2018 Fl Smmc Program Overview Quiz

The correct answer explains that MMA (presumably referring to Medicare Advantage) will provide medical services, while LTC (presumably referring to Long-Term Care insurance) will provide long-term care services. This suggests that the two types of insurance have different coverage focuses, with MMA primarily covering medical expenses and LTC primarily covering long-term care expenses.

Enrollees are required to be enrolled in managed care under the category of "Mandatory". This means that it is compulsory for individuals to participate in managed care programs, and they do not have the option to opt out or choose an alternative healthcare arrangement.

The CARES assessment is required to recommend the least restrictive, safe, and most appropriate placement for individuals, as well as identify their Level of Care and long-term care needs. This assessment helps in determining the appropriate level of care and support services for individuals, ensuring that they receive the necessary care while maintaining their independence and safety. It is a comprehensive evaluation that takes into account various factors such as medical conditions, functional abilities, and support systems to determine the most suitable placement and level of care for the individual.

The correct answer suggests that Susie is eligible for a comprehensive plan and has the option to enroll in the same plan for both LTC and MMA programs. However, it is not mandatory for her to do so. This implies that Susie has the flexibility to choose different plans for each program if she wishes.

After enrolling into a LTC plan, a care coordinator/case manager will be assigned to the enrollees. This individual will meet with the enrollees to assess their needs, develop a personalized plan of care, and assist them in obtaining the appropriate care. The care coordinator/case manager will provide additional assistance and coordination of care throughout the LTC plan, ensuring that the enrollees receive the necessary support and services they require. This individual plays a crucial role in ensuring the overall well-being and quality of care for the enrollees.

The correct answer is "Develop a plan of care, assign direct services providers, and perform an assessment." This answer is correct because it accurately describes the role of a care coordinator or case manager. They are responsible for developing a comprehensive plan of care for the enrollee, which includes assigning direct service providers to meet their needs. Additionally, they perform assessments to evaluate the enrollee's condition and determine the appropriate level of care required.

Enrollees whose Medicaid eligibility ends for less than 6 months are in a temporary loss period. This means that their Medicaid coverage is temporarily suspended, but if they regain eligibility within the specified time frame, they will be reinstated back into the plan they had previously. This period allows individuals to maintain continuity of care and ensures that they do not have a gap in their healthcare coverage.

The examples listed in the answer are all additional benefits that go beyond the basic medical services typically covered by insurance. Over the Counter Items, Circumcision, Adult Dental, and Pet Therapy are not typically covered by standard health insurance plans, but they provide extra value and support for individuals. These benefits can help improve overall well-being and provide additional options for individuals seeking specialized care or alternative treatments.

The correct answer is the Agency for Health Care Administration. This department is responsible for administering the Medicaid program and has offices throughout the state to assist Medicaid recipients. The Department of Elder Affairs focuses on issues related to the elderly, the Social Security Administration handles social security benefits, and the Florida Legislature is responsible for making laws in the state of Florida.

Enrollees in the LTC program who are experiencing a "temporary loss" period will be able to continue receiving services from the LTC plan for a maximum period of 60 days. However, during this time, they will not have the option to change plans. This means that they cannot switch to a different LTC plan if they choose to. They will still be able to receive the necessary services from their current LTC plan during this temporary loss period.

Once enrolled in a managed care plan, enrollees are required to see providers who are part of the network and participate in the plan. This is because managed care plans negotiate contracts with specific healthcare providers to ensure that enrollees receive the appropriate care within the network. Seeing providers outside of the network may result in higher out-of-pocket costs or may not be covered at all. Therefore, it is true that enrollees must see providers that participate with their managed care plan.

Recipients can enroll in multiple ways: they can call a designated phone number, enroll online through a website, use an interactive voice response (IVR) system, or enroll in person. These options provide flexibility and convenience for recipients to choose the enrollment method that suits them best.

The correct answer is "The Plan". This is because the question is asking about benefits or prior authorizations that are not listed on the plan brochure. In this case, the enrollee would need to contact the specific plan they are enrolled in to inquire about these details. The other options listed (AHCA, DCF, SSA) are not relevant to this specific question.

During the initial 120 days and Good Cause plan changes, individuals will be granted another 120-day change period. This means that if someone makes changes to their plan during the first 120 days or due to a Good Cause, they will have an additional 120 days to make further changes if needed. This allows individuals to have more flexibility and time to adjust their plan according to their needs and circumstances.

The given answer is not a prohibited activity because it provides accurate information about the dental services offered by MMA plans and encourages the individual to contact the plan for more information. This statement does not involve any false or misleading claims, unlike the other options which either make subjective statements or use personal anecdotes to persuade the individual.

DCF (Department of Children and Families) and SSA (Social Security Administration) are the agencies that determine Medicaid eligibility. DCF is responsible for determining eligibility for families and children, while SSA determines eligibility for individuals who are elderly or disabled. These agencies assess income, assets, and other factors to determine if an individual or family meets the requirements for Medicaid coverage.

A direct service provider is a company that has been approved to work for the LTC plan to provide long-term care services to enrollees. This means that the company has met the necessary qualifications and requirements to offer services specifically related to long-term care. They have been approved by the LTC plan, indicating that they have undergone a vetting process to ensure their ability to provide the necessary care and support to enrollees. This distinguishes them from other companies that may provide different types of medical services or services for specific age groups.

A co-payment is a small amount of money that an enrollee pays directly to the healthcare provider for each visit or treatment. The co-pays typically range from $1 to $3. This payment is separate from any other costs or fees associated with the healthcare plan.

Open enrollment is typically a period of time during which individuals can enroll in or make changes to their health insurance coverage. The correct answer, 60 days, suggests that open enrollment lasts for 60 days. This means that individuals have a limited window of time, specifically 60 days, to sign up for or modify their health insurance plans.

Prescription Medication is not provided by the Long-Term Care program. The program focuses on providing services such as respite care, adult day healthcare, home-delivered meals, and assisted living. Prescription medication is typically covered by health insurance or Medicare Part D, rather than the Long-Term Care program.

The two components that make up the Statewide Medicaid Managed Care Program are LTC (Long-Term Care) and MMA (Managed Medical Assistance).

DCF (Department of Children and Families) Applicants will be directed to use the Express Enrollment website. This is because the Express Enrollment website is likely specifically designed for DCF applicants to streamline the enrollment process and provide them with the necessary information and resources.

Express Enrollment is the process in which people will be directed to another website to choose a Medicaid managed care health plan after completing the Medicaid application with the Department of Children and Families (DCF).

Managed care allows a recipient to see a primary care provider who will coordinate their overall care and refer them to a specialist if necessary. This means that the recipient will have a designated healthcare professional who will oversee their medical needs and ensure that they receive appropriate and timely referrals to specialists when required. This arrangement helps to streamline and coordinate the recipient's healthcare, ensuring that they receive comprehensive and well-coordinated care.

A comprehensive care plan is a type of plan that allows enrollees to receive both long-term care (LTC) and Medicare and Medicaid Assistance (MMA) services. This plan provides a wide range of services and support to individuals who qualify for both programs. It ensures that all of their healthcare needs are addressed and coordinated effectively.

The statement is false because a mandatory enrollee does not have the choice to enroll in a managed care plan or receive services through FFS/straight Medicaid. Mandatory enrollees are required to enroll in a managed care plan and are not given the option to choose FFS/straight Medicaid.

The correct answer is the first option, which states that in order to enter the LTC program, one must be at least 18 years old, file for financial eligibility, and meet the required level of care. This means that individuals must meet certain financial criteria and have a documented need for long-term care services. Age is also a factor, as the program is only available to those who are at least 18 years old.

The correct answer is to review the extra benefits on the brochure to see if a root canal is listed. If it is not listed, then the caller should refer to the plan for more information. This approach allows for a thorough examination of the available benefits and ensures that the caller receives accurate information about coverage for a root canal.

Susie Smith should be advised to call the care coordinator at the plan because they are responsible for managing her Long-Term Care and can assist her in changing the company that provides her home delivered meals.

SMMC stands for Statewide Medicaid Managed Care. This program is designed to provide managed care services to Medicaid recipients in a specific state. It aims to improve the coordination and quality of healthcare services for Medicaid beneficiaries by contracting with managed care organizations (MCOs) to deliver and oversee their healthcare. This acronym is commonly used in the healthcare industry to refer to this specific program.

Enrollees will initially have 120 days to change the plan without a Good Cause Reason. This means that within the first 120 days of enrolling in the plan, individuals can make changes to their plan without needing to provide a valid reason for doing so. After this initial period, individuals may still be able to make changes, but they would need to have a Good Cause Reason for doing so.

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The last day an enrollee can complete a plan change to be effective the following month is the last day of the month before 11:59pm. This means that if an enrollee wants their plan change to take effect in February, for example, they must complete the change by the last day of January before 11:59pm.

The Special Needs Unit includes trained nurses who are specifically assigned to assist enrollees with complex medical needs. These nurses have the necessary skills and training to provide the required care and support to individuals with complex medical conditions. They are likely to have a deep understanding of the unique needs and challenges faced by enrollees with complex medical needs and are equipped to provide the appropriate assistance and care.

The correct answer is "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan." This answer reassures Sonia that she has a window of 120 days to change her plan if she is not satisfied with it. It offers her flexibility and the opportunity to explore other options within a reasonable timeframe.

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Fee-For-Service is also known as Straight Medicaid because it refers to a payment model where healthcare providers are reimbursed for each service they provide to patients. In this system, healthcare services are paid for individually, rather than through a fixed monthly payment or pre-paid plan. Straight Medicaid allows patients to choose their healthcare providers and receive the necessary services without restrictions or limitations.

Recipients who are enrolled in other waivers or programs have the option to either stay on their current waiver and continue receiving services, or they can choose to leave the waiver and receive services through a long-term care plan. This means that they have the flexibility to decide which option works best for them in terms of accessing the necessary services.

Express Enrollments will be effective when Medicaid is approved. The effective date can be any day of the month, meaning that the coverage will begin immediately upon approval and does not need to wait until the first day of the following month. This allows for quicker access to healthcare services for the enrollee.

The correct answer is to call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over. This is because DCF (Department of Children and Families) and SSA (Social Security Administration) are the agencies responsible for determining Medicaid eligibility. By contacting them, LTC enrollees can get accurate information about their eligibility status and take appropriate actions within the given timeframe.