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2019 MMA Specialty Plan Contract Information

Magellan Complete Care’s Specialty Plan for Medicaid beneficiaries with Serious Mental Illness is available in the following regions and counties for the 2019 contract cycle:

 

Region 4         Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia

Region 5         Pasco and Pinellas

Region 7         Brevard, Orange, Osceola, and Seminole

 

For Magellan Complete Care providers in Regions 2, 6, 9, 10 or 11: Please refer to the following Continuity of Care Provisions below:

 

Continuity of Care Provisions

Health and dental plans are required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that when enrollees transition from one health plan to another, one service provider to another, or one service delivery system to another, their services continue seamlessly throughout their transition. The Agency has instituted the following COC provisions:

 

Health care providers should not cancel appointments with current patients. Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out-date in each region.

Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. Plans must pay for previously authorized services for up to 60 days after the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.

Providers will be paid promptly.  During the continuity of care period, plans are required to follow all timely claims payment contractual requirements.  The Agency will monitor complaints to ensure that any issues with delays in payment are resolved.

Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.

 

If you have any questions please call us at 1-800-327-8613.

 

Posted 2/7/2019