2017 Test Prep: Quiz 3

Magellan Complete Care

Sunshine Health Child Welfare Plan

Children's Medical Services Network Specialty Plan

Sunshine Health

Identify long-term care needs, recommend the least restrictive, safe, and most appropriate placement and establish the appropriate Level of Care.

Assist with changing direct service providers and ensuring that licensing is up to date.

Screens members and provides information for the Participant Direction Option Program.

Establish Medicaid eligibility and provides counseling for other government funded programs.

When a recipient changes from one MMA plan to another MMA plan.

When a recipient changes from FFS to a plan.

When a recipient changes from a LTC plan to private insurance.

All of the Above

Immediately advise the caller that is not an option and refer to DCF to get another type of Medicaid.

Advise the caller they are required to be in a plan to continue receiving services and ask what is their reason for wanting FFS/Straight Medicaid. Refer to the plan if the caller is having issues with the plan and/or file a complaint.

Advise the caller the request will be submitted and they will have straight Medicaid the 1st of the following month.

Submit the request to the supervisor for approval since people that have special medical needs can have straight Medicaid.

The member can receive services for up to 60 days without eligibility.

The member has applied for Medicaid and eligibility is pending with DCF.

The member has gained eligibility and will be enrolled into the previous plan.

If the member gains eligibility, they will be enrolled in the same plan they had previously. Refer to DCF for eligibility status.

Only FFS because they are voluntary.

Cannot enroll into a plan because of an active TPL on file.

They have the option of remaining on FFS or enrolling into a health plan.

Only enroll into a plan and cannot have FFS because of the TPL on file.