Applicable ONLY to SMMC Contracts Effective 2018-2023
2021 |
||
| Non-Emergency Transportation Requirements Policy Transmittal: 2021-40 [ 
130.7 kB
]
|
PT 2021-40 | 12/29/2021 |
| Update to PT 2020-57 Implementation of the Private Duty Nursing (PDN) Incentive Payment and Ad Hoc Quarterly PDN Report Policy Transmittal: 2021-39 [
100.9 kB
]
|
PT 2021-39 | 12/20/2021 |
| Home and Community-Based (HCB) Settings Requirements Policy Transmittal: 2021-38 [
144.9 kB
]
|
PT 2021-38 | 12/16/2021 |
| Ending COVID-19 Temporary Flexibilities for Provider Credentialing Requirements Policy Transmittal: 2021-37 [
85.7 kB
]
|
PT 2021-37 | 12/16/2021 |
| Case Manager Caseload Report Report Change Notice: 2021-13 [
125.2 kB
]
Attachment: Case Manager Caseload Report Template [ 
112.3 kB
]
|
RCN 2021-13 | 12/01/2021 |
| Updated Deadline Extension for Potentially Preventable Events and Potentially Preventable Dental-Related Emergency Department Visits Performance Improvement Projects (PIPs) Policy Transmittal: 2021-36 [
59.8 kB
]
|
PT 2021-36 | 11/22/2021 |
| Health Plan Performance Measures and Enrollee Satisfaction Survey Requirements for July 1, 2022 Reporting Policy Transmittal: 2021-35 [
145.5 kB
]
|
PT 2021-35 | 11/22/2021 |
| Dental Plan Performance Measures and Enrollee Satisfaction Survey Requirements for July 1, 2022 Reporting Policy Transmittal: 2021-34 [
96.6 kB
]
Attachment: Dental Performance Measure Specifications Manual for July 1, 2022 Reporting [
256.3 kB
]
|
PT 2021-34 | 11/22/2021 |
| Update to PT 2020-71-R: COVID-19 State of Emergency: Vaccine Administration Policy Transmittal: 2021-33 [
122.6 kB
]
|
PT 2021-33 | 11/18/2021 |
| Nursing Facility Enhanced Rate October 2021 Through December 2021 Policy Transmittal: 2021-32 [
60 kB
]
|
PT 2021-32 | 11/16/2021 |
| Monoclonal Antibody COVID-19 Infusion Policy Transmittal: 2021-31 [
178.2 kB
]
Fee Schedule Lookup Example [
222 kB
]
|
PT 2021-31 | 11/01/2021 |
| Ad Hoc Request for Encounter Data Validation (EDV) Study Policy Transmittal: 2021-30 [
119.9 kB
]
Attachment: State Fiscal Year 2021-22 Encounter Data Validation Study Plan Data Submission Requirements [
1.1 MB
]
|
PT 2021-30 | 10/01/2021 |
| Deadline Extension for Potentially Preventable Events and Potentially Preventable Dental-Related Emergency Department Visits Performance Improvement Projects (PIPs) Policy Transmittal: 2021-29 [
91.9 kB
]
– REVISED |
PT 2021-29-R | 09/17/2021 |
| MMA Physician Incentive Program (MPIP) Requirements Year 6 Policy Transmittal: 2021-28 [
65.2 kB
]
|
PT 2021-28 | 09/03/2021 |
| Achieved Savings Rebate (ASR) Dental Financial Report Report Change Notice: 2021-12 [
90.3 kB
]
Attachment: ASR Dental Financial Report Template [
775 kB
]
|
RCN 2021-12 | 09/02/2021 |
| Achieved Savings Rebate (ASR) Financial Report Report Change Notice: 2021-11 [
90.2 kB
]
Attachment: ASR Financial Report Template [
2.4 MB
]
|
RCN 2021-11 | 09/02/2021 |
| Provider Complaint Notice of Status Requirements Policy Transmittal: 2021-27 [
49.5 kB
]
Notice of Status Letter Template 10.14.2021 [ 
19.6 kB
]
REVISED |
PT 2021-27 | 08/27/2021 |
| Update to PT 2021-21: COVID-19 State of Emergency: COVID-19 Vaccine Administration Initiative Policy Transmittal: 2021-26 [
118.1 kB
]
Initiative Methodology UPDATED 8.19.2021 [
82.1 kB
]
|
PT 2021-26 | 08/19/2021 |
| Coverage of Medication Assisted Treatment (MAT) Drugs Policy Transmittal: 2021-25 [
115.1 kB
]
Centers for Medicaid and Medicare Services, State Health Official Letter, Mandatory Medicaid State Plan Coverage of Medication-Assisted Treatment, Issued 12/30/2020 [
207.2 kB
]
|
PT 2021-25 | 07/23/2021 |
| Medical Foster Care Services Report Policy Transmittal: 2021-24 [
656.1 kB
]
Attachment 1: Medical Foster Care Services Report Summary – redline [
65.4 kB
]
Attachment 2: Medical Foster Care Services Report Template [
349.7 kB
]
|
PT 2021-24 | 07/06/2021 |
| Provider Satisfaction Survey Policy Transmittal: 2021-23 [
330.3 kB
]
|
PT 2021-23 | 06/23/2021 |
| Health Insurance Provider Fee (IRS Form 8963) Policy Transmittal: 2021-22 [
805.6 kB
]
|
PT 2021-22 | 06/23/2021 |
| COVID-19 State of Emergency: COVID-19 Vaccine Administration Initiative Policy Transmittal: 2021-21 [
685.5 kB
]
Attachment 1: Initiative Methodology [
62.1 kB
]
Attachment 2: Performance Measures Liquidated Damages Contract Citations [
83.1 kB
]
|
PT 2021-21 | 06/18/2021 |
| COVID-19 State of Emergency: Ending Temporary Flexibilities Policy Transmittal: 2021-20 [
1.6 MB
]
|
PT 2021-20 | 06/18/2021 |
| Hospital Terminations Policy Transmittal: 2021-19 [
50.5 kB
]
Attachment: Hospital Termination Checklist [
20.2 kB
]
|
PT 2021-19 | 06/14/2021 |
| Marketing/Public/Educational Events Report Report Change Notice: 2021-10 [
91 kB
]
Attachment 1: Marketing/Public/Educational Events Report Summary-redline [
92 kB
]
Attachment 2: Marketing/Public/Educational Events Report Template [
159.3 kB
]
|
RCN 2021-10 | 06/09/2021 |
| Screening, Brief Intervention, and Referral to Treatment (SBIRT) Procedure Codes Added Effective January 1, 2021 Policy Transmittal: 2021-18 [
104 kB
]
|
PT 2021-18 | 05/24/2021 |
| Performance Measure Reporting Requirements Effective July 1, 2021 Policy Transmittal: 2021-17 [
105 kB
]
Attachment 1: Performance Measure Summary Report - redline [
131.2 kB
]
Attachment 2: Performance Measure Report File Layout [
59.7 kB
]
Plans notified via email this report template updated 6/16/2021: The following technical corrections were made to the ‘0210 SUB-MEASURE ABBREV DESC’ tab, (1) the Sub-Measure abbreviation for ‘Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents (all three components) were updated to match the sub-measure group descriptions for the different age groups (cell C153, C154, C156, C157, C159, and C160); (2) For the Ambulatory Care (AMBa) measure, there were two different age groups in one cell. A change was made to remove the incorrect age group in Cells D26 and D27; On the ‘0211 SUB-MEASURE ABBREV DESC’ tab an update was made to correct the comma misplacement on measures calculated using member months. All instances for these measures now read “Per 100,000 member months”. Plans notified via email this report template updated 6/9/2021: A technical correction was made to the ‘0211 SUB-MEASURE ABBREV DESC’ tab; the Sub-Measures abbreviation for ‘All Women Ages 21 to 44 who were provided a long-acting reversible method of contraception (LARC)’ (cell C44) was updated to ccwadlarc. |
PT 2021-17 | 05/18/2021 |
| Well Child Visit Report Report Change Notice: 2021-09 [
112.4 kB
]
Attachment 1: Well Child Visit Report Summary-redline [
77.9 kB
]
Attachment 2: Well Child Visit Report Template [
328.5 kB
]
|
RCN 2021-09 | 05/17/2021 |
| Update to PT 2021-09: Updated MMA Physician Incentive Program (MPIP) Requirements Year 5 Effective January 1, 2021 and Delayed Submission of MPIP Year 6 Proposals Policy Transmittal: 2021-16 [
116.6 kB
]
Attachment: 2021 MPIP EM Procedure Code Medicare Rates - Update [
26.9 kB
]
|
PT 2021-16 | 05/17/2021 |
| SMMC Contract Submission Requirements Policy Transmittal: 2021-15 [
44.1 kB
]
Attachment 1: SMMC Contract Submission Summary Chart [
30.6 kB
]
Chart Updated 5/27/2021: Dental plans notified via email, dental plan contract citation omitted in error from case management program description. Attachment 2: SMMC Managed Care Plan Report Guide 05.13.2021-redline [
112.3 kB
]
|
PT 2021-15 | 05/13/2021 |
| Electronic Visit Verification (EVV) Requirements Policy Transmittal: 2021-14 [
103.2 kB
]
|
PT 2021-14 | 05/05/2021 |
| Non-Discrimination Compliance Requirements Policy Transmittal: 2021-13 [
105.4 kB
]
|
PT 2021-13 | 05/04/2021 |
| Ad Hoc Request for EVV Personal Care Procedure Codes Policy Transmittal: 2021-12 [
148.7 kB
]
Attachment: EVV Personal Care Services Procedure Codes 04.21.2021 [
9.7 kB
]
|
PT 2021-12 | 04/26/2021 |
| Integrated Behavioral Health Care Survey Policy Transmittal: 2021-11 [
149 kB
]
Attachment: Integrated Behavioral Health Care Survey Results Template 04.15.2021 [
29.2 kB
]
|
PT 2021-11 | 04/15/2021 |
| COVID-19 State of Emergency: Non-Emergency Transportation Services for Vaccine Transportation Contract Interpretation: 2021-01 [
68.5 kB
]
|
CI 2021-01 | 04/08/2021 |
| Update to PT 2020-71-R: COVID-19 State of Emergency: Vaccine Administration Policy Transmittal: 2021-10 [
57.6 kB
]
|
PT 2021-10 | 04/07/2021 |
| Updated MMA Physician Incentive Program (MPIP) Requirements Year 5 Effective January 1, 2021 and Delayed Submission of MPIP Year 6 Proposals Policy Transmittal: 2021-09 [
122.3 kB
]
Attachment 1: MMA MPIP Rate Calculation Guidance [
118.2 kB
]
Attachment 2: 2021 MPIP EM Procedure Code Medicare Rates [
26.8 kB
]
|
PT 2021-09 | 03/25/2021 |
| Non-Emergency Transportation Timeliness Report Report Change Notice: 2021-08 [
120.6 kB
]
Attachment 1: Non-Emergency Transportation Timeliness Report Summary [
84 kB
]
Attachment 2: Non-Emergency Transportation Timeliness Report Template [
641.7 kB
]
Template updated 4/22/2021: Minor Technical Corrections. Plans notified via email that template updated 5/25/2021: Technical Corrections to new drop down options. |
RCN 2021-08 | 03/19/2021 |
| Marketing Agent Status Report Report Change Notice: 2021-07 [
121 kB
]
Attachment 1: Marketing Agent Status Report Summary [
80.7 kB
]
Attachment 2: Managed Care Plan Training Report Template [
31 kB
]
|
RCN 2021-07 | 03/19/2021 |
| Update on PT 2020-61 Ad Hoc Request for Real Time Reporting of Private Duty Nursing (PDN) Issues Report Policy Transmittal: 2021-08 [
100.5 kB
]
Attachment: Real Time Reporting of PDN Issues Report [
30.7 kB
]
|
PT 2021-08 | 03/04/2021 |
| Managed Care Plan Training Report Policy Transmittal: 2021-07 [
100.9 kB
]
Attachment 1: Managed Care Plan Training Report Summary [
75.3 kB
]
Attachment 2: Managed Care Plan Training Report Template [
26.5 kB
]
Plans notified via email template updated 3/18/2021: Reformatted Columns G, H, and I |
PT 2021-07 | 03/04/2021 |
| MMA Performance Measures with Race/Ethnicity Stratification Reporting Effective July 1, 2021 Policy Transmittal: 2021-06 [
99.3 kB
]
|
PT 2021-06 | 02/22/2021 |
| Capitation Adjustments for Unauthorized Programs or Activities Policy Transmittal: 2021-05 [
115.6 kB
]
|
PT 2021-05 | 02/15/2021 |
| Durable Medical Equipment and Medical Supplies Benefit Policy Transmittal: 2021-04 [
123.1 kB
]
SMMC Snapshot: Durable Medical Equipment And Medical Supply Services (DME) [
143.6 kB
]
|
PT 2021-04 | 02/08/2021 |
| Update to PT 2020-67 Annual Performance Improvement Projects (PIPs) Deadline Extension for Potentially Preventable Events (PPE) Report Policy Transmittal: 2021-03 [
64.7 kB
]
|
PT 2021-03 | 01/29/2021 |
| Update to PT 2020-70: Ad Hoc Request for Weekly Home Health Electronic Visit Verification (EVV) Reports Policy Transmittal: 2021-02 [
65.3 kB
]
Attachment: EVV Vendor Weekly Status Report Template [
25.9 kB
]
|
PT 2021-02 | 01/29/2021 |
| Quarterly Fraud and Abuse Activity Report Report Change Notice: 2021-06 [
111.4 kB
]
Attachment 1: Quarterly Fraud and Abuse Activity Report Summary - redline [
127.8 kB
]
Attachment 2: Quarterly Fraud and Abuse Activity Report Template [
3.5 MB
]
Plans notified via email template updated 3/18/2021: Added “Provider Type 91-Case Management Agency” to drop-down selection in column H: Provider Type (Under Review). |
RCN 2021-06 | 01/22/2021 |
| Suspected/Confirmed Waste Report Report Change Notice: 2021-05 [
111.4 kB
]
Attachment 1: Suspected/Confirmed Waste Report Summary - redline [
82.6 kB
]
Attachment 2: Suspected/Confirmed Waste Report Template [
42.2 MB
]
Updated |
RCN 2021-05 | 01/21/2021 |
| Enrollee Complaints, Grievances & Appeals Report Report Change Notice: 2021-04 [
111.7 kB
]
Updated Attachment 1: Enrollee Complaints, Grievances & Appeals Report Summary – redline [
98.8 kB
]
Attachment 2: Enrollee Complaints, Grievances & Appeals Report Template [
3.8 MB
]
|
RCN 2021-04 | 01/15/2021 |
| Provider Complaint Report Report Change Notice: 2021-03 [
111.5 kB
]
Update Attachment 1: Provider Complaint Report Summary - redline [
80.8 kB
]
Updated Attachment 2: Provider Complaint Report Template [
3 MB
]
|
RCN 2021-03 | 01/15/2021 |
| Denied/Suspended/Terminated Provider Report Report Change Notice: 2021-02 [
111.3 kB
]
Updated Attachment: Denied/Suspended/Terminated Provider Template [
2 MB
]
|
RCN 2021-02 | 01/15/2021 |
| Annual Fraud and Abuse Activity Report Report Change Notice: 2021-01 [
111.2 kB
]
Attachment: Annual Fraud and Abuse Activity Report Template [
49.9 kB
]
|
RCN 2021-01 | 01/15/2021 |
| Dental Performance Measures and Reporting Requirements for July 1, 2021 Reporting Policy Transmittal: 2021-01 [
154.2 kB
]
Attachment: Dental Performance Measure Specifications Manual [
238.2 kB
]
|
PT 2021-01 | 01/05/2021 |
2020 |
||
| MMA Plan Referrals to DOEA for Nursing Facility Hospice Enrollees Email Message [
8 kB
]
Attachment: Informed Consent Form Template [
18.1 kB
]
|
12/29/2020 | |
| Ad Hoc Request for 2019 Achieved Savings Rebate (ASR) Claims Data Policy Transmittal: 2020-72 [
127.4 kB
]
|
PT 2020-72 | 12/29/2020 |
| COVID-19 State of Emergency: Vaccine Administration Policy Transmittal: 2020-71 [
113.3 kB
]
- REVISED Attachment: COVID-19 Vaccine Administration [
68.3 kB
]
- REVISED |
PT 2020-71-R | 12/21/2020 |
| Ad Hoc Request for Monthly Home Health Electronic Visit Verification (EVV) Reports (Change in Frequency) Policy Transmittal: 2020-70 [
65.3 kB
]
Attachment: EVV Vendor Status Report Template 12.14.2020 [
31.3 kB
]
|
PT 2020-70 | 12/15/2020 |
| Coverage of Vaccines for MediKids Enrollees Policy Transmittal: 2020-69 [
68.3 kB
]
|
PT 2020-69 | 12/10/2020 |
| Behavioral Health PIP Requirement Update Policy Transmittal: 2020-68 [
73.6 kB
]
Attachment: Behavioral Health PIP Update December 2020 [
84.6 kB
]
|
PT 2020-68 | 12/03/2020 |
| Update to PT 2020-46: Annual Performance Improvement Projects (PIPs) Deadline Extension and Updated PIP Summary Forms Policy Transmittal: 2020-67 [
96.4 kB
]
Attachment 1: FL2020-21 BH PIP Submission Form F1 0920 [
1.3 MB
]
Attachment 2: FL2020-21 PIP Submission Form Completion Instructions F1 0920 Attachment 3: FL2020-21 PIP Submission Form F1 0920 [
1.3 MB
]
|
PT 2020-67 | 11/25/2020 |
| MMA Physician Incentive Program (MPIP) Year 5: FL Medicaid Cesarean Section Rate Calculation Specifications Policy Transmittal: 2020-66 [
145.5 kB
]
Attachment: Year 5 Attachment II Florida Medicaid Cesarean Rate Calculation Specifications FINAL [
114.9 kB
]
|
PT 2020-66 | 11/25/2020 |
| Ad Hoc Request for Updated Interim Performance Measures Data Report Policy Transmittal: 2020-65 [
161 kB
]
Attachment: Ad Hoc Interim Performance Measure Data Report Template [
20.3 kB
]
|
PT 2020-65 | 11/25/2020 |
| Medicaid Fraud Performance Targets Policy Transmittal: 2020-64 [
147.6 kB
]
Attachment: Medicaid Fraud Performance Target Formula [
110.1 kB
]
|
PT 2020-64 | 11/24/2020 |
| Ad Hoc Request for Encounter Data Validation Study Policy Transmittal: 2020-63 [
148 kB
]
Attachment: HSAG Dental Data Submission Requirements [
1 MB
]
|
PT 2020-63 | 11/24/2020 |
| Electronic Visit Verification (EVV) Requirements Policy Transmittal: 2020-62 [
145.2 kB
]
|
PT 2020-62 | 11/20/2020 |
| Ad Hoc Request for Real Time Reporting of Home Health Provider Issues Policy Transmittal: 2020-61 [
174 kB
]
|
PT 2020-61 | 11/17/2020 |
| Public Readiness and Emergency Preparedness (PREP) Act Policy Transmittal: 2020-60 [
164.2 kB
]
Attachment: List of Billable NDCs for the Plans - PREP Act - 3-18 Years [
42.6 kB
]
|
PT 2020-60 | 11/16/2020 |
| Update to CI 2019-02 - MMA Coverage of Nursing Facility Services Prior to Enrollment in the LTC Program and Monthly Report Contract Interpretation: 2020-02 [
166.7 kB
]
Attachment 1: Informed Consent Form Template [
17.7 kB
]
Attachment 2: MMA Nursing Facility Report Template [
15.5 kB
]
SMMC Snapshot: SMMC MMA 120-Day Short Term Nursing Facility Benefit Scenarios [
104.4 kB
]
|
CI 2020-02 | 11/12/2020 |
| MMA Physician Incentive Program (MPIP) Requirements Year 5 Policy Transmittal: 2020-59 [
143.9 kB
]
|
PT 2020-59 | 11/12/2020 |
| Delegation of Notices of Adverse Benefit Determination and Ad Hoc Report Request Policy Transmittal: 2020-58 [
161.4 kB
]
Attachment: Subcontractor Audit Report Template 11.06.2020 [
51.8 kB
]
|
PT 2020-58 | 11/06/2020 |
| Implementation of the Private Duty Nursing (PDN) Incentive Payment and Ad Hoc Quarterly PDN Report Policy Transmittal: 2020-57 [
155.2 kB
]
Attachment 1: Home Health Withhold and Disbursement Methodology [
116.2 kB
]
Attachment 2: Ad Hoc Quarterly PDN Report Template [
53.2 kB
]
|
PT 2020-57 | 11/05/2020 |
| Interim Billing for Inpatient Hospital Services Policy Transmittal: 2020-56 [
145.7 kB
]
|
PT 2020-56 | 11/04/2020 |
| Policy Transmittal 2020-29 Update: Temporary Weekly Reporting Requirements End Policy Transmittal: 2020-55 [
95 kB
]
|
PT 2020-55 | 11/02/2020 |
| Marketing, Public, and Educational Events and Updated Reporting Requirements Policy Transmittal: 2020-54 [
90 kB
]
Marketing Public Educational Events Report Template 10.02.2020 [
152.9 kB
]
|
PT 2020-54 | 10/09/2020 |
| Achieved Savings Rebate (ASR) Financial Reporting Policy Transmittal: 2020-53 [
139 kB
]
ASR Financial Report Template 09152020 [
2.4 MB
]
ASR Dental Financial Report Template 09152020 [
778.1 kB
]
|
PT 2020-53 | 10/02/2020 |
| Ad Hoc Request for Dental Plan Encounter Notification Service (ENS) Data Policy Transmittal: 2020-52 [
141.3 kB
]
Ad Hoc Dental ENS Data Report Template [
136.9 kB
]
|
PT 2020-52 | 09/25/2020 |
| COVID-19 State of Emergency: Annual Hernandez Settlement Agreement (HSA) Survey Report Policy Transmittal: 2020-51 [
147.1 kB
]
|
PT 2020-51 | 09/22/2020 |
| Prescribed Drug List Compliance Contract Interpretation: 2020-01 [
138.8 kB
]
Attachment 1: Snapshot PDL Compliance FAQ [
163.7 kB
]
|
CI 2020-01 | 09/11/2020 |
| COVID-19 State of Emergency: Adult Community Support Services Policy Transmittal: 2020-50 [
165.7 kB
]
|
PT 2020-50 | 09/03/2020 |
| SUPPORT Act Requirements Policy Transmittal: 2020-49 [
145 kB
]
|
PT 2020-49 | 08/31/2020 |
| MMA Performance Measure and Survey Changes for July 1, 2021 Reporting Policy Transmittal: 2020-48 [
148.7 kB
]
|
PT 2020-48 | 08/31/2020 |
| Updated Electronic Visit Verification (EVV) Compliance Requirements Policy Transmittal: 2020-47 [
145.3 kB
]
EVV Vendor Status Report Template 08.19.2020 [
49 kB
]
|
PT 2020-47 | 08/19/2020 |
| Annual Performance Improvement Projects (PIPs) Deadline Extension Policy Transmittal: 2020-46 [
108.2 kB
]
|
PT 2020-46 | 08/19/2020 |
| Ad Hoc Request for Interim Performance Measures Data Report Policy Transmittal: 2020-45 [
159.3 kB
]
Ad Hoc Request for Interim Performance Measures Data Report Template [
20.3 kB
]
|
PT 2020-45 | 08/19/2020 |
| Ad Hoc Request for Value-Based Payment Survey Data Policy Transmittal: 2020-44 [
157.5 kB
]
Value Based Payment Models Survey Template |
PT 2020-44 | 08/13/2020 |
| Virtual Marketing, Public, and Educational Events and Updated Reporting Requirements Policy Transmittal: 2020-43 [
123.4 kB
]
Attachment: Marketing Public Educational Events Report Template 08.01.2020 [
100.7 kB
]
|
PT 2020-43 | 07/30/2020 |
| Additional Ad Hoc Request for Private Duty Nursing Data Policy Transmittal: 2020-42 [
143.6 kB
]
Attachment: Ad Hoc PDN Template 07.28.2020 [
45.3 kB
]
|
PT 2020-42 | 07/30/2020 |
| COVID-19 State of Emergency: Updated Hospital Transfer Requirements Policy Transmittal: 2020-41 [
90.1 kB
]
Update to Policy Transmittal 2020-39 |
PT 2020-41 | 07/14/2020 |
| Ad Hoc Request for Telemedicine Utilization Data Policy Transmittal: 2020-40 [
138.7 kB
]
Attachment 1: Telemedicine Utilization Data Template [
12.7 kB
]
|
PT 2020-40 | 07/10/2020 |
| COVID-19 State of Emergency: Hospital Transfer Requirements Policy Transmittal: 2020-39 [
89.3 kB
]
|
PT 2020-39 | 07/09/2020 |
| Ad Hoc Request for Private Duty Nursing Data Policy Transmittal: 2020-38 [
143.6 kB
]
Attachment: Ad Hoc PDN Template 06.24.2020 [
44 kB
]
|
PT 2020-38 | 06/26/2020 |
| Ad Hoc Request for Pharmacy Transaction Fee Information Policy Transmittal: 2020-37 [
139.7 kB
]
Attachment 1: Milliman: Additional Data Request [
164.7 kB
]
Attachment 2: Milliman: Exhibit A Additional Data Request [
18.4 kB
]
|
PT 2020-37 | 06/25/2020 |
| Critical Incident Reporting and Adverse and Critical Incident Summary Reporting Policy Transmittal: 2020-36 [
143.4 kB
]
Attachment 1: SMMC Report Guide Chapter 15: Critical Incident Report – Individual [
111.1 kB
]
Attachment 2: SMMC Report Guide Chapter 7: Adverse and Critical Incident Summary Report [
81.4 kB
]
AIRS User GUIDE for Health Plans [
3.2 MB
]
The AIRS Individual Critical Incident Demonstration video may be viewed on the Agency’s YouTube channel under the “Medicaid Quality” playlist at https://www.youtube.com/watch?v=_0qv0uPUBHw&feature=youtu.be Adverse & Critical Incident Summary Reporting for Comprehensive & Long Term Care (LTC) - Plus Plans https://youtu.be/ucl997vh6hc Adverse Incident Summary Reporting for MMA - Only, Specialty, and Dental Plans. https://youtu.be/7TUO38_3clM |
PT 2020-36 | 06/18/2020 |
| COVID-19 State of Emergency: Prior Authorization Reinstatement Policy Transmittal: 2020-35 [
143 kB
]
|
PT 2020-35 | 06/12/2020 |
| COVID-19 State of Emergency: Well-Child Visits Provided via Telemedicine Policy Transmittal: 2020-34 [
114.3 kB
]
|
PT 2020-34 | 05/29/2020 |
| Revised Templates for July 1, 2020 Reporting of Performance Measures and Well Child Visit (CMS-416) and FL 80% Screening Report Policy Transmittal: 2020-33 [
138.3 kB
]
Attachment 1: Performance Measures Report Template SMMC-FI [
599.5 kB
]
Attachment 2: Well Child Visit Report Template 03312020 [
280 kB
]
|
PT 2020-33 | 05/14/2020 |
| Fraud, Abuse, Waste, and Disclosure Reporting Requirements Policy Transmittal: 2020-32 [
89.4 kB
]
Attachment: Instructions for Submission of the Supplemental Referral [
145.5 kB
]
|
PT 2020-32 | 05/08/2020 |
| COVID-19 State of Emergency: Behavioral Health Requirements Policy Transmittal: 2020-31 [
137 kB
]
|
PT 2020-31 | 05/05/2020 |
| COVID-19 State of Emergency: Public Health Emergency: Adult Day Care Retainer Payments Policy Transmittal: 2020-30 [
97.7 kB
]
Attachment 1: Adult Day Care Retainer Payment Form [
24.5 kB
]
Attachment 2: Managed Care Plan Acknowledgment and Notification Template [
14.9 kB
]
|
PT 2020-30 | 05/01/2020 |
| COVID-19 State of Emergency: Reporting Requirements Policy Transmittal: 2020-29 [
156 kB
]
Attachment: Report Summary 4.30.2020rev [
25.7 kB
]
|
PT 2020-29 | 04/30/2020 |
| Reprocessing State Fiscal Year (SFY) 2019-20 Diagnosis Related Group (DRG) Rates Policy Transmittal: 2020-28 [
95.6 kB
]
|
PT 2020-28 | 04/29/2020 |
| Achieved Savings Rebate (ASR) Financial Reporting Policy Transmittal: 2020-27 [
136.6 kB
]
Attachment 1: ASR Financial Report Template 04272020 [
2.3 MB
]
(Formula Updates, Template Updated 7/10/2020) Attachment 2: ASR Dental Financial Report Template 04272020 [
776.9 kB
]
|
PT 2020-27 | 04/28/2020 |
| COVID-19 State-of-Emergency: COVID-19 Laboratory Testing |
PT 2020-26 | 04/27/2020 |
| COVID-19 State-of-Emergency: Behavioral Health Telemedicine/Telehealth Requirements |
PT 2020-25 | 04/21/2020 |
| COVID-19 State of Emergency: Prior Authorization and Claims Payment Requirements |
PT 2020-24 | 04/21/2020 |
| COVID-19 State-of-Emergency: Coverage of Non-Emergency Ambulance Policy Transmittal: 2020-23 [
86.8 kB
]
|
PT 2020-23 | 04/17/2020 |
| Performance Measure Reporting, Recipient Surveys, Provider Satisfaction Survey Reporting Policy Transmittal: 2020-22 [
195.4 kB
]
Attachment [
55.7 kB
]
|
PT 2020-22 | 04/17/2020 |
| Achieved Savings Rebate (ASR) Financial Reporting Policy Transmittal: 2020-21 [
141.2 kB
]
Attachment 1: ASR Financial Report SMMC 033020 [
2.3 MB
]
Attachment 2: ASR Dental Financial Report SMMC 033020 [
776.4 kB
]
|
PT 2020-21 | 04/04/2020 |
| COVID-19 State of Emergency: Telemedicine Services |
PT 2020-20 | 04/03/2020 |
| Ad Hoc Request for Pharmacy Claims Data Policy Transmittal: 2020-19 [
140.7 kB
]
Attachment: Milliman Data Request for PBM Pricing [
80.1 kB
]
|
PT 2020-19 | 04/01/2020 |
| COVID-19 State of Emergency: Coverage of Services and Other Provisions Policy Transmittal: 2020-18 [
143.5 kB
]
|
PT 2020-18 | 03/25/2020 |
| COVID-19 State of Emergency: Non-Urgent and Non-Emergent Services (Transportation) Policy Transmittal: 2020-17 [
137.8 kB
]
|
PT 2020-17 | 03/22/2020 |
| COVID-19 State of Emergency: Temporary Expansion of Long-Term Care Provider Qualifications |
PT 2020-16 | 03/20/2020 |
| COVID-19 State of Emergency: Coverage of Services Attachment 1: DEM Order NO. 20-006 [
205.6 kB
]
Attachment 2: DOH No. 20-002 [
161.2 kB
]
|
PT 2020-15 | 03/18/2020 |
| COVID-19 State of Emergency: Medicaid Coverage of Laboratory Testing, Guidance for NEMT Brokers and Providers, and Managed Care Plan Provider Credentialing Policy Transmittal: 2020-14 [
148.4 kB
]
Attachment: Guidance for NEMT Brokers and Providers on COVID-19 [
111.2 kB
]
|
PT 2020-14 | 03/14/2020 |
| Statewide Essential Providers Policy Transmittal: 2020-13 [
88.9 kB
]
|
PT 2020-13 | 03/12/2020 |
| Guidance on the COVID-19 State of Emergency Policy Transmittal: 2020-12 [
150.5 kB
]
Attachment: COVID-19 Public Health Emergency Order No. 20-002 [
206.2 kB
]
|
PT 2020-12 | 03/12/2020 |
| Ad Hoc Request for Monthly Electronic Visit Verification (EVV) Reports Policy Transmittal: 2020-11 [
251.3 kB
]
Attachment: EVV Vendor Status Report Template 02/28/2020 [
42.8 kB
]
(Some Header Descriptions Revised, Template Updated 3/10/2020) |
PT 2020-11 | 02/28/2020 |
| Ad Hoc Request for Private Duty Nursing (PDN) Policies and Procedures Policy Transmittal: 2020-10 [
266.1 kB
]
|
PT 2020-10 | 02/24/2020 |
| Case Management File Audit Report and Operational Guidelines Policy Transmittal: 2020-09 [
147.5 kB
]
Attachment 1: Case Management File Audit Report Template [
26 kB
]
Attachment 2: Case Management File Audit Report Operational Guidelines [
35.1 kB
]
|
PT 2020-09 | 02/21/2020 |
| Ad Hoc Request for Documentation of Subcontractor Insolvency Account Policy Transmittal: 2020-08 [
253.4 kB
]
|
PT 2020-08 | 02/11/2020 |
| Provider Satisfaction Survey Policy Transmittal: 2020-07 [
263.4 kB
]
Attachment 1: MMA Provider Satisfaction Survey Tool [
89 kB
]
Attachment 2: LTC Provider Satisfaction Survey Tool [
89.9 kB
]
Attachment 3: Dental Provider Satisfaction Survey Tool [
88.7 kB
]
|
PT 2020-07 | 02/07/2020 |
| Non-Emergency Transportation Timeliness Report Policy Transmittal: 2020-06 [
148.1 kB
]
Non-Emergency Transportation Timeliness Report Template [
628.9 kB
]
(Drop Down Values Extended, Template Updated 3/11/2020) SMMC Managed Care Report Guide Chapter 35 Redline version [
805.3 kB
]
|
PT 2020-06 | 02/03/2020 |
| Electronic Visit Verification (EVV) Compliance Requirements Policy Transmittal: 2020-05 [
259.2 kB
]
|
PT 2020-05 | 01/31/2020 |
| Ad Hoc Request for Pharmacy Claims Data Policy Transmittal: 2020-04 [
251.5 kB
]
Attachment 1: Milliman: Data Request for Independent Analysis of PBM Pricing Practices in SMMC Program [
208.6 kB
]
Attachment 2: Milliman: Exhibit A Claims Data Request [
16.9 kB
]
|
PT 2020-04 | 01/30/2020 |
| Community Behavioral Health Services Policy Transmittal: 2020-03 [
153.4 kB
]
|
PT 2020-03 | 01/30/2020 |
| MMA Performance Measures for July 1, 2020 Reporting Policy Transmittal: 2020-02 [
252.4 kB
]
|
PT 2020-02 | 01/27/2020 |
| Achieved Savings Rebate (ASR) Financial Reporting Policy Transmittal: 2020-01 [
137.8 kB
]
Attachment 1: ASR Report Template [
2.4 MB
]
(Formula Corrections, Template Updated 2/10/2020) Attachment 2: ASR Dental Report Template [
768.3 kB
]
|
PT 2020-01 | 01/17/2020 |
2019 |
||
| Home and Community-Based (HCB) Settings Requirements Policy Transmittal: 2019-25 [
262.7 kB
]
Attachment: HCB Setting Progress Report Template [
27.7 kB
]
|
PT 2019-25 | 12/10/2019 |
| Transportation Network Companies (TNCs) Contract Interpretation: 2019-08 [
359 kB
]
Attachment 1: TNC Request Form [
25.6 kB
]
|
CI 2019-08 | 12/06/2019 |
| Appointment Wait Times Report Policy Transmittal: 2019-24 [
147.9 kB
]
Attachment 1: Report Guide, Chapter 9 (Track Changes Version) [
152.1 kB
]
Attachment 2: Report Template [
51.2 kB
]
|
PT 2019-24 | 12/05/2019 |
| Electronic Visit Verification (EVV) Implementation Parameters Policy Transmittal: 2019-23 [
182.5 kB
]
|
PT 2019-23 | 11/26/2019 |
| LTC Training Plan and Training Materials Policy Transmittal: 2019-22 [
249.8 kB
]
|
PT 2019-22 | 11/25/2019 |
| Requirements for Personal Care and Adult Companion Care Services Contract Interpretation: 2019-07 [
250.5 kB
]
|
CI 2019-07 | 10/29/2019 |
| Achieved Savings Rebate (ASR) Reporting Policy Transmittal: 2019-21 [
248.8 kB
]
Attachment 1: ASR Financial Template 10/8/2019 [
2.3 MB
]
Attachment 2: ASR Dental Financial Template 10/8/2019 [
763.3 kB
]
Attachment 3: CMS Informational Bulletin 05/15/2019 [
113.9 kB
]
|
PT 2019-21 | 10/08/2019 |
| MMA Physician Incentive Program (MPIP) Requirements Policy Transmittal: 2019-20 [
258 kB
]
|
PT 2019-20 | 10/03/2019 |
| Electronic Visit Verification System Contract Interpretation: 2019-06 [
254.5 kB
]
|
CI 2019-06 | 9/18/2019 |
| Medical Foster Care Services Reporting Policy Transmittal: 2019-19 [
147.8 kB
]
Attachment: Medical Foster Care Services Report Template [
343.6 kB
]
|
PT 2019-19 | 9/16/2019 |
| Administration of the Prescribed Drug Program in SMMC Policy Transmittal: 2019-18 [
251 kB
]
Attachment: Pharmacy Benefit Manager Information Request [
10.9 kB
]
|
PT 2019-18 | 9/10/2019 |
| Behavioral Health and Medical Neglect Child Staffings Policy Transmittal: 2019-17 [
254.9 kB
]
Attachment 1: Child Staffing Attendance Report Template Instructions [
24.4 kB
]
Attachment 2: Child Staffing Attendance Report Template [
37.4 kB
]
|
PT 2019-17 | 08/23/2019 |
| Submission of Dispute Requests Policy Transmittal: 2019-16 [
106.6 kB
]
|
PT 2019-16 | 08/07/2019 |
| Revised Requirements for Health Performance Measures & Provider and Enrollee Satisfaction Surveys (LTC) Policy Transmittal: 2019-15 [
181.4 kB
]
Attachment: LTC Performance Measures Technical Specifications Manual [
24.1 kB
]
|
PT 2019-15 | 08/02/2019 |
| Reinstatement of Services Authorization Performance Outcome Report Policy Transmittal: 2019-14 [
150.7 kB
]
Attachment: Services Authorization Performance Outcome Report Template [
92.2 kB
]
|
PT 2019-14 | 07/26/2019 |
| Suspension of Services Authorization Performance Outcome Report Policy Transmittal: 2019-13 [
147.9 kB
]
|
PT 2019-13 | 6/11/2019 |
| Achieved Savings Rebate (ASR) Financial Reporting (Dental Plans) Policy Transmittal: 2019-12 [
244.4 kB
]
Attachment: Dental Achieved Savings Rebate Financial Reporting Template [
756.9 kB
]
|
PT 2019-12 | 5/23/2019 |
| Update to PT 2019-06: Achieved Savings Rebate (ASR) Financial Reporting Policy Transmittal: 2019-11 [
57.6 kB
]
Attachment: Achieved Savings Rebate Financial Reporting Template [
2.3 MB
]
|
PT 2019-11 | 05/07/2019 |
| Update to PT 2019-04 Ad Hoc Request for Early Intervention Services (EIS) Provider Network Report Policy Transmittal: 2019-10 [
146.6 kB
]
Attachment: EIS Provider Network Ad Hoc Report Template 04262019 [
182.6 kB
]
|
PT 2019-10 | 04/26/2019 |
| Revised Templates for July 1, 2019 Reporting of Performance Measures and CHCUP (CMS-416) and FL 80% Screening Ratio Report Policy Transmittal: 2019-09 [
145.8 kB
]
Attachment 1: Performance Measures Report LTC & MMA Template [
457.5 kB
]
Attachment 2: CHCUP (CMS-416) and FL 80% Screening Ratio Report Template [
239.5 kB
]
|
PT 2019-09 | 04/10/2019 |
| Revised Reporting Requirements for Privacy Incidents/Breaches of Protected Health Information (PHI) Contract Interpretation: 2019-05 [
252.4 kB
]
|
CI 2019-05 | 04/09/2019 |
| Medical Foster Care Ad Hoc Report Policy Transmittal: 2018-08 [
146.1 kB
]
Attachment: Medical Foster Care Ad Hoc Report Template 04-03-2019 [
1.7 MB
]
|
PT 2019-08 | 04/03/2019 |
| Revised Requirements for Performance Measures, Provider, and Enrollee Satisfaction Surveys Policy Transmittal: 2019-07 [
254.7 kB
]
Attachment 1: MMA Performance Measure Specifications [
280.1 kB
]
Attachment 2: HIV-AIDS Attachment for July 1, 2019 Reporting [
44.9 kB
]
|
PT 2019-07 | 03/22/2019 |
| Provider Termination and Continuity of Care Contract Interpretation: 2019-04 [
247 kB
]
|
CI 2019-04 | 03/21/2019 |
| Cancer Hospital Reimbursement Requirements Contract Interpretation: 2019-03 [
150.4 kB
]
|
CI 2019-03 | 03/21/2019 |
| Achieved Savings Rebate (ASR) Financial Reporting Policy Transmittal: 2019-06 [
244.4 kB
]
Attachment: ASR Financial Report [
2.3 MB
]
|
PT 2019-06 | 03/21/2019 |
| Patient Responsibility Report Discontinued Policy Transmittal: 2019-05 [
248.6 kB
]
|
PT 2019-05 | 03/21/2019 |
| Ad Hoc Request for Early Intervention Services (EIS) Provider Network Report Policy Transmittal: 2019-04 [
146.7 kB
]
Attachment: Ad Hoc EIS Provider Network Report Template [
988.4 kB
]
|
PT 2019-04 | 02/22/2019 |
| MMA Coverage of Nursing Facility Services Prior to Enrollment in the LTC Program and Monthly Ad Hoc Report Contract Interpretation: 2019-02 [
254.3 kB
]
Nursing Facility Services Report Template [
34.8 kB
]
|
CI 2019-02 | 2/15/2019 |
| Revised Due Dates for the Dental Plan Performance Improvement Projects (PIPs) and for the Dental Enrollee and Provider Satisfaction Surveys Policy Transmittal: 2019-03 [
150.1 kB
]
|
PT 2019-03 | 2/4/2019 |
| Update to PT 2019-01 Ad Hoc Request for Provider Education and Training Materials for Medical Foster Care (MFC) Providers Policy Transmittal: 2019-02 [
146.7 kB
]
Attachment: MFC Ad Hoc Report Template 02.01.19 [
1.1 MB
]
|
PT 2019-02 | 2/1/2019 |
| Notice of Adverse Benefit Determination (NABD) Contract Interpretation: 2019-01 [
250.4 kB
]
|
CI 2019-01 | 1/24/2019 |
| Ad Hoc Request for Provider Education and Training Materials for MFC Providers Policy Transmittal: 2019-01 [
272.9 kB
]
Attachment: MFC Ad Hoc Report Template 01.10.19 [
148.8 kB
]
|
PT 2019-01 | 1/23/2019 |
2018 |
||
| Enrollee Continuity of Care Data for Transition Phase 3 (Regions 1, 2, 3, and 4) Policy Transmittal: 2018-05 [
251 kB
]
Attachment 1: Instructions and File Layouts [
338.1 kB
]
Attachment 2: PNV Provider Data (PD) File Specs_08312018 [
179.2 kB
]
Attachment 3: Participant Directed Option (PDO) Template [
27.2 kB
]
Attachment 4: Non-Emergent Transportation (NET) Template [
42.2 kB
]
Plan PA Submission Checklist [
16.5 kB
]
|
PT 2018-05 | 11/1/2018 |
| Requirements for Submission of Performance Improvement Projects (PIPs) Policy Transmittal: 2018-04 [
252.4 kB
]
|
PT 2018-04 | 10/23/2018 |
| Subcontractor Requirements Contract Interpretation: 2018-01 [
253.1 kB
]
|
CI 2018-01 | 10/19/2018 |
| Enrollee Continuity of Care Data for Transition Phase 2 (Regions 5, 6, 7, and 8) Policy Transmittal: 2018-03 [
251.1 kB
]
Attachment 1: Instructions and File Layouts [
339.1 kB
]
Attachment 2: PNV Provider Data (PD) File Specs_08312018 [
179.3 kB
]
Attachment 3: Participant Directed Option (PDO) Template [
27.2 kB
]
Attachment 4: Non-Emergent Transportation (NET) Template [
42.2 kB
]
Plan PA Submission Checklist [
16.5 kB
]
|
PT 2018-03 | 10/1/2018 |
| Enrollee Continuity of Care Data for Transition Phase 1 (Regions 9, 10, and 11) Policy Transmittal: 2018-02 [
98.5 kB
]
Attachment 1: Instructions and File Layouts [
337.1 kB
]
Attachment 2: PNV Provider Data (PD) File Specs [
179.2 kB
]
Attachment 3: Participant Directed Option (PDO) Template [
27.2 kB
]
Attachment 4: Non-Emergent Transportation (NET) Template [
41.7 kB
]
Plan PA Submission Checklist [
16.5 kB
]
|
PT 2018-02 | 9/21/2018 |
| Electronic Visit Verification (EVV) System Policy Transmittal: 2018-01 [
250.9 kB
]
|
PT 2018-01 | 9/7/2018 |
