{"text_format":"3","workbook":"xlsx","n_sheets":7,"sheets":["Instructions","iBudget Waitlist (CIDD)","iBudget Waiver","Chronic Conditions","Pregnancy","Seniors","Dropdown Fields"],"not_rendered":{"macros":1},"read":"whole","date_system":"1900"}

{"sheet":"Instructions","index":0,"n_rows":77,"n_cols":3,"rows_kept":77,"merged":[[0,1,0,17],[2,1,2,17],[3,1,3,17],[5,1,5,16],[7,1,7,17],[9,1,9,17],[11,1,11,17],[12,1,12,17],[13,1,13,17],[15,1,15,17],[17,1,17,17],[19,1,19,17],[21,1,21,17],[23,1,23,17],[25,1,25,19],[27,1,27,19],[29,1,29,19],[31,1,31,17],[33,2,33,17],[35,1,35,17],[37,2,37,17],[39,2,39,17],[41,2,41,17],[43,2,43,17],[45,2,45,17],[47,2,47,17],[49,2,49,17],[51,2,51,17],[53,2,53,17],[55,2,55,17],[57,2,57,17],[59,2,59,17],[61,2,61,17],[63,2,63,17],[65,2,65,17],[67,1,67,17],[69,2,69,17],[71,2,71,17],[73,2,73,17],[75,1,75,17],[76,2,76,17]]}
[null,"Instructions for Completing the Special Populations Care Coordination (SPC) Report"]
[]
[null,"This report is due quarterly, by the thirtieth (30th) calendar day of the month following the end of the quarter being reported."]
[null,"Do not make any entries other than those specified below.  Do not alter the template or formulas.\nPlease click \"Enable Content\" to utilize all functions of the template."]
[]
[null,"Special Populations:"]
[]
[null,"For the purposes of this report, special populations include the following categories:                                                                                              "]
[]
[null,"a. Chronic conditions: enrollees with a chronic condition of cancer, cardiovascular disease, diabetes, and/or HIV (as identified by the Agency through enrollment files provided to the Dental Plan)."]
[]
[null,"b. iBudget Waitlist/ CIDD: enrollees on the iBudget Waitlist/CIDD Pilot (as identified by the Agency through enrollment files provided to the Dental Plan)."]
[]
[null,"c. iBudget Waiver: enrollees on the iBudget Waiver (as identified by the Agency through enrollment files provided to the Dental Plan)."]
[]
[null,"d. Pregnancy: pregnant enrollees (as identified by the Agency through enrollment files provided to the Dental Plan)."]
[]
[null,"e. Seniors: enrollees ages sixty-five (65) years and older (as identified by the Agency through enrollment files provided to the Dental Plan)."]
[]
[null,"Managed Care Plan Information"]
[]
[null,"Dental Plan Name: Enter the complete dental plan name."]
[]
[null,"Plan 7-Digit Medicaid ID: Enter the Dental Plan's seven (7)-digit plan Medicaid identification number."]
[]
[null,"Reporting Quarter/Year: Enter the date of the reporting quarter and year (e.g. Quarter 1/2025, Quarter 2/2025)."]
[]
[null,"Report Submission Date: Enter the date the plan submitted the report in the following format: MM/DD/YYYY."]
[]
[null,"Report Submitted By: Enter the first name and last name (ONLY) of the dental plan's contact individual for this report. Exclude titles, \"Sr\", \"Jr\", \"2nd\", etc."]
[]
[null,"Total Population Reported"]
[]
[null,"Column O -","Enter the total number of enrollees in each tab.  The chronic conditions tab includes subpopulations (e.g. cancer, diabetes, HIV).  Enter the total for each specified subpopulation in the chronic conditions tab. "]
[]
[null,"Columns Included on ALL Special Populations Tabs"]
[]
[null,"Column A -","Enrollee Name (Last, First)."]
[]
[null,"Column B - ","Enrollee ten digit Medicaid Identification Number."]
[]
[null,"Column C - ","Enrollee Date of Birth (MM/DD/YYYY)."]
[]
[null,"Column D - ","Enrollee current age in years. This column automatically calculates the enrollee's date of birth.  "]
[]
[null,"Column E - ","Enrollee Region (where currently residing). Select the region from the drop-down menu."]
[]
[null,"Column F - ","Plan Enrollment Date (MM/DD/YYYY). Enter the enrollee's effective plan enrollment date."]
[]
[null,"Column G - ","Date Special Population Identified by Plan (MM/DD/YYYY). Enter the date the plan identified the enrollee from the Agency enrollment files provided to the Dental plan. This field is required for all enrollees listed in this report and should not be left blank. "]
[]
[null,"Column H -","Initial Contact with the Enrollee or Authorized Representative (MM/DD/YYYY). Enter the initial contact date.  The initial contact date must be within 30 days of the enrollee's transition into the Dental Plan and when identified by the plan as a special population. If the date provided is not within 30 days of the enrollee's enrollment or the \"date the special population identified by the plan\", address the reason why in the comments section (column O). If Unable To Reach enrollee or authorized representative, enter 00/00/0000 in the field and provide a description of outreach efforts in the comments section (column O)."]
[]
[null,"Column I - ","Most Recent Contact with Enrollee Authorized Representative (MM/DD/YYYY). Enter the Care Coordinator's last successful contact with the enrollee or authorized representative. For new enrollees within the reporting quarter, the initial date of contact is acceptable.  If the most recent contact date is not within the reporting quarter, provide the reason in the comments section (column O).  If Unable To Reach enrollee or authorized representative, enter 00/00/0000 in the field and provide a description of outreach efforts in the comments section (column O)."]
[]
[null,"Column J - ","Enrollee Contact Information Review Status (drop-down).  Provide the review status of the enrollee's contact information. Select from the choices included in the drop-down menu to indicate if the enrollee's contact information was updated, or if no updates required, or if there was no successful contact.  "]
[]
[null,"Column K -","Enrollee Support Systems and Designated Representatives Review (drop-down). Select from the choices included in the drop-down menu to indicate if the enrollee's support systems and/or designated representatives' information was updated, or if there were no updates required, or if there was no successful contact.  "]
[]
[null,"Column L -","Previous Dental Appointment (MM/DD/YYYY). Enter the date of the enrollee's last dental appointment. If none is provided, enter 00/00/0000 in the field and comment in column O. "]
[]
[null,"Column M - ","Dental Provider Assistance (drop-down). Indicate if assistance with locating a dental provider was needed. Select from the choices included in the drop-down menu (assistance provided, no assistance required, or no successful contact).  "]
[]
[null,"Column N - ","Upcoming Appointment (MM/DD/YYYY). Enter the date of the enrollee's next dental appointment. If none is provided, enter 00/00/0000 in the field and address the reason(s) and/or assistance provided in the comments section (column O). "]
[]
[null,"Column O - ","Comments - Add comments related to any date column/cell reflecting 00/00/0000, (e.g., why no date is included and for no successful contact) and as indicated for additional information. "]
[]
[null,"Columns Included ONLY on the iBudget Waitlist and iBudget Special Populations Tabs"]
[]
[null,"Column P - ","Care Coordinator's (CC) Name (Last, First). Enter the name of the assigned Care Coordinator.  "]
[]
[null,"Column Q - ","Supplemental Assessment Complete / Updated (MM/DD/YYYY). Enter the date the supplemental assessment was completed. If none is provided, enter 00/00/0000 in the field and address the reason(s) in the supplemental assessment comment section (column R). "]
[]
[null,"Column R - ","Supplemental Assessment Comments - Add comments related to any date column reflecting 00/00/0000, (e.g., why no date is included) and as indicated for additional information. "]
[]
[null,"Column Included ONLY on the Chronic Conditions Tab"]
[null,"Column P - ","Chronic Condition (drop-down). Select the enrollee's chonic condition from the drop-down menu (CA = cancer, CD = cardiovascular disease, DM = diabetes, HV= HIV).  Select all conditions that apply. "]

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[]
["Dental Plan Name:",null,null,"Special Populations Care Coordination (SPC) Report",{"$nulls":8},"Total Population Reported:"]
["Plan 7-Digit Medicaid ID:"]
["Reporting Month/Year:"]
["Report Submission Date:"]
["Report Submitted By:"]
[{"$nulls":3},"Dental - iBudget Waitlist "]
[]
[]
[]
["Enrollee's Full Name    \n(Last, First)                                     ","Enrollee Medicaid Identification Number","Date of Birth ","Current Age in Years","Region","Plan Enrollment Date ","Date of Special Population  Identified by Plan                (MM/DD/YYYY)","Initial Contact with Enrollee or Authorized Representative   (MM/DD/YYYY)         ","Most Recent Contact with Enrollee or Authorized Representative  (MM/DD/YYYY)","Enrollee Contact Information Review Status     (Drop down)  ","Enrollee Support Systems and Designated Representatives   Review             (Drop down) ","Previous Dental Appointment (MM/DD/YYYY)","Assistance Locating a Dental Provider         (Drop down)        ","Upcoming Appointment   (MM/DD/YYYY)","Care Coordination Comments","Care Coordinator's (CC) Name                   (Last, First)","Supplemental Assessment Completed/ Updated          (MM/DD/YYYY)      ","Supplemental Assessment Comments"]
["e.g., Doe, Jane","e.g., 1234567890","MM/DD/YYYY","Autcalculates","e.g., A","MM/DD/YYYY","MM/DD/YYYY","MM/DD/YYYY","MM/DD/YYYY","(updated, no updates required, or no successful contact)","(updated, no updates required, or no successful contact)","MM/DD/YYYY","(assistance provided, no assistance required, or no successful contact)","MM/DD/YYYY","Add comments related to any date column reflecting 00/00/0000, (e.g., why no date is included). Include any comments as indicated.","e.g., Jones, Mary","MM/DD/YYYY","Add comments related to the supplemental assessment date column reflecting 00/00/0000, (e.g., why no date is included). Include any comments as indicated."]
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[]
["Dental Plan Name:",null,null,"Special Populations Care Coordination (SPC) Report",{"$nulls":8},"Total Population Reported:"]
["Plan 7-Digit Medicaid ID:"]
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{"sheet":"Dropdown Fields","index":6,"n_rows":36,"n_cols":3,"rows_kept":36,"hidden":true,"merged":[[2,2,2,6],[3,2,3,6],[4,2,4,6],[5,2,5,6],[6,2,6,6],[7,2,7,6],[8,2,8,6],[9,2,9,6],[10,2,10,6]]}
[]
[null,"Column E -New SMMC Region "]
[null,"A","Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, and Washington."]
[null,"B","Alachua, Baker, Bradford, Citrus, Clay, Colombia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Nassau, Putman, St. Johns, Sumter, Suwanee, Union and Volusia."]
[null,"C","Pasco and Pinellas."]
[null,"D","Hardee, Highlands, Hillsborough, Manatee, and Polk "]
[null,"E","Brevard, Orange, Osceola, and Seminole."]
[null,"F","Charlotte, Collier, Desoto, Glades, Hendry,, Lee, and Sarasota."]
[null,"G","Indian River, Martin, Okeechobee, Palm Beach and St. Lucie."]
[null,"H","Broward"]
[null,"I ","Miami-Dade and Monroe"]
[]
[]
[null,"Column L - Enrollee Contact Information Review Status"]
[null,"updated"]
[null,"no updates required"]
[null,"no successful contact"]
[]
[]
[null,"Column M - Enrollee Support Systems and Designated Representatives Review  "]
[null,"updated"]
[null,"no updates required"]
[null,"no successful contact"]
[]
[]
[null,"Column O - Dental Provider Assistance"]
[null,"assistance provided"]
[null,"no assistance required"]
[null,"no successful contact"]
[]
[null,"Chronic Conditions Tab "]
[null,"Column P"]
[null,"CA"]
[null,"CD"]
[null,"DM"]
[null,"HV"]