2013 OPPAGA Report] Priority for Waiting List: Crisis enrollment rules (F.A.C. 65G ) allow for a crisis application. If approved, individual moves to top of list. Denial allows fair hearing challenge. FAMILIAL DYSAUTONOMIA WAIVER Clinical eligibility determined by AHCA
9 Financial eligibility determined by DCF Administered by AHCA AHCA is the designated single-state agency for Medicaid Same as Medicaid Case management, respite, consumable medical supplies, durable medical equipment, behavioral services, non-residential support services, dental services. Eligibility: Age: 3 and up Clinical: level of care. Diagnosis of familial dysautonomia. Requires inpatient hospital Financial: The individual is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Apply for eligibility through AHCA Statutory Authority: 1915(c) of SSA (42 U.S.C. 1396n) Rules: Federal: 42 C.F.R et seq. State: F.A.C. Rule 59G Enrollment: 8 Waiting List: None Priority for Waiting List: Prioritization based on scores of fragility assessment. ADULT CYSTIC FIBROSIS WAIVER Clinical eligibility determined by DOEA (CARES assessment) Financial eligibility determined by DCF Administered by DOH Same as Medicaid Chore, case manager, counseling (individual and family), dental, home-delivered meals, homemaker, massage therapy, nutritional supplements, personal care, PERS, PT, medication, RT, respite, skilled nursing, specialized medical equipment and supplies Eligibility: Age: 18 and up
10 Clinical: Diagnosed with Cystic Fibrosis by a physician. At risk of hospitalization Financial: The individual is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Apply for eligibility through DOH Brain and Spinal Cord Injury Central Registry ( ) or online at BSCIP website Statutory Authority: Federal: 1915(c) of SSA (42 U.S.C. 1396n) Rules: Federal: 42 C.F.R et seq. State: F.A.C. Rule 59G Enrollment 110 Waiting List: None MODEL WAIVER Clinical eligibility determined by CMS Financial eligibility determined by DCF Administered by AHCA Same as Medicaid Assistive technology, case management by CMS, environmental accessibility adaptations, nursing home transition, respite (other home health services covered by Medicaid) Eligibility: Age: Up to age 20 Clinical: Diagnosed with degenerative spinocerebellar disease by a physician; Medically complex or medically fragile; At risk of hospitalization as determined by Children s Multidisciplinary Assessment Team (CMAT) Financial: The individual is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Apply for eligibility through AHCA, Level of care assessment through CMS (CMAT). Statutory Authority: Federal: 1915(c) of SSA (42 U.S.C. 1396n)
11 Rules: Federal: 42 C.F.R et seq. State: F.A.C. Rule 59G Enrollment: 5 Waiting List: 3 Priority for Waiting List: Prioritization based on scores of fragility assessment. PROJECT AIDS CARE (PAC) WAIVER Clinical eligibility determined by DOEA (CARES assessment) Financial eligibility determined by DCF Administered by AHCA Same as Medicaid Case management, chore, day health care, education and support, environmental accessibility adaptations, home-delivered meals, homemaker, personal care, restorative message, skilled nursing, specialized medical equipment and supplies, specialized personal care for children in foster care, therapeutic management of substance abuse Eligibility: Age: No age criteria Clinical: Diagnosed with AIDS by physician; Presence of AIDS-related opportunistic infection; At risk of institutionalization (CARES assessment); Disabled by SSA standards Financial: The individual is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Apply for eligibility through AHCA Statutory Authority: Federal: 1915(c) of SSA (42 U.S.C. 1396n) Rules: Federal: 42 C.F.R et seq. State: F.A.C. Rule 59G Handbook:Project AIDS Care Waiver Services Enrollment: 6,844 Waiting List: None
12 TRAUMATIC BRAIN INJURY/SPINAL CORD INJURY (TBI/SCI) WAIVERS Clinical eligibility determined by DOEA (CARES assessment) Financial eligibility determined by DCF Administered by DOH Same as Medicaid Assistive technology, attendant (nursing) care (limited to 3 hours/day), behavioral, case management, companion, CMS, PER, environmental adaptations, life skills training, OT, PT, ST, RT, counseling, rehab engineering eval, res hab Eligibility: Age: 18 or older Clinical: Diagnosed with traumatic brain or spinal cord injury, defined in , F.S.; Medically stable; Level II level of care for nursing home (CARES assessment); Referred to Brain and Spinal Cord Injury Program (BSCIP) Central Registry Financial: The individual is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Contact DOH s BSCIP Central Registry ( ) or online at the BSCIP website Statutory Authority: Federal: 1915(c) of SSA (42 U.S.C. 1396n) State: Rules: Federal: 42 C.F.R et seq. State: F.A.C. Rule 59G and.131 Handbook: TBI/SBI Waivers Coverage and Limitations Handbook Enrollment: 286 Waiting List:309 Priority for Waiting List: Prioritization based on scores of fragility assessment. LONG TERM CARE PROGRAM WAIVER Clinical eligibility/priority determined by DOEA (CARES assessment)
13 Financial eligibility determined by DCF Administered by AHCA through private managed care organizations (MCOs) through the state. Same as Medicaid; MCOs are funded on a capitated rate Case management, companion, adult day health care, assisted living, attendant (nursing) care, behavioral, home accessibility, home-delivered meals, homemaker, hospice, skilled nursing, DME, medication administration and management, nursing facility, personal care, PERS, Respite, OT, PT, ST, RT, transportation Eligibility: Age: 18 or older Clinical: Disabled, as defined by SSA; Level of care for institutionalization (CARES assessment); Individuals already enrolled in the following waivers: Aged and Disabled Adult, Channeling for Frail Elders, Assisted Living, Nursing Home Diversion. Financial: The individual is treated as a separate household, so only his or her income/assets are considered. Same criteria as Medicaid for Institutional Care Placement. Enrollment Process: Contact AHCA or the Aging and Disability Resource Center in your area Statutory Authority: Federal: 1915(b) of SSA (42 U.S.C. 1396u-2) and 1915(c) of SSA (42 U.S.C. 1396n) State: Chapter 409, Part IV, F.S. Rules: Federal: 42 C.F.R. Part 438 State: F.A.C. Rule 59G and.131 Handbook: Member benefit handbook for the individual MCO Enrollment: Over 85,000 Waiting List: 34,559 Priority for Waiting List: Prioritization based on scores of fragility assessment. DOEA is managing the waiting list. Rules authorized by 2014 Legislature but not yet developed.
Medicaid Covered Services Not Provided by Managed Medical Assistance Plans
Medicaid Covered Services Not Provided by Managed Medical Assistance Plans This document outlines services not provided by MMA plans, but are available to Medicaid recipients through Medicaid fee-for-service.
More informationDEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK. Chapter 3. Description of DOEA Coordination With Other State and Federal Programs
Chapter 3 Description of DOEA Coordination With Other State and Federal Programs TABLE OF CONTENTS Section: Topic Page I. Overview and Specific Legal Authority 3-3 II. 3-5 A. Adult Care Food Program 3-5
More informationDEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK. Chapter 3. Description of DOEA Coordination with Other State and Federal Programs
Chapter 3 Description of DOEA Coordination with Other State and Federal Programs TABLE OF CONTENTS Section: Topic Page I. Overview and Specific Legal Authority 3-3 II. 3-5 A. Adult Care Food Program 3-5
More informationExecutive Summary...1. Section I Introduction...3
TABLE OF CONTENTS Executive Summary...1 Section I Introduction...3 Section II Statewide Services Provided to Special Needs Children...5 Introduction... 5 Medicaid Services... 5 Children s Medical Services
More informationMEDIMASTER GUIDE. MediMaster Guide. Positively Aging /M.O.R.E The University of Texas Health Science Center at San Antonio
MEDIMASTER GUIDE MediMaster Guide 25 Appendix: MediMaster Guide MEDICARE What is Medicare? Medicare is a hospital insurance program in the U.S. that pays for inpatient hospital care, skilled nursing facility
More informationoppaga Profile of Florida s Medicaid Home and Community Based Services Waivers
oppaga Profile of Florida s Medicaid Home and Community Based Services Waivers JANUARY 00 Report No. 0 0 Office of Program Policy Analysis & Government Accountability an office of the Florida Legislature
More informationLong-Term Care Glossary
Long-Term Care Glossary Adjudicated Claim Activities of Daily Living (ADL) A claim that has reached final disposition such that it is either paid or denied. Basic tasks individuals perform in the course
More informationDEVELOPMENTAL DISABILITIES INDIVIDUAL BUDGETING MEDICAID WAIVER COVERAGE AND LIMITATIONS HANDBOOK
Florida Medicaid DEVELOPMENTAL DISABILITIES INDIVIDUAL BUDGETING MEDICAID WAIVER COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration UPDATE LOG DEVELOPMENTAL DISABILITIES INDIVIDUAL
More informationDepartment of Elder Affairs Programs and Services Handbook Chapter 3: Description of DOEA Coordination with Other State/Federal Programs CHAPTER 3
CHAPTER 3 Description of DOEA Coordination with Other State/Federal Programs 3-1 Table of Contents TABLE OF CONTENTS Section: Topic Page I. Overview and Specific Legal Authority 3-4 II. 3-7 A. Adult Care
More informationHCBS Waiver Consolidation Monthly Stakeholder Meeting
HCBS Waiver Consolidation Monthly Stakeholder Meeting Traumatic Brain Injury/ Spinal Cord Injury (TBI/SCI) & Adult Cystic Fibrosis (ACF) Waiver Tuesday, November 14 th, 2017 Webinar Housekeeping Attendee
More informationDepartment of Elder Affairs Programs and Services Handbook Chapter 3: Description of DOEA Coordination with other State/Federal Programs CHAPTER 3
CHAPTER 3 Description of DOEA Coordination with Other State/Federal Programs 3-1 Table of Contents Section: Topic Page I. Overview and Specific Legal Authority 3-4 II. 3-7 A. Adult Care Food Program 3-7
More informationFood Stamps Caseload Distribution (FS)... 1
Table of Contents General Program Information 0210.0000 Food Stamps... 1 0210.0001 Caseload Distribution (FS)... 1 0210.0100 FOOD STAMP PROGRAM (FS)... 1 0210.0101 Legal Basis (FS)... 1 0210.0102 Program
More informationGAL DISABILITIES TRAINING CONFERENCE MAY 23, 2014 Nancy E. Wright, Esq. & Kirsten Clanton, Esq.
GAL DISABILITIES TRAINING CONFERENCE MAY 23, 2014 Nancy E. Wright, Esq. & Kirsten Clanton, Esq. Medicaid-ese 101: The Agencies AHCA DCF CMS (bonus if you know both Federal & Florida!) DOH DOAH OAH (of
More informationFlorida Medicaid. Medical Foster Care Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
More informationLouisiana Medicaid Update
Louisiana Medicaid Update HFMA Region 9 Conference November 15, 2015 Origins of Medicaid Means tested entitlement program Established 1965 by Title XIX of the Social Security Act Public health coverage
More informationFlorida Medicaid. State Mental Health Hospital Services Coverage Policy. Agency for Health Care Administration. January 2018
Florida Medicaid State Mental Health Hospital Services Coverage Policy Agency for Health Care Administration Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions...
More informationMaryland Medicaid Program. Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012
Maryland Medicaid Program Aaron Larrimore Medicaid Department of Health and Mental Hygiene May 31, 2012 1 Maryland Medicaid In Maryland, Medicaid is also called Medical Assistance or MA. MA is a joint
More informationMedicaid Simplification
Medicaid Simplification This Act authorizes the director of the state department of health and welfare to restructure the state Medicaid program in order to achieve improved health outcomes for Medicaid
More informationFlorida Medicaid. Early Intervention Services Coverage Policy. Agency for Health Care Administration August 2017
+ Florida Medicaid Early Intervention Services Coverage Policy Agency for Health Care Administration August 2017 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal
More informationOverview of Medicaid Program
Joint HHS Appropriations Subcommittee FY 2017-19 Overview of Medicaid Program Steve Owen, Fiscal Research Division Overview of Medicaid WHAT IS MEDICAID? Medicaid is funded through Title XIX of the Social
More informationSMMC: LTC and MMA. Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC
SMMC: LTC and MMA Linda R. Chamberlain, P.A. Member Firm Florida Elder Lawyers PLLC 727.443.7898 Why should you care about SMMC Florida has 7M+ people 50 y/o + 4M+ Social Security beneficiaries 3.5M+ Medicare
More informationWhat Does Medicaid Do?
Page 1 of 5 Texas Department of Health What Does Medicaid Do? Table 4.1 Medicaid Eligibility in Texas: 1998 TANF-Related Categories (dollar amounts = maximum income limit for eligibility: asset cap: $2000)
More informationMedicaid Fundamentals. John O Brien Senior Advisor SAMHSA
Medicaid Fundamentals John O Brien Senior Advisor SAMHSA Medicaid Fundamentals Provides medical benefits to groups of low-income people with no medical insurance or inadequate medical insurance. Federally
More informationTHIS INFORMATION IS NOT LEGAL ADVICE
Medicaid Medicaid is a federal/state program that gives certain groups of people a card that can be used to get free medical care, nursing home care, and prescription drugs at reduced prices. In general,
More informationFlorida Medicaid. Hospice Services Coverage Policy
Florida Medicaid Agency for Health Care Administration June 2016 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible Recipient... 2 2.1
More informationFlorida Medicaid. Evaluation and Management Services Coverage Policy
Florida Medicaid Evaluation and Management Services Coverage Policy Agency for Health Care Administration June 2016 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1
More informationMedicaid & Global Commitment
Medicaid & Global Commitment Nolan Langweil, Joint Fiscal Office, Lindsay Parker, Vermont Agency of Human Services Updated January 13, 2017 1 PART ONE Medicaid Background 2 What is Medicaid? Created in
More informationSECTION D. Medicaid Programs MEDICAID PROGRAMS
SECTION Medicaid Programs The epartment supports and operates Medicaid programs in partnership with the Agency for Health Care Administration (AHCA), Florida s designated Medicaid agency. Medicaid programs
More informationFlorida Medicaid. Statewide Medicaid Managed Care Long-term Care Program Coverage Policy
Florida Medicaid Statewide Medicaid Managed Care Long-term Care Program Coverage Policy Agency for Health Care Administration Table of Contents 1.0 Introduction... 1 1.1 Description and Program Goal...
More informationThe Florida KidCare Program Evaluation
The Florida KidCare Program Evaluation Calendar Year 2015 MED147 Deliverable # 59 12/6/16 Prepared by the Institute for Child Health Policy University of Florida Under Contract to the Agency for Health
More informationStatewide Medicaid Managed Care Long-term Care Program Coverage Policy
Statewide Medicaid Managed Care Long-term Care Program Coverage Policy Coverage Policy Review June 16, 2017 Today s Presenters D.D. Pickle, AHC Administrator 2 Objectives Provide an overview of the changes
More informationMedicare and Medicaid
Medicare and Medicaid Medicare Medicare is a multi-part federal health insurance program managed by the federal government. A person applies for Medicare through the Social Security Administration, but
More informationDEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK Chapter 5: Community Care for the Elderly Program CHAPTER 5
CHAPTER 5 Administration of the Community Care for the Elderly (CCE) Program July 2011 5-1 Table of Contents TABLE OF CONTENTS Section: Topic Page I. Purpose of the CCE Program 5-3 II. Legal Basis and
More informationFlorida Medicaid. Statewide Inpatient Psychiatric Program Coverage Policy
Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy Agency for Health Care Administration December 2015 Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority...
More informationFlorida Statewide Transition Plan. Home and Community Based Settings Rule CMS 2249-F and CMS 2296-F
Florida Statewide Transition Plan Home and Community Based Settings Rule CMS 2249-F and CMS 2296-F September 30, 2016 Table of Contents I. Purpose... 4 II. Overview... 4 III. Compliance Assessment... 5
More informationMEDICAID OPTIONAL ELIGIBILITY AND SERVICES: OPTIONS THAT AREN T REALLY OPTIONS
MEDICAID OPTIONAL ELIGIBILITY AND SERVICES: OPTIONS THAT AREN T REALLY OPTIONS Introduction Created in 1965, Medicaid is a federal and state-funded program that most people think of as simply a health
More informationMedicaid EPSDT Why is it Important to Me?
Medicaid EPSDT Why is it Important to Me? NC Tide: 2016 Annual Conference Friday, September 9, 2016 Jane Perkins Iris Green Legal Dir., NHeLP Senior Atty., DR-NC perkins@healthlaw.org iris.green@disabilityrightsnc.org
More informationAlaska Mental Health Trust Authority. Medicaid
Alaska Mental Health Trust Authority Medicaid November 20, 2014 Background Why focus on Medicaid? Trust result desired in working on Medicaid policy issues and in implementing several of our focus area
More informationHOUSING AND SERVICES PARTNERSHIP ACADEMY MEDICAID 101
HOUSING AND SERVICES PARTNERSHIP ACADEMY MEDICAID 101 Medicaid Background Federal and State Roles Whom Does Medicaid Serve? What Does Medicaid Cover? Medicaid Waiver Programs and Services In 1965, Medicare
More informationRevised: November 2005 Regulation of Health and Human Services Facilities
Revised: November 2005 Regulation of Health and Human Services Facilities This guidebook provides an overview of state regulation of residential facilities that provide support services for their residents.
More informationFlorida Medicaid. Behavioral Health Therapy Services Coverage Policy. Agency for Health Care Administration [Month YYYY] Draft Rule
Florida Medicaid Behavioral Health Therapy Services Coverage Policy Agency for Health Care Administration [Month YYYY] Draft Rule Florida Medicaid Table of Contents 1.0 Introduction... 1 1.1 Description...
More information65G Definitions. For the purposes of this chapter, the term: (1) Allocation Algorithm: The mathematical formula based upon statistically
65G-4.0213 Definitions. For the purposes of this chapter, the term: (1) Allocation Algorithm: The mathematical formula based upon statistically validated relationships between individual characteristics
More informationPUBLIC MEETING LONG-TERM CARE WAIVER ENROLLMENT MANAGEMENT SYSTEM (EMS) Presented by: Florida Department of Elder Affairs Staff
PUBLIC MEETING LONG-TERM CARE WAIVER ENROLLMENT MANAGEMENT SYSTEM (EMS) Rick Scott, Governor Charles T. Corley, Secretary Presented by: Florida Department of Elder Affairs Staff Introductions & Purpose
More informationStatewide Medicaid Managed Care Long-term Care Program
Statewide Medicaid Managed Care Long-term Care Program Justin Senior Deputy Secretary for Medicaid Agency for Health Care Administration July 25, 2013 Presentation Overview Current Medicaid Snapshot and
More informationQuarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs
Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs First Quarter Fiscal Year 2012/13 (July, August, September) Submitted November 2012 Barbara Palmer Director
More informationService Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note:
Service Array: Mental Health Medicaid Specialty Supports and Services Descriptions Note: If you are a Medicaid beneficiary and have a serious mental illness, or serious emotional disturbance, or developmental
More informationFlorida Medicaid. Therapeutic Group Care Services Coverage Policy
Florida Medicaid Therapeutic Group Care Services Coverage Policy Agency for Health Care Administration July 2017 Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal
More informationDEPARTMENT OF ELDER AFFAIRS PROGRAMS AND SERVICES HANDBOOK. Chapter 5. Administration of the Community Care for the Elderly (CCE) Program
Chapter 5 Administration of the Community Care for the Elderly (CCE) Program Table of Contents TABLE OF CONTENTS Section: Topic Page I. Purpose of the CCE Program 5-3 II. Legal Basis and Specific Legal
More informationDEVELOPING A MEDICAID SUPPORTIVE HOUSING SERVICES BENEFIT
DEVELOPING A MEDICAID SUPPORTIVE HOUSING SERVICES BENEFIT CONSIDERATIONS AND DECISION POINTS EXECUTIVE SUMMARY This tool is designed to assist States in the development of a Medicaid benefit to pay for
More informationSpecialty Health Care Plan for Persons with Developmental Disabilities
Specialty Health Care Plan for Persons with Developmental Disabilities January 2012 Facilitated by Celeste Putnam Chrysalis Consulting Group, Inc. 124 Marriott Drive, Suite 203 Tallahassee, Florida 32301
More informationJim Wotring Director, National Technical Assistance Center for Children s Mental Health, Georgetown University
Jim Wotring Director, National Technical Assistance Center for Children s Mental Health, Georgetown University Claudia Brown Claudia Brown, Health Insurance Specialist Center for Medicaid & State Operations
More informationQuarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs
Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs Second Quarter Fiscal Year 2015-16 (October, November, December) Submitted February, 2016 Barbara Palmer
More informationApplication for a 1915(c) Home and Community-Based Services Waiver
Page 1 of 76 Application for a 1915(c) Home and Community-Based Services Waiver PURPOSE OF THE HCBS WAIVER PROGRAM The Medicaid Home and Community-Based Services (HCBS) waiver program is authorized in
More informationYour Florida Medicaid Information Guide
Your Florida Medicaid Information Guide A Basic Primer on Florida Medicaid: What it is and How to Obtain it LISA KLINE GOLDSTEIN, ESQ. LKG LAW, P.A. 561-267-2207 WWW.LKGLAWPA.COM 2012 [Type text] Page
More informationClinical Utilization Management Guideline
Clinical Utilization Management Guideline Subject: Therapeutic Behavioral On-Site Services for Recipients Under the Age of 21 Years Status: New Current Effective Date: January 2018 Description Last Review
More informationServices Covered by Molina Healthcare
Services Covered by Molina Healthcare As a Molina Healthcare member, you will continue to receive all medically-necessary Medicaid-covered services at no cost to you. The following list of covered services
More informationSummary of Legislation Relating to Sunset Commission Recommendations 84 th Legislature
Bill Number and Caption SB 200 (Nelson/Price) HHSC continuation and functions for the Health and Human Services Commission and the provision of health and human services in this state. Selected Bill Provisions
More informationFlorida Medicaid. Traumatic Brain and Spinal Cord Injury Waiver Services Handbook. Agency for Health Care Administration
Florida Medicaid Traumatic Brain and Spinal Cord Injury Waiver Services Handbook Agency for Health Care Administration JEB BUSH, GOVERNOR ALAN LEVINE, SECRETARY May 15, 2006 Dear Medicaid Provider: Enclosed
More informationFlorida Medicaid. Behavioral Health Community Support and Rehabilitation Services Coverage Policy. Agency for Health Care Administration [Month YYYY]
Florida Medicaid Behavioral Health Community Support and Rehabilitation Services Coverage Policy Agency for Health Care Administration [Month YYYY] Draft Rule Table of Contents 1.0 Introduction... 1 1.1
More informationFREQUENTLY ASKED QUESTIONS (FAQS) FOR PROVIDER INDUSTRY
FREQUENTLY ASKED QUESTIONS (FAQS) FOR PROVIDER INDUSTRY 1. What changes are proposed for the Medicaid Program in the State Fiscal Year 2012 budget? Will clients be notified if these changes are not approved
More informationChapter 18 MEDICAID AND STATE CHILD HEALTH INSURANCE PROGRAMS
Benefits Planning, Assistance and Outreach Chapter 18 MEDICAID AND STATE CHILD HEALTH INSURANCE PROGRAMS Introduction This chapter was adapted, with permission, from materials previously published by Neighborhood
More informationFlorida Medicaid. Medicaid School Based Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Medicaid School Based Services Coverage Policy Agency for Health Care Administration Draft Rule Table of Contents 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3
More informationRFI /17. State of Florida Agency for Persons with Disabilities Request for Information
RFI 001-16/17 State of Florida Agency for Persons with Disabilities Request for Information Intermediate Care Facilities for Individuals with Intellectual Disabilities Utilization & Continued Stay Review
More informationCOMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN. Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013
COMMUNITY-BASED LONG TERM CARE PROGRAMS IN WISCONSIN I. INTRODUCTION Attorney Mitchell Hagopian Disability Rights Wisconsin July 2013 In 1981, with the creation of the Community Options Program, the state
More informationNotice of Instruction 5905 Breckenridge Parkway, Suite F Tampa, Florida (813) Fax (813)
Notice of Instruction 5905 Breckenridge Parkway, Suite F Tampa, Florida 33610 (813) 740-3888 Fax (813) 623-1342 Notice of Instruction Number: 071610 Revised Aged and Disabled Adult Waiver Services Coverage
More informationMedicaid 201: Home and Community Based Services
Medicaid 201: Home and Community Based Services Kathy Poisal Division of Long Term Services and Supports Disabled and Elderly Health Programs Group Center for Medicaid and CHIP Services Centers for Medicare
More informationBehavior Analyst Assistants. 1 4 Behavior Assistant Services Behavior Analysis Independent Vendors (Individuals OR Employees of Agencies)
ibudget Florida System Option # - Modified Status Quo Service No. Services Encompassed in New Group (See New Service Title Who Can Provide? Count Service Title Appendix) Board Certified Behavior Analyst,
More informationContinuing Certain Medicaid Options Will Increase Costs, But Benefit Recipients and the State
January 2005 Report No. 05-03 Continuing Certain Medicaid Options Will Increase Costs, But Benefit Recipients and the State at a glance Florida provides Medicaid services to several optional groups of
More informationMedicaid Home- and Community-Based Waiver Programs
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: October 2016 Medicaid Home-
More informationFlorida Medicaid PROVIDER GENERAL HANDBOOK
Florida Medicaid PROVIDER GENERAL HANDBOOK Agency for Health Care Administration July 2012 UPDATE LOG FLORIDA MEDICAID PROVIDER GENERAL HANDBOOK How to Use the Update Log Introduction The current Medicaid
More information65G Definitions. For the purposes of this chapter, the term: (1) Allocation Algorithm: The mathematical formula based upon statistically
65G-4.0213 Definitions. For the purposes of this chapter, the term: (1) Allocation Algorithm: The mathematical formula based upon statistically validated relationships between individual characteristics
More informationBenefits. Section D-1
Benefits Section D-1 Practitioners/providers who participate in Medicaid agree to accept the amount paid as payment in full (see 42 CRF 447.15) with the exception of co-payment amounts required in certain
More informationAMERICAN INDIAN 638 CLINICS PROVIDER MANUAL Chapter Thirty-nine of the Medicaid Services Manual
AMERICAN INDIAN 638 CLINICS PROVIDER MANUAL Chapter Thirty-nine of the Medicaid Services Manual Issued December 1, 2009 Claims/authorizations for dates of service on or after October 1, 2015 must use the
More informationKY Medicaid Co-pays Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following:
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
More informationMEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN
Louisiana Behavioral Health Partnership MEDICAID MANAGED LONG-TERM SERVICES AND SUPPORTS OPPORTUNITIES FOR INNOVATIVE PROGRAM DESIGN Rosanne Mahaney - Delaware Lou Ann Owen - Louisiana Brenda Jackson,
More informationPeachCare for Kids. Handbook
PeachCare for Kids Handbook Table of Contents What is PeachCare for Kids?...2 Who is eligible?...3 How do you apply for PeachCare for Kids?...3 Who will be your child s primary doctor?...4 Your child s
More informationKY Medicaid Co-pays. Acute admissions medical Per admission diagnoses $0 Acute health care related to. Per admission substance abuse and/or for
This is a list of current covered services and co-pays. Except for the Pharmacy Non-Preferred co-pay, co-pays do not apply to the following: Non-KCHIP children Children under 19 in foster care Pregnant
More informationQuarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs
Quarterly Report on Agency Services to Floridians with Developmental Disabilities and Their Costs Fourth Quarter Fiscal Year 2016-17 (April, May, June) Submitted August 1, 2017 Barbara Palmer Director
More informationFIDA. Care Management for ALL
Care Management for ALL In 2011, Governor Andrew M. Cuomo established a Medicaid Redesign Team (MRT), which initiated significant reforms to the state s Medicaid program. This included a critical initiative
More informationFlorida Medicaid. Home Health Visit Services Coverage Policy
Florida Medicaid Home Health Visit Services Coverage Policy Agency for Health Care Administration November 2016 Table of Contents Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions...
More informationFlorida Medicaid. Behavioral Health Assessment Services Coverage Policy. Agency for Health Care Administration [Month YYYY] Draft Rule
Florida Medicaid Behavioral Health Assessment Services Coverage Policy Agency for Health Care Administration [Month YYYY] Draft Rule Florida Medicaid Behavioral Health Assessment Services Coverage Policy
More informationLong-Term Care Services for the Elderly
INFORMATION BRIEF Research Department Minnesota House of Representatives 600 State Office Building St. Paul, MN 55155 Danyell Punelli, Legislative Analyst 651-296-5058 Updated: January 2017 Long-Term Care
More informationFlorida Medicaid. Outpatient Hospital Services Coverage Policy. Agency for Health Care Administration. Draft Rule
Florida Medicaid Agency for Health Care Administration Draft Rule Table of Contents Florida Medicaid 1.0 Introduction... 1 1.1 Description... 1 1.2 Legal Authority... 1 1.3 Definitions... 1 2.0 Eligible
More informationMedicaid 101. Presented by: Scott Crain Parent Mentor Hall County Schools
Medicaid 101 Presented by: Scott Crain Parent Mentor Hall County Schools scott.crain@hallco.org There are two primary ways of receiving Medicaid benefits. SSI: (Supplemental Security Income) which comes
More informationEnrollment, Eligibility and Disenrollment
Section 2. Enrollment, Eligibility and Disenrollment Enrollment: Enrollment in Medicaid Programs: The State of Florida (State) has the sole authority for determining eligibility for Medicaid and whether
More information1.2.4(a) PURCHASE OF SERVICE POLICY TABLE OF CONTENTS. General Guidelines 2. Consumer Services 3
TABLE OF CONTENTS General Guidelines 2 Consumer Services 3 Services for Children Ages 0-36 months 3 Infant Education Programs 4 Occupational/Physical Therapy 4 Speech Therapy 5 Services Available to All
More information(f) Department means the New Hampshire department of health and human services.
Adopted Rule 6/16/10. Effective: 7/1/10 1 Adopt He-W 544.01 544.16, cited and to read as follows: CHAPTER He-W 500 MEDICAL ASSISTANCE PART He-W 544 HOSPICE SERVICES He-W 544.01 Definitions. (a) Agent means
More informationKENTUCKY DECEMBER 7, Cabinet for Health and Family Services HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER REDESIGN
KENTUCKY Cabinet for Health and Family HOME AND COMMUNITY BASED SERVICES (HCBS) WAIVER REDESIGN DECEMBER 7, 2016 Session Timeline Time Topic 9:30 9:45 AM Welcome: Introductions & Agenda Review 9:45 10:15
More informationEarly and Periodic Screening, Diagnosis, and Treatment Program EPSDT Florida - Sunshine Health Annual Training
Early and Periodic Screening, Diagnosis, and Treatment Program EPSDT Florida - Sunshine Health Annual Training EPSDT Overview EPSDT purpose and requirements mandated by the Agency for Health Care Administration
More informationAugust 2004 Report No Scope. Background. 1 Section 11.51(6), F.S. 2 Expected Medicaid Savings Unrealized ; Performance, Cost Information Not
August 2004 Report No. 04-53 Medicaid Should Improve Cost Reduction Reporting and Monitoring of Health Processes and Outcomes at a glance While Medicaid expenditures have continued to increase, the annual
More informationTemporary Assistance for Needy Families (TANF)
Temporary Assistance for Needy Families (TANF) A Guide for Subcontractors February 2017 Edition 1 TABLE OF CONTENTS I. Overview of Temporary Assistance for Needy Families...3 I.A. Authority...3 I.B. Purpose...4
More informationATTACHMENT II EXHIBIT II-B Effective Date: August 15, 2016 LONG-TERM CARE (LTC) MANAGED CARE PROGRAM
Section I. Definitions and Acronyms ATTACHMENT II EXHIBIT II-B Effective Date: August 15, 2016 LONG-TERM CARE (LTC) MANAGED CARE PROGRAM Section I. Definitions and Acronyms The definitions and acronyms
More informationPublic Notice Document 03/21/ /19/2018
Florida Managed Medical Assistance Waiver 1115 Research and Demonstration Waiver Project Number 11-W-00206/4 Public Notice Document 03/21/2018 04/19/2018 Agency for Health Care Administration This page
More informationBasic Covered Benefits and Services
Basic Covered Benefits and A prior authorization is when UnitedHealthcare Community Plan gives the doctor permission to perform certain services. Bed Liners Coverage Covered for members age 4 and up; Prior
More informationMedicaid 101: The Basics for Homeless Advocates
Medicaid 101: The Basics for Homeless Advocates July 29, 2014 The Source for Housing Solutions Peggy Bailey CSH Senior Policy Advisor Getting Started Things to Remember: Medicaid Agency 1. Medicaid is
More informationFLORIDA MEDICAID DEVELOPMENTAL DISABILITIES WAIVER SERVICES COVERAGE AND LIMITATIONS HANDBOOK. Agency for Health Care Administration
FLORIDA MEDICAID DEVELOPMENTAL DISABILITIES WAIVER SERVICES COVERAGE AND LIMITATIONS HANDBOOK Agency for Health Care Administration May 2010 Developmental Disabilities Waiver Services Coverage and Limitations
More informationRYAN WHITE HIV/AIDS PROGRAM SERVICES Definitions for Eligible Services
RYAN WHITE HIV/AIDS PROGRAM SERVICES Definitions for Eligible Services (Last Updated: July 15, 2013) Ryan White HIV/AIDS Program funds are intended to support only the HIV-related needs of clients. All
More informationAgency for Persons with Disabilities Provider Enrollment Application. Instructions
Agency for Persons with Disabilities Application Instructions SECTION A ALL PROVIDERS ALL providers are to complete SECTION A of the APD Application to provide waiver services under ibudget Florida. Submit
More informationPAC Waiver. eqhealth Solutions PAC Waiver Authorization Process
PAC Waiver eqhealth Solutions PAC Waiver Authorization Process January 2015 1 Purpose of Presentation Upon completion of the webinar, participants will be able to: 1. Prepare and submit PAC Waiver Requests
More informationMedicaid Overview. Home and Community Based Services Conference
Centers for Medicare & Medicaid Services Medicaid Overview Home and Community Based Services Conference September 11, 2012 1 Overview of Presentation Basic facts about the Medicaid State Plan/program requirements
More information