I’m thrilled to report a landmark settlement which will improve the quality and quantity of home care services for Medicaid enrollees receiving home and community based services. Congratulations to attorney Nancy Wright of Gainesville, Florida (lead Counsel), Disability Rights Florida and Southern Legal Counsel.
Under the Settlement Agreement, health plans that administer Medicaid long-term care services will be “required to provide an array of home and community-based services that enable enrollees to live in the community and to avoid institutionalization”.
The Settlement Agreement also states, among other things, that AHCA will:
- Adopt rules that set out requirements for coverage of long-term care services
- Require a new assessment procedure that takes into account the availability, willingness and ability of voluntary caregivers.
- Amend their contract with health plans to ensure compliance with these rules
- Require changes to health plan member handbooks to clarify enrollee rights and how to file consumer complaints
- Train (or re-train) health plans, hearing officers, AHCA staff and others on the new requirements
- Monitor case managers on how assessments are being done
- Use enrollee surveys that ask about sufficiency of services
The agreement impacts all six health plans now operating in Florida to provide Medicaid services through the Long-Term Care Program: Coventry/Aetna, Humana, Sunshine Health, Molina, United Healthcare and Amerigroup.
Should you have any questions regarding this topic or any other Medicaid related enquiry, please contact our office on 941-906-1231 to schedule an appointment to meet with one of our attorneys.
