.
Home Delivered Meals
Hospice
Personal Care
Nutritional Assessment/Risk Reduction Services
CMS case workers.
Trained nurses skilled to assist with children with special needs.
Trained nurses staffed to help AHS employees with their complex medical needs.
Trained nurses staffed to assist recipients with complex medical needs.
When Medicaid is approved. The effective date can be any day of the month.
When Medicaid is approved. The effective date is always on the first of the month.
As soon as the applicant applies for Medicaid, even if the status is "Processing".
The following month. The recipient will have FFS for the first month.
They are not eligible to make a plan change because they are currently in a Nursing Home.
Can change plan to PACE only.
Can change into another available LTC plan.
They must keep the current American Eldercare plan.
Tell the caller their doctor must update their medical record and report it to AHCA.
Tell the caller to fax us documentation of the special condition, so the case can be updated.
Tell the caller they must report their special condition to the Center's for Disease Control and the Department of Health.
Tell the caller the SNU Nurse will call them to get more information on their special condition and set up a home visit.
Sunshine Health Child Welfare
Magellan Complete Care
Children's Medical Services
Positive Healthcare/Clear Health Alliance
Inform the member their Medicaid is going to be restored and should call back within 24-48 hours.
Inform the member they are eligible for an express enrollment and you will transfer them accordingly.
Inform the member they may be reinstated back into the plan they had previously, once Medicaid is approved and they are eligible to enroll. Any Questions and concerns on eligibility refer them to the DCF or SSA.
Temporary Loss only refers to MMA because the member will be Reinstated.
Temporary Loss only refers to LTC because the member can still receive services for 60 days.
Temporary Loss means Medicaid ended for a period of time. MMA -180 days (6 months) or less and LTC- 60 days or less. There are different processes for each program.
MMA
LTC
MediKids
A. IC: The recipient lives in an ICF facility and has the choice between receiving services from the facility or through the APD office.
B. The recipient does not qualify for any services at this time because she does not have any Medicaid eligibility.
C. WL: Since the recipient is Voluntary for LTC, she has the choice to enroll into a LTC plan or wait until APD has granted approval in order to receive APD services.
D. WR: The recipient is already a waiver recipient and will receive LTC services from both the plan and the APD Office.
A. If a member decides not to enroll into a LTC plan during the waitlist period, the member will not receive LTC services. APD services will be received when the member is approved for the APD Waiver.
B. APD will provide the member with long-term care services while he/she is waiting for full APD waiver approval.
C. LTC services will be covered under Straight Medicaid until APD has approved services.
D. The Department of Children and Families will pay for services using the state’s Medicaid funding.
A. AHCA, this office determines Medicaid eligibility and could inform Suzan of which Medicaid services Michael qualifies for.
B. APD, this office can provide Suzan with information concerning waivers for people with developmental disabilities and may conduct a screening to determine if her son qualifies for such.
C. SSA, since Michael has Autism, he probably qualifies for SSI, and the Social Security Office can verify his eligibility for disability cash assistance.
D. DOEA, Suzan could check to see if her son could qualify for entry into the Long-Term Care program.to possibly enter into a nursing home.
A. The recipient is currently incarcerated and will receive services from the site in which he/she is currently incarcerated.
B. Since the member has HIV, they are excluded from receiving LTC services because their specialty plan will cover these.
C. The recipient is on the waitlist for APD and will not receive services unless APD grants approval.
D. The recipient currently resides in an Intermediate Care Facility and will receive services from the facility.
A. Explain to the caller that LTC eligibility has been lost and refer the caller to DCF to reapply for Medicaid.
B. Explain to the caller that LTC eligibility has been lost and refer the caller to DOEA to reapply for entry into LTC.
C. Inform the caller that her husband was dis-enrolled from his LTC plan and will receive services through the waiver provided by the APD office. Refer to APD for information on services.
D. Inform the caller that the existing MMA enrollment into Humana Medical Plan will cover the LTC services her husband needs, then refer her to Humana
Inpatient hospital stay
Prescription Drugs
Preventive Services
Doctor's Visits
Tell Flora, she can't choose a plan and discontinue the call.
Submit a discrepancy log to request for Flora to be enrolled into a plan.
Advise Flora that Medicare is her primary insurance and she has limited Medicaid coverage that picks up some of the out of pocket expenses from Medicare.
Advise Flora that she can't pick a plan because she has FFS.
A Medicare Advantage Plan that covers both Medicare Part A and Part B insurance benefits.
Medicare that covers prescriptions only.
Medicare that covers only inpatient hospital stay.
Medicare that covers preventative services only.
Allows qualified individuals to have Medicaid pay Medicare for Medicare Part B premiums.
Allows qualified individuals the option to enroll into Medicaid Managed Care Plans outside of their region.
Allows qualified individuals to have Medicaid pay for their Medicare premiums, deductibles, and coinsurance.
Allows qualified individuals the option to hire a family member to help provide services in the home.
Mandatory
Voluntary
Excluded
True
False
Refer Susan to Medicare.
Advise Susan which MMA plans sounds similar to the Medicare plan she has.
Refer Susan to the AHCA Medicaid Helpline.
Advise Susan to contact the Social Security Administration to obtain a list of MMA plans affiliated with Medicare plans.
DCF
SSA
AHCA Medicaid Helpline
The health plan
SSA
AHCA Medicaid Helpline
SMMC Help Line
DCF
Office of Demographic Information
DCF/SSA
AHCA Medicaid Helpline
SMMC Help Line
I want to apply for Medicaid.
I want to change the name on my Medicaid case.
I need a list of providers that accept Straight Medicaid.
I have SSI and need to update my address.
Department of Children and Families
Department of Elder Affairs
Agency for Persons with Disabilities
Elderly Foundation of America
Agency for Healthcare Administration
Social Security Administration
Medicaid Fraud Hotline
Provider Eligibility Helpline
Healthy Babies and Children
Florida Moms Association
AHCA Medicaid Helpline
Department of Children and Families
AHCA Medicaid Helpline
DCF
DOEA
SSA
CARES
DCF
AHCA
DOEA
Yes, as long as John verify his name, title, phone number and provide a Statement of Authority.
Yes, because Laetitia stated she authorizes John to speak on her behalf.
No. Agents cannot speak with health plan representatives. Do not continue the call.
Yes, because John Hendricks works for a specialty plan and specialty plans representatives may speak on behalf of members.
Advise Sandy that she is not authorized on the case and cannot continue with the call.
Advise Sandy that she must have authorization from Michael's parents to continue with the call and complete enrollment.
Document the name, agency, title, work phone number and request Sandy to provide detail on how she is authorized to make decisions for the member.
Advise Sandy to complete the Designated Authorized Representative in order to continue with the call.
No, because underage parent cannot enroll their children.
Yes, underage parents can call to enroll their children.
No, Keith needs to fax a Statement of Authority in order for the agent to continue with the call.
No, because Keith is not listed as the payee on the case.
Continue the call and advise Mrs. Ramos to send in the letter documenting her authority by fax, email or U.S. mail.
Advise Mrs. Ramos to have the authorized parent to call to change her grandchildren's plan.
Continue the call and take Mrs. Ramos' word since she said that she is the grandmother.
Advise Mrs. Ramos that you are unable to continue the call because she is not authorized.
Ask the caller to give us a call back once he can verify the physical address that's on file.
After two failed attempts to verify the physical address on file, refer to DCF/SSA to verify and/or update the address.
Ask the caller to verify the mailing address and refer to DCF/SSA to update the address.
Ask the caller to fax in legal documentation of his authority to act on his sister's behalf to us.
True
False
The plan will not change because the child is not pre-approved for CMS.
The first of the following month.
If CMS approves the plan change, it will be effective the first of the following month.
When the medicaid is approved for the child.
Search for Meals on Wheels and tell the caller which LTC plans they accept. Inform the caller that you cannot assign Meals on Wheels, but a Care Coordinator from the plan will help assign the providers once the plan is effective.
Search for Meals on Wheels and tell the caller which LTC plans they accept. Assign Meals on Wheels to the plan enrollment. Tell the caller she will receive this service when the plan starts.
Search for Meals on Wheels and tell the caller which LTC plans they accept. Tell the caller she will need to call Meals on Wheels directly for delivery and menu information.
Tell the caller she will receive a list of providers from the plan once it becomes effective. She should call DOEA to find out if Meals on Wheels works with LTC plans.
Offer to search for a PCP in the area, ask for preferences such as male or female, a language preference, etc.
Tell the caller to research the doctors in the area and call us back.
Tell the caller the plan will send a list of doctors when the plan becomes effective.
Provide the caller the plan website so they can get a full list of providers.
Inform Mr. Bannerman that in order to complete the enrollment, he is required to choose a Primary care Provider under the plan's network.
Inform Mr. Bannerman that he really doesn't need a primary care provider and that he can choose one whenever he wants to.
Inform Mr. Bannerman that you can help him find a PCP in the area and he is not required to choose a PCP at this time. If he does not choose one then the plan will assign a PCP.
Inform Mr. Bannerman that the plan will choose a doctor that doesn't have a lot of patients for him.
Inform Mrs. Osborne that this is the most up-to-date information that we have received from the plan and that she can call the plan to add Dr. Imani Akindo once the plan become effective.
Advise Mrs. Osborne that Dr. Imani Akindo did not show under Humana and apparently no longer accepts Humana any more.
Inform Mrs. Osborne that this is the most up-to-date information that we have received from the plan and that Dr. Imani Akindo is not on the list and another provider will need to be selected.
Advise Mrs. Osborne that Dr. Imani Akindo accepts all of the plans available in her region, but she will have to call the plan to add her as the PCP.
DCF and SSA
Elder Affairs and CARES
HMO's and PSN's
AHCA and DOEA
Pre-Paid Medicaid
Straight Medicaid
Medically Needy
Basic Services
Have to start the enrollment process to be eligible for the LTC program all over.
Be responsible for paying the plan for services received during the temporary loss.
Continue receiving services from the LTC plan for up to 60 days and cannot change plans.
Have the option to change to a different LTC plan if they choose to.
Be at least 18 years old, File for financial eligibility and Meet the required Level of Care.
Be 65 or older, need someone to care for you and already be approved for Medicare.
Have filed for a disability check, food and medical assistance through SSA.
Need someone to take care of you while your family goes to work.
Prescriptions, Check Ups, Laboratory, X Rays
Over the Counter Items, Circumcision, Adult Dental, Pet Therapy
Surgery, Birthing Center Services, Hospice Services
Emergency Services, Transportation, Podiatric Services
Continuity of Care
Comprehensive Care Plan
Coordination of Dual Eligibles
CARES Assessment
AHCA
The plan
DCF
SSA
Become the Power of Attorney and make changes to the recipients case.
Develop a plan of care, assign direct services providers, and perform an assessment.
Determine if the recipient would qualify for food stamps and cash assistance.
Perform a CARES assessment to determine the level of care.
60
90
120
180
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