Florida Statutes 409.984 – Enrollment in a long-term care managed care plan
Current as of: 2024 | Check for updates
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(1) The agency shall automatically enroll into a long-term care managed care plan those Medicaid recipients who do not voluntarily choose a plan pursuant to s. 409.969. The agency shall automatically enroll recipients in plans that meet or exceed the performance or quality standards established pursuant to s. 409.967 and may not automatically enroll recipients in a plan that is deficient in those performance or quality standards. If a recipient is deemed dually eligible for Medicaid and Medicare services and is currently receiving Medicare services from an entity qualified under 42 C.F.R. part 422 as a Medicare Advantage Preferred Provider Organization, Medicare Advantage Provider-sponsored Organization, or Medicare Advantage Special Needs Plan, the agency shall automatically enroll the recipient in such plan for Medicaid services if the plan is currently participating in the long-term care managed care program. Except as otherwise provided in this part, the agency may not engage in practices that are designed to favor one managed care plan over another.
(2) When automatically enrolling recipients in plans, the agency shall take into account the following criteria:
(a) Whether the plan has sufficient network capacity to meet the needs of the recipients.
Terms Used In Florida Statutes 409.984
- Agency: means the Agency for Health Care Administration. See Florida Statutes 409.962
- Managed care plan: means an eligible plan under contract with the agency to provide services in the Medicaid program. See Florida Statutes 409.962
- Medicaid: means the medical assistance program authorized by Title XIX of the Social Security Act, 42 U. See Florida Statutes 409.962
- recipient: means an individual who the department or, for Supplemental Security Income, the Social Security Administration determines is eligible pursuant to federal and state law to receive medical assistance and related services for which the agency may make payments under the Medicaid program. See Florida Statutes 409.962
(b) Whether the recipient has previously received services from one of the plan’s home and community-based service providers.
(c) Whether the home and community-based providers in one plan are more geographically accessible to the recipient’s residence than those in other plans.
(3) Notwithstanding s. 409.969(2), if a recipient is referred for hospice services, the recipient has 30 days during which the recipient may select to enroll in another managed care plan to access the hospice provider of the recipient’s choice.
(4) If a recipient is referred for placement in a nursing home or assisted living facility, the plan must inform the recipient of any facilities within the plan that have specific cultural or religious affiliations and, if requested by the recipient, make a reasonable effort to place the recipient in the facility of the recipient’s choice.