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SMMC 2018-23: Agency-Approved Contract Materials

 1. Case Management File Audit Report Operational Guidelines MS Excel Document [29KB]
  • Web site updated with this material 2/20/2019.
  • 2018-2023 Contract Citation: coming soon
 2. Child Health Screenings Periodicity Schedule
  • Web site updated with this material 9/20/2018.
  • 2018-2023 MMA Contract Citation: Attachment II, Exhibit II-A, Section VI.D.3.b.
  • 2018-2023 MMA Contract Citation: Attachment II, Exhibit II-A, Section VI.D.3.c.(4)
 3.  Comprehensive Hemophilia Disease Management Program
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit, II-A, Section V.A.1.a.(13)(i)
 4.  Consent for Voluntary Suspension of Authorized Services Template in the Statewide Medicaid Managed Care Program Form MS Word Document [40KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VI.E.4.
 5.  Enrollee Handbook Template for Dental Benefits MS Word Document [71KB]
  • Web site updated with this material 10/1/2018.
  • 2018-2023 Contract Citation: coming soon
 6.  Enrollee Handbook Template for Enrollees with MMA and LTC Benefits MS Word Document [399KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section V.B.8.
 7.  Encounter Notification Service (ENS) Through Florida’s Health Information Exchange
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment B, Exhibit II-A, Section VI.
 8.  Freedom of Choice Certification Form for Enrollees with MMA and LTC Benefits MS Word Document [35KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section VI.E.3.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VI.E.5.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section VI.E.8.
 9.  Health and Dental Plan Privacy Incidents/Breaches Reporting Form PDF Document [926KB]
  • Web site updated with this material 2/11/2019.
  • 2018-2023 Contract Citation: Attachment II, Exhibit A-8 Standard Contract, Business Associate Agreement
10.  In Lieu of Service (ILOS) Submission Form for SMMC Managed Care Plans
  • Coming Soon!
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section VI.D.2.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VI.A.2.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section VI.A.2.b.
11. MMA Physician Incentive Program (MPIP)
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VIII.E.1.
  • Section 409.967(2)(a), Florida Statutes
12. Notice of Adverse Benefit Determination (NABD) Template for Enrollees with LTC Benefits MS Word Document [41KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section VII.E.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section VI.G.1.k.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section IX.E.3.a.(18)
13. Notice of Adverse Benefit Determination (NABD) Template for Enrollees with MMA and Dental Benefits MS Word Document [41KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section VII.E.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VII.E.
14. Notice of Adverse Benefit Determination (NABD) Template for MediKids MS Word Document [41KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section VII.E.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VII.E.
15. Notice of Plan Appeal Resolution (NPAR) Template MS Word Document [30KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section VII.I.1.
16. Notice of Plan Appeal Resolution (NPAR) Template for MediKids Enrollees MS Word Document [31KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section Vll.I.1.
17. Disclosure of Ownership and Control Interest Statement [173KB PDF]
  • Web site updated with this material 1/14/2019.
  • 2018-2023 Contract Citation: Attachment II, Section XV.C.
18. Participant Direction Option (PDO) for Enrollees Receiving LTC Benefits
19. Participant Direction Option (PDO) for Plans Providing LTC Benefits
  • Manual - July 2018 [111KB MS Word]
  • Training Webinar Presentation - January 16, 2019 [503KB PDF]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section Vl.A.3.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section VlII.C.2.e.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section X.B.5.c.(5)
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section X.B.5.d.(9)
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section X.B.5.e.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section X.C.1.b.
20. Performance Measures for the Long-Term Care Waiver
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-B, Section IX.B.2.b.
21. Pharmacy Lock-In Policy MS Word Document [81KB]
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit, II-A, Section VI.A.1.a.(13)(g)
22. Requirements for Provision of Oral and Written Material in Different Languages
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Section V.A.6.
  • 2018-2023 Contract Citation: Attachment II, Section V.B.2.
  • 2018-2023 Contract Citation: Attachment II, Section V.B.9.a.(7)
  • 2018-2023 Contract Citation: Attachment II, Section V.C.1.b.
  • 2018-2023 Contract Citation: Attachment II, Section V.C.2.
  • 2018-2023 Contract Citation: Attachment II, Section IX.E.3.a.(4)
  • 2018-2023 Contract Citation: Attachment II, Section X.B.6.
23. Unborn Activation and Newborn Enrollment Requirements
  • Web site updated with this material 9/20/2018.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section III.C.1.a.-b.
  • 2018-2023 Contract Citation: Attachment II, Exhibit II-A, Section VIII.C.4.a.(5)