2018 Fl Smmc Program Overview Quiz

• Pre-Paid Medicaid

• Straight Medicaid

• Medically Needy

• Basic Services

• 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

• is the Thursday before the 2nd to the last Saturday of the month before 11:59pm.

• is the second to the last day of the month before 11:59pm.

• is the last day of the month before 11:59pm.

• Department of Elder Affairs

• Social Security Administration

• The Agency for Health Care Administration

• Florida Legislature

• Be at least 18 years old, File for financial eligibility and Meet the required Level of Care.

• Have filed for a disability check, food and medical assistance through SSA.

Be 65 or older, need someone to care for you and already be approved for Medicare.

• Need someone to take care of you while your family goes to work.

• AHCA and The Florida Legislature

• DCF & SSA

• LTC & MMA

• LTC & CARES

• KidCare Applicants

• DCF Applicants

• SSA Applicants

• WIC Applicants

• 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.

• Eligibility

• Recertification

• Express Enrollment

• Reinstatement

• Tell the caller dental for adults is not covered.

• Tell the caller to call the Agency for Healthcare Administration.

• Tell the caller all dental is covered by Medicaid.

• Review the extra benefits on the brochure to see if it's listed, if not listed refer to the plan.

True

False

• 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 enrollees with complex medical needs.

• Call, Mail, Text, In Person

• Call, Online, IVR, In person

• Mail, Online, Send a Fax

• Call, Text, Mail, Fax

• "Since this is free medical care, once you enroll you cannot change it."

• "Don't worry, you have 60 days for open enrollment to change the plan for any reason, call us back if you want to change the plan."

• "Once you enroll, you will be in a no change period, and you will not be able to change the plan."

• "Don't worry, you have 120 days to change the plan for any reason. Call us back if you want to change the plan."

• Receive services from doctors that accept straight Medicaid.

• See a primary care provider that will coordinate their overall care and will be referred to a specialist if needed.

• Call the AHCA Medicaid Helpline concerning their benefits and questions.

• See any primary care provider and specialists under any plan in their current region.

• Tell Susie to call the care coordinator at the plan.

• Tell Susie to call DOEA.

• Tell Susie she cannot change direct service providers.

• Tell Susie she can change the provider during open enrollment.

• Call DOEA to request an extension on their Medicaid eligibility.

• Call the LTC plan to find out about their Medicaid eligibility before the 60 days are over.

• Call the LTC plan to find out about their Medicaid eligibility before the 60 days are over. • Make plans to find another facility since they are losing Medicaid eligibility.

• Call DCF or SSA to find out about their Medicaid eligibility status before the 60 days are over.

• Continuity of Care

• Comprehensive Care Plan

• Coordination of Dual Eligibles

• CARES Assessment

• Enroll Susie into an LTC plan

• Refer Susie to SSA

• Refer Susie to DOEA to get screened for LTC

• Refer Susie to her Primary Care Doctor

• AHCA

• The Plan

• DCF

• SSA

• These recipients must stay on their current waiver to receive services until it runs out and then apply to receive services through a long-term care plan.

• These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through fee-for-service Medicaid.

• These recipients can stay on their current waiver and also receive the same services through a long-term care plan.

• These recipients can stay on their current waiver to receive services or can leave the waiver and receive services through a long-term care plan.

• Changes during Open Enrollment and Reinstatements will be granted another 120 day change period.

• Changes during the initial 120 days and Good Cause plan changes will be granted another 120 day change period.

• Changes during the 60 day open enrollment will be granted another 120 day change period.

• establish Medicaid eligibility and verification of assets.

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

• determine if the recipient will qualify for disability with the SSA or for worker’s compensation.

• identify if the recipient qualifies for services under the Agency for Persons with Disabilities.

• Selective Medicaid Management Care

• Statewide Medicaid Managed Care

• Standard Managed Medical Complete

• Statewide Managed Medical Core

• 180

• 90

• 120

• 30