SECTION 409.984. Enrollment in a long-term care managed care plan.

• ¹(1) The agency shall automatically enroll into a long-term care managed care plan those Medicaid recipients who do not voluntarily choose a plan pursuant to s. 409.969. The agency shall automatically enroll recipients in plans that meet or exceed the performance or quality standards established pursuant to s. 409.967 and may not automatically enroll recipients in a plan that is deficient in those performance or quality standards. If a recipient is deemed dually eligible for Medicaid and Medicare services and is currently receiving Medicare services from an entity qualified under 42 C.F.R. part 422 as a Medicare Advantage Preferred Provider Organization, Medicare Advantage Provider-sponsored Organization, or Medicare Advantage Special Needs Plan, the agency shall automatically enroll the recipient in such plan for Medicaid services if the plan is currently participating in the long-term care managed care program. For a dually eligible recipient receiving Medicare services from an entity qualified under 42 C.F.R. part 422 who is not participating in the long-term care managed care program, the agency shall automatically enroll the dually eligible recipient in a long-term care plan that has established a collaboration and coordination agreement with that nonparticipating entity, if the agency determines the agreement is sufficient to ensure provision of all required services in a manner consistent with state and federal requirements. Except as otherwise provided in this part, the agency may not engage in practices that are designed to favor one managed care plan over another.
  (2) When automatically enrolling recipients in plans, the agency shall take into account the following criteria:

  (a) Whether the plan has sufficient network capacity to meet the needs of the recipients.

  (b) Whether the recipient has previously received services from one of the plan’s home and community-based service providers.

  (c) Whether the home and community-based providers in one plan are more geographically accessible to the recipient’s residence than those in other plans.
  (3) Notwithstanding s. 409.969(2), if a recipient is referred for hospice services, the recipient has 30 days during which the recipient may select to enroll in another managed care plan to access the hospice provider of the recipient’s choice.
  (4) If a recipient is referred for placement in a nursing home or assisted living facility, the plan must inform the recipient of any facilities within the plan that have specific cultural or religious affiliations and, if requested by the recipient, make a reasonable effort to place the recipient in the facility of the recipient’s choice.

History.-s. 25, ch. 2011-134; s. 56, ch. 2012-5; ss. 45, 46, ch. 2020-114.

Note

Note.-

A. Section 45, ch. 2020-114, amended subsection (1) “[i]n order to implement Specific Appropriation 226 of the 2020-2021 General Appropriations Act.”

B. Section 46, ch. 2020-114, provides that “[t]he amendments to s. 409.984(1), Florida Statutes, by this act expire July 1, 2021, and the text of that subsection shall revert to that in existence on June 30, 2020, except that any amendments to such text enacted other than by this act shall be preserved and continue to operate to the extent that such amendments are not dependent upon the portion of text which expires pursuant to this section.” Effective July 1, 2021, subsection (1), as amended by s. 46, ch. 2020-114, will read:

(1) The agency shall automatically enroll into a long-term care managed care plan those Medicaid recipients who do not voluntarily choose a plan pursuant to s. 409.969. The agency shall automatically enroll recipients in plans that meet or exceed the performance or quality standards established pursuant to s. 409.967 and may not automatically enroll recipients in a plan that is deficient in those performance or quality standards. If a recipient is deemed dually eligible for Medicaid and Medicare services and is currently receiving Medicare services from an entity qualified under 42 C.F.R. part 422 as a Medicare Advantage Preferred Provider Organization, Medicare Advantage Provider-sponsored Organization, or Medicare Advantage Special Needs Plan, the agency shall automatically enroll the recipient in such plan for Medicaid services if the plan is currently participating in the long-term care managed care program. Except as otherwise provided in this part, the agency may not engage in practices that are designed to favor one managed care plan over another.

History.-s. 25, ch. 2011-134; s. 56, ch. 2012-5; ss. 45, 46, ch. 2020-114.

Note

Note.-

A. Section 45, ch. 2020-114, amended subsection (1) “[i]n order to implement Specific Appropriation 226 of the 2020-2021 General Appropriations Act.”

B. Section 46, ch. 2020-114, provides that “[t]he amendments to s. 409.984(1), Florida Statutes, by this act expire July 1, 2021, and the text of that subsection shall revert to that in existence on June 30, 2020, except that any amendments to such text enacted other than by this act shall be preserved and continue to operate to the extent that such amendments are not dependent upon the portion of text which expires pursuant to this section.” Effective July 1, 2021, subsection (1), as amended by s. 46, ch. 2020-114, will read:

(1) The agency shall automatically enroll into a long-term care managed care plan those Medicaid recipients who do not voluntarily choose a plan pursuant to s. 409.969. The agency shall automatically enroll recipients in plans that meet or exceed the performance or quality standards established pursuant to s. 409.967 and may not automatically enroll recipients in a plan that is deficient in those performance or quality standards. If a recipient is deemed dually eligible for Medicaid and Medicare services and is currently receiving Medicare services from an entity qualified under 42 C.F.R. part 422 as a Medicare Advantage Preferred Provider Organization, Medicare Advantage Provider-sponsored Organization, or Medicare Advantage Special Needs Plan, the agency shall automatically enroll the recipient in such plan for Medicaid services if the plan is currently participating in the long-term care managed care program. Except as otherwise provided in this part, the agency may not engage in practices that are designed to favor one managed care plan over another.