Florida’s MCO Medicaid path may be taken by other states

Back in 2013, Florida deployed a Statewide Medicaid Managed Care longterm Care Program system, also regarded as a nursing home diversion program, to meet the needs of their older residents. Under this application, Medicaid eligible seniors that require long-term care supports may get assistance within their home, in the area, or even in assisted living. SMMC LTC divides Florida to 11 regions with multiple Managed Health Care companies that provide services. Its not all provider is available in all 11 regions. Needy seniors who need care and are financially qualified, select a “Strategy” in a number of those providers who offer care in their own geographical location. That provider gets in charge of each of the participant’s long term care requirements. Participants may also have the ability to receive Managed Medical Assistance via Florida Medicaid. Counselors are available to help participants select a long-term care program.

Having chosen a strategy, each participant is assigned an Extended Term Care Case Manager. This individual conducts an extensive assessment of his/her care requirements. Family members and other persons knowledgeable about the player can participate in the assessment process. The results of the assessment is just a Care Plan that claims that the most restrictive environment by which the player may get care and what supports and care they might need at that environment. A complete collection of possible services is available in the benefits section below. The plan has a network of care and service providers to meet each of The needs of the participants. Nevertheless, each plan offers clients a level of participant leadership. This Player Directed Option means app participants have any choice in who provides them with caution solutions, at minimum in the fields of personal care and homemaker services. Program participants, or perhaps a representative chosen by the application participant, are able to engage, train, and manage the maintenance provider. Family members, including adult kids and even spouses, could be hired and also receive reimbursement as providers. Some readers in Florida may know of PDO with other names including Cash & Counseling or Client Directed Care. When a program participant thinks a degree or type of maintenance, or a Special support assistance, that he/she has not yet been approved is Necessary, they could request a Medicaid fair hearing. A third-party Company manages the participant’s dispute with the Managed Care Organization.


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