How does continuity of care work?
Aetna Better Health® of Florida will be responsible for COC for new members transitioning onto our Medicaid and Florida Healthy Kids plans. If a new member is already receiving a preauthorized, ongoing course of treatment for a covered service, we’ll cover the costs for that course of treatment, even if delivered by an out-of-network provider. New Long-Term Care members receive a comprehensive assessment and a plan of care, and services are authorized and arranged to address their needs.
We ask providers with transitioning members to cooperate in all respects with providers of other managed care plans to ensure the best health outcomes for our members.
Extensions beyond the 120-day period
Some COC services may qualify for an extension beyond the 120-day period. We’ll continue to pay for care from the member’s current provider beyond 120 days, regardless of whether the provider is in-network, for services, including:
Prenatal and postpartum care
Services throughout pregnancy and through completion of postpartum care (six (6) weeks after birth).
Transplants
Care and follow-up for one (1) year post-transplant.
Oncology (radiation and/or chemotherapy)
Services for the duration of the current round of treatment.
Hepatitis C treatment
The full course of therapy for hepatitis C treatment medications..
The 120-day continuation period
For new members, we will honor documented authorization of ongoing covered services for one hundred twenty (120) days after their effective date of enrollment. We’ll approve this continuation of services until the member’s primary care provider (PCP), or behavioral health provider (depending on the type of care) reviews the member’s treatment plan, which shall be no more than one hundred twenty (120) calendar days after the effective date of enrollment.
Provider payment for pre-authorized services
Providers, regardless of network, should continue to provide any preauthorized services to new members of our plan. We’ll pay claims for those services for up to 120 days after they enroll. Claims will be paid at 100% of the Medicaid fee schedule unless a separate rate is negotiated.
Learn more about Florida’s COC provisions
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Aetna Better Health of Florida’s Rural Health Clinic Grant (RHC) funding is to assist providers in covering fees or consultations needed in order to adopt or expand the use of electronic health records (EHR) system, connectivity to the state Health Information Exchange and other community providers. Any funds issued by Aetna Better Health of Florida will be used exclusively to promote enhancements of EHR system.
If you’re a rural health clinic interested in this grant, you can complete our EHR questionnaire and email it to us.