2025
RCN 2025-01-R
[
| RCN 2025-01-R | 01/30/2025 |
PT 2025-07
[
| PT 2025-07 | 01/30/2025 |
PT 2025-06:
[
239.5 kB
]
Suspected/Confirmed Waste Reporting – Frequency Change and Survivability End Date UpdateAttachment 1: Suspected/Confirmed Waste Reporting Report Summary [
125.8 kB
]
Attachment 2: Suspected/Confirmed Waste Reporting Report Summary – Redline [ 
27.1 kB
]
Attachment 3: Suspected/Confirmed Waste Reporting Report Template [ 
74.5 kB
]
| PT 2025-06 | 01/30/2025 |
|
PT 2025-05:
[
246.3 kB
]
Ad Hoc Request, MMA Provider Incentive Program (MPIP) Updated Requirements – Timeframe & Provider Performance Metrics Report Attachment: MPIP Quality Measures Report Template CY 2023 [
44.9 kB
]
| PT 2025-05 | 01/30/2025 |
|
PT 2025-04:
[
240.4 kB
]
Update to PT 2023-23; Ad Hoc Request for Periodically Updated Individualized Transition Plan for Nursing Facility Children – Reporting Requirements Attachment 1: 1227 Order on Proposed Modifications [
126.5 kB
]
Attachment 2: 1228 Order Modifying Injunction [
50.2 kB
]
| PT 2025-04 | 01/24/2025 |
|
PT 2025-02:
[
240.7 kB
]
Update to PT 2023-24; Ad Hoc Request for Reporting – Monthly Private Duty Nursing (PDN) Reporting Attachment 1: PDN Child II.B Template – SMMC – UPDATED [
29.3 kB
]
| PT 2025-02 | 01/10/2025 |
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PT 2025-01
[
286.4 kB
]
: Revised Notice of Plan Appeal Resolution Template for MediKids – Effective Immediately Attachment 1: Notice of Plan Appeal Resolution (NPAR) Template – MediKids Enrollees [
33.1 kB
]
Attachment 2: Notice of Plan Appeal Resolution (NPAR) Template – MediKids Enrollees Redline [
33 kB
]
| PT 2025-01 | 01/06/2025 |
2024
| Participant Direction Option Report Change Notice: 2024-06 [
149.9 kB
]
Attachment 1: Participant Direction Option (PDO) Report Summary [
76.3 kB
]
Attachment 2: Participant Direction Option (PDO) Report Summary Redline [
29.5 kB
]
Attachment 3: Participant Direction Option (PDO) Roster Report Template [
40.6 kB
]
Attachment 4: Participant Direction Option (PDO) Roster Report Template Redline [
40.7 kB
]
| RCN 2024-06 | 12/19/2024 |
|
PT 2024-22
[
232.8 kB
]
: Enrollee Continuity of Care Data for SMMC 3.0 – Dental Attachment 1: Instructions – Dental [
203.7 kB
]
Attachment 2: Prior Authorization (PA) Dental Layouts Inbound and Outbound [
18.9 kB
]
| PT 2024-22 | 12/19/2024 |
|
PT 2024-21
[
178.4 kB
]
: Enrollee Continuity of Care Data for SMMC 3.0 Attachment 1: Instructions [
58.5 kB
]
Attachment 2: PA Layouts: Inbound and Outbound [
30.8 kB
]
Attachment 3: PNV Provider Data (PD) File Specs [
133.1 kB
]
Attachment 4: Participant Directed Option (PDO) Template [
25.1 kB
]
Attachment 5: Non-Emergent Transportation (NET) Template [
38.6 kB
]
Attachment 6: Plan PA Submission Checklist [
24.9 kB
]
| PT 2024-21 | 11/26/2024 |
|
PT 2024-20
[
173.1 kB
]
: Enrollee and Provider Notice Requirement to Withdraw Services from a Region Attachment 1: Enrollee Transition Notice Template [
29.2 kB
]
Attachment 2: Provider Transition Notice Template [
30.2 kB
]
| PT 2024-20 | 11/26/2024 |
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PT 2024-19
[
217.9 kB
]
: Update to PT 2024-11 Re: Diabetic Supplies - Pharmacy Services | PT 2024-19 | 11/26/2024 |
|
PT 2024-18:
[
279.4 kB
]
Update to PT 2024-08, PT 2024-02 and PT 2023-23: Ad Hoc Request for Periodically Updated Individualized Transition Plan for Nursing Facility Children – Reporting Requirements Attachment 1: Transition Plan Template-English - Redline [
424.7 kB
]
Attachment 2: Transition Plan Template-English [
89.3 kB
]
Attachment 3: Transition Plan Template-Spanish - Redline [
519.3 kB
]
Attachment 4: Transition Plan Template-Spanish [
102 kB
]
| PT 2024-18 | 11/13/2024 |
|
PT 2024-17:
[
277.6 kB
]
“Train-the-Trainer” – Care Coordinator Training Program | PT 2024-17 | 10/29/2024 |
PT 2024-16:
[
| PT 2024-16 | 10/29/2024 |
| Update to PT 2023-24: Ad Hoc Request Monthly PDN Reporting PT 2024-15 [
91.9 kB
]
Attachment: PDN Child II(B) Reporting Schedule through July 2025 [
19.8 kB
]
| PT 2024-15 | 10/08/2024 |
| Ad Hoc Request for Encounter Data Validation (EDV) Study PT 2024-14 [
316.7 kB
]
Attachment 1: FL 2024-25_EDV Dental Plan Data Submission Requirements [
336.2 kB
]
Attachment 2: FL SFY2024-2025_EDV Control Total-Dental [
12.7 kB
]
Attachment 3: FL 2024-25_EDV Specialty Plan Data Submission Requirements [
411.8 kB
]
Attachment 4: FL SFY2024-2025_EDV Control Total-Specialty [
15.8 kB
]
| PT 2024-14 | 09/30/2024 |
| Dental Plan Performance Measures for July 1, 2025 Reporting (Measurement/Calendar Year 2024) PT 2024-13 [
273.8 kB
]
Attachment: Dental Performance Measure Specifications for July 1, 2025 Reporting [
174.2 kB
]
| PT 2024-13 | 9/16/2024 |
| Health (MMA and LTC) Performance Measure Changes for July 1, 2025 Reporting (Measurement Year 2024) PT 2024-12 [
356.6 kB
]
| PT 2024-12 | 9/16/2024 |
| Diabetic Supplies – Pharmacy Services PT 2024-11 [
306.2 kB
]
Attachment: DSP Recipient Letter [
30.9 kB
]
| PT 2024-11 | 09/13/2024 |
| Revised Notices of Adverse Benefit Determination Templates Effective October 1, 2024 PT 2024-10 [
256.3 kB
]
Attachment 1: LTC Notice of Adverse Benefit Determination Template [
40.8 kB
]
Attachment 2: MMA and Dental Notice of Adverse Benefit Determination Template [
42 kB
]
Attachment 3: MediKids Notice of Adverse Benefit Determination Template [
41.3 kB
]
| PT 2024-10 | 08/30/2024 |
| Home and Community-Based Settings Requirements PT 2024-09 [
177.5 kB
]
Attachment: 2024 HCB Settings Progress Report template [
37.8 kB
]
| PT 2024-09 | 07/12/2024 |
| Enhanced Care Coordination Report Report Change Notice: 2024-05 [
383 kB
]
Attachment 1: Enhanced Care Coordination Report Template [
44.9 kB
]
Attachment 2: Enhanced Care Coordination Report Template Redline [
40.2 kB
]
| RCN 2024-05 | 06/13/2024 |
| Update to PT 2024-02: Update to PT 2023-23: Ad Hoc Request for Periodically Updated Individualized Transition Plan for Nursing Facility Children – Reporting Requirements PT 2024-08 [
206.7 kB
]
Attachment 1: Transition Plan Template [
84.3 kB
]
Attachment 2: Transition Plan Template Redline [
62 kB
]
Attachment 3: Ad Hoc Transition Plan Report Template [
22.4 kB
]
| PT 2024-08 | 06/12/2024 |
| Performance Measures Report Report Change Notice: 2024-04 [
150 kB
]
Attachment 1: Performance Measures Report File Layout – redline [
88.9 kB
]
Attachment 2: Performance Measures Report File Layout [
85.5 kB
]
Template updated 5/30/2024: Minor Technical Corrections. Plans notified via email that this report template was updated on 5/30/2024: A technical correction has been made to the Performance Measure Report File layout Instructions tab, Reporting by Race section (cell B20). The Reporting by Race section has been updated to include all measures identified for Race/Ethnicity Stratification reporting in PT 2023-18, and to clarify that these stratifications are required for all measure components for the applicable measures. Immunization for Adolescents (IMA) and Initiation and Engagement of Substance Use Disorder Treatment (IET) were added to the section and clarification regarding measure components was added for Asthma Medication Ratio (AMR), Colorectal Cancer Screening (COL), Follow-up after ED Visits for Substance Use (FUA), Prenatal and Postpartum Care (PPC), and Well-Child Visits in the First 30 Months of Life (W30). Attachment 3: Well-Child Visit and FL Screening Report Template [
294.5 kB
]
Attachment 4: Well-Child Visit and FL Screening Report Summary – redline [
36.9 kB
]
Attachment 5: Well-Child Visit and FL Screening Report Summary [
85.7 kB
]
| RCN 2024-04 | 05/08/2024 |
| Dental Provider Incentive Program (DPIP) Requirements PT 2024-07 [
297.3 kB
]
Attachment 1: DPIP General Announcement Letter Template CY 25-26 [
32 kB
]
Attachment 2: DPIP Estimated Value of Enhanced Reimbursement (EVER) Report Template [ 
2.9 MB
]
Attachment 3: DPIP Actual Value of Enhanced Payment (AVEP) Report Template [
36.8 kB
]
| PT 2024-07 | 05/06/2024 |
| Updated MMA Physician Incentive Program (MPIP) Requirements - Pediatric Evaluation and Management Codes and Fee Increase for MPIP 2023-2024 Year PT 2024-06 [
298.3 kB
]
Attachment: EM Codes Rates Medicare Rates 2023-2024 [
26.3 kB
]
| PT 2024-06 | 04/29/2024 |
| Update to PT 2023-12 Ad Hoc Request for Individualized Transition Plan for Nursing Facility Children - Implementation of Private Duty Nursing (PDN) Services and Supports PT 2024-05 [
309.9 kB
]
| PT 2024-05 | 04/19/2024 |
Achieved Savings Rebate (ASR) Financial Report Template – Medical Loss Ratio (MLR) Comparison A technical correction has been made to the Achieved Savings Rebate template. Cells U11 through U15 have been unlocked on the MLR Exhibit tab for the MMA and LTC plans. For the Dental plans, the difference column is now comparing total to date instead of Q4 on the MLR exhibit tab. | RCN 2024-03 | 04/17/2024 |
| Update to PT 2023-19: Two New Forms related to Freedom of Choice for Children PT 2024-04 [
264.3 kB
]
Attachment 1: Freedom of Choice Certification for Children in Nursing Facilities 03.08.2024 [
771.4 kB
]
Attachment 2: Freedom of Choice Certification for Children in Nursing Facilities Redline [
219.6 kB
]
| PT 2024-04 | 03/08/2024 |
| Update to PT 2023-13 Implementation of Parental Real-Time Reporting of Failure to Provide Private Duty Nursing (PDN) Services – Requirements PT 2024-03 [
312.6 kB
]
Attachment A: Parental Real-Time Reporting of Failure to Provide PDN Services Care Coordinator Form [
662.1 kB
]
Attachment B: Parental Real-Time Reporting of Failure to Provide PDN Log Plan Reporting Template Official [
29.9 kB
]
Attachment C: Parental Real-Time Reporting of Failure to Provide PDN Log Plan Reporting Template Redline [
30 kB
]
| PT 2024-03 | 03/04/2024 |
| Achieved Savings Rebate (ASR) Financial Report Template RCN 2024-02 [
149.4 kB
]
- REVISEDAttachment: Achieved Savings Rebate (ASR) Financial Report Template [
2.4 MB
]
| RCN 2024-02-R | 03/28/2024 |
| Update to PT 2023-23 Ad Hoc Request for Periodically Updated Individualized Transition Plan for Nursing Facility Children – Reporting Requirements PT 2024-02 [
307.5 kB
]
Attachment: Transition Plan Template [
829.7 kB
]
| PT 2024-02 | 02/22/2024 |
| Enrollee Roster and Facility Residence Report Report Change Notice: 2024-01 [
147.6 kB
]
Attachment 1: Enrollee Roster and Facility Residence Report Template_2.21.2024 [
41.5 kB
]
A technical correction has been made to the Enrollee Roster and Facility Residence Report (ERFRR) template. The “N/A” option for Region (Column H), as well as the “Out-of-state” and “Out-of-country” options for County of Residence (Column I) have been added to the template Attachment 2: Enrollee Roster and Facility Residence Report Template Redline [
40.6 kB
]
| RCN 2024-01 | 2/14/2024 |
| Ad Hoc Request - Partially Rescinding PT 2024-01 [
311.8 kB
]
| PT 2024-01 | 02/08/2024 |
2023
| Ad Hoc Request for Reporting - Monthly Private Duty Nursing (PDN) Reporting PT 2023-24 [
202.3 kB
]
Attachment 1: PDN Child II.B Template - SMMC [
25.4 kB
]
Attachment 2: PDN Child II.B Reporting Schedule [
17.9 kB
]
| PT 2023-24 | 12/21/2023 |
| Ad Hoc Request for Periodically Updated Individualized Transition Plan for Nursing Facility Children – Reporting Requirements PT 2023-23 [
328.9 kB
]
| PT 2023-23 | 11/29/2023 |
| Ad Hoc Reporting Monthly Nursing Facility Child Information PT 2023-22 [
148.4 kB
]
Attachment: Nursing Facility V.A.3 Template – SMMC [
24.6 kB
]
| PT 2023-22 | 11/8/2023 |
| Ad Hoc Request Monthly Private Duty Nursing (PDN) Authorization PT 2023-21 [
325.8 kB
]
Attachment: PDN Authorization V(A)(1) Template – SMMC [
21.1 kB
]
| PT 2023-21 | 11/03/2023 |
| Monthly Contact with Children Receiving Private Duty Nursing (PDN) PT 2023-20 [
318.1 kB
]
| PT 2023-20 | 10/31/2023 |
| Freedom of Choice for Children PT 2023-19 [
230.1 kB
]
Attachment 1: Freedom of Choice Certification for Children in Nursing Facilities [
188.2 kB
]
Attachment 2: Freedom of Choice Survey for Children Receiving Private Duty Nursing (PDN) Who Have Been Referred to the Children’s Multidisciplinary Assessment Team (CMAT) [
215.2 kB
]
| PT 2023-19 | 10/31/2023 |
| Health Performance Measure Survey Changes for July 1, 2024 Policy Transmittal 2023-18 [
217.7 kB
]
| PT 2023-18 | 10/24/2023 |
| Dental Performance Measure Survey Changes for July 1, 2024 Policy Transmittal 2023-17 [
160.8 kB
]
Attachment: Dental Performance Measure Specifications for July 1, 2024 Reporting [
186.8 kB
]
| PT 2023-17 | 10/24/2023 |
| Ad Hoc Request for Encounter Data Validation (EDV) Study Policy Transmittal 2023-16 [
266.3 kB
]
Attachment: FL 2023-24 EDV Plan Data Submission Requirements [
848.9 kB
]
| PT 2023-16 | 09/27/2023 |
| Ad Hoc Request for Electronic Visit Verification (EVV) Report Update Policy Transmittal 2023-15 [
230.7 kB
]
Attachment 1: EVV Status Report Template 09.23.2023 [
32.4 kB
]
Attachment 2: EVV Status Report Template Redline [
33.1 kB
]
| PT 2023-15 | 09/26/2023 |
| Ad Hoc Request for Medicaid Managed Care Plan and Nursing Facility Care Coordinators – Roles, Functions, and Responsibilities Policy Transmittal 2023-14 [
225.6 kB
]
Attachment A: Coordination of Care for Children, Youth, and Young Adults in Nursing Facilities – Roles Functions, and Responsibilities of Care Coordinators [
232.1 kB
]
Attachment B: Nursing Facility Letter [
202.5 kB
]
| PT 2023-14 | 09/08/2023 |
| Ad Hoc Request for Implementation of Parental Real-Time Reporting of Failure to Provide Private Duty Nursing (PDN) Services – Requirements Policy Transmittal 2023-13 [
210.7 kB
]
Attachment A: Parental Real-Time Reporting of Failure to Provide PDN Services Care Coordinator Form [
180.3 kB
]
Attachment B: Parental Real-Time Reporting of Failure to Provide PDN Services” plan reporting template [
22.8 kB
]
| PT 2023-13 | 09/08/2023 |
| Ad Hoc Request for Individualized Transition Plan for Nursing Facility Children - Implementation of Private Duty Nursing (PDN) Services and Supports Policy Transmittal 2023-12 [
206 kB
]
Attachment A: PDN Support Services Letter [
198 kB
]
| PT 2023-12 | 09/08/2023 |
Ad Hoc Request for Pediatricians in Certain Value-Based Payment Arrangements | PT 2023-11 | 09/01/2023 |
| Individualized Transition Plan – Nursing Facility Children Policy Transmittal: 2023-10 [
202 kB
]
Attachment: Individualized Transition Plan – Letter Template 07.28.2023 [
222.7 kB
]
| PT 2023-10 | 07/28/2023 |
| Ad Hoc Request for Dental Provider Incentive Payment (DPIP) Program Information Policy Transmittal: 2023-09 [
150.3 kB
]
Attachment: DPIP Template - Providers + Members_07.21.2023 [
226.6 kB
]
| PT 2023-09 | 07/21/2023 |
Annual and Quarterly Pharmacy Claims Reconciliation Report A technical correction has been made to the Annual Quarterly PC Reconciliation Report template. Column headers on the Reconciliation Report tab now reflect calendar quarters rather than fiscal quarters. This update is documented on the “Document Version Log” tab of the template. Plans should use the updated version of the template for the next quarterly submission due on 10-25-2023. | PT 2023-08 | 07/07/2023 |
| Ambulatory Surgical Centers and Enhanced Ambulatory Patient Grouping Pricing Policy Transmittal: 2023-07 [
186.4 kB
]
| PT 2023-07 | 07/07/2023 |
| Ad Hoc Cultural Competency Plan Submissions Policy Transmittal: 2023-06 [
157.3 kB
]
| PT 2023-06 | 07/07/2023 |
Updated MMA Physician Incentive Program (MPIP) Requirements Year 7 Effective January 1, 2023 Attachment 1 updated 7/25/2023: Minor Technical Corrections. Plans notified via email that this attachment was updated on 7/25/2023. A technical correction has been made to the Attachment 1 2023 MPIP EM Procedure Codes Medicare Rates file, to the 2023 Medicare Rates for Procedure Code 99242. The changes are reflected on the PCP – Pediatricians tab. | PT 2023-05 | 06/08/2023 |
| MMA Physician Incentive Program (MPIP) Requirements Policy Transmittal: 2023-04 [
498.7 kB
]
Attachment 1: 2023-2024 MPIP General Announcement Letter Template [
36.2 kB
]
Attachment 2: 2023-2024 Florida Medicaid Cesarean Rate Calculation Specifications [
118.9 kB
]
| PT 2023-04 | 06/07/2023 |
| Performance Measures Report Report Change Notice: 2023-06 [
148.4 kB
]
Attachment 1: Performance Measures Report File Layout [
82.7 kB
]
– redlineAttachment 2: Performance Measures Report File Layout [
80 kB
]
Template updated 6/9/2023: Minor Technical Corrections. Plans notified via email that this report template was updated on 6/9/2023: A technical correction has been made to the Performance Measure Report File layout for the Initiation and Engagement of Alcohol and Other Drug Abuse or Dependence Treatment (IET) metric to capture the revised age stratifications for MY 2022. Plans shall report three age stratifications and a total: 13-17 years, 18-64 years, 65+ years, and Total (these components match those reported in the IDSS for NCQA submission). The changes are reflected on the 0210 SUB-MEASURE ABBREV DESC tab. Attachment 3: Well-Child Visit Report Template [
285 kB
]
Attachment 4: Well-Child Visit Report Summary [
26.2 kB
]
– redlineAttachment 5: Well-Child Visit Report Summary [
85.7 kB
]
| RCN 2023-06 | 04/12/2023 |
| Achieved Savings Rebate (ASR) Dental Financial Report Report Change Notice : 2023-05 [
148.5 kB
]
Attachment: ASR Dental Financial Report Template [
761.9 kB
]
| RCN 2023-05 | 04/12/2023 |
| Achieved Savings Rebate (ASR) Financial Report Report Change Notice: 2023-04 [
148.5 kB
]
Attachment: ASR Financial Report Template [
2.4 MB
]
| RCN 2023-04 | 04/12/2023 |
| Update to PT 2021-02: Ad Hoc Request for Weekly Home Health Electronic Visit Verification (EVV) Reports Policy Transmittal: 2023-03 [
114.3 kB
]
Attachment: EVV Vendor Monthly Status Report Template [
32 kB
]
| PT 2023-03 | 01/27/2023 |
| Achieved Savings Rebate (ASR) Dental Financial Report Report Change Notice: 2023-03 [
148 kB
]
Attachment: ASR Dental Financial Report Template [
757.9 kB
]
| RCN 2023-03 | 01/18/2023 |
| Ad Hoc Request – Dental Provider Incentive Payment (DPIP) Program Policy Transmittal: 2023-02 [
170.9 kB
]
Attachment: Dentist Performance Metric Ad Hoc Report Template [
14.1 kB
]
| PT 2023-02 | 01/06/2023 |
| Quarterly Fraud and Abuse Activity Report Report Change Notice: 2023-02 [
167.8 kB
]
| RCN 2023-02 | 01/13/2023 |
| Achieved Savings Rebate (ASR) Financial Report Report Change Notice: 2023-01 [
147.4 kB
]
Attachment: ASR Financial Report Template [
2.4 MB
]
| RCN 2023-01 | 01/13/2023 |
| Ad Hoc Request – Encounter Data Validation Study Policy Transmittal: 2023-01 [
127.8 kB
]
Attachment: FL SFY2022-23 EDV Study Plan Data Submission Requirements [
1.2 MB
]
| PT 2023-01 | 01/05/2023 |
| Updated Transportation Network Companies Contract Interpretation: 2023-01 [
144.3 kB
]
| CI 2023-01 | 01/05/2023 |
