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It's a New Day in Public Health.

The Florida Department of Health works to protect, promote & improve the health of all people in Florida through integrated state, county, & community efforts.

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For Health Care Professionals

CMS Plan

At the Children's Medical Services (CMS) Plan, we recognize that our providers are the foundation of the health care services we deliver. That is why we recruit only the most talented physicians and health care providers to meet the needs of the special children we serve.

CMS provides a comprehensive system of care for eligible children with special health care needs. We believe in providing accessible, comprehensive, and family-centered care in a medical home setting. In addition, we have intervention, prevention, and other specialty programs that provide community based services in the natural environment and other appropriate settings.

CMS providers are an integral part of a network of local community providers, hospitals, and university medical centers around the state that provide quality care to children who need it most.

Young girl getting a shot

CMS Provider Alerts 

  • Provider Transition
  • Did you receive a notice?
  • Continuity of Care Provisions
  • Temporary Payment Change
  • CMS: We’re Here to Stay
  • CME Opportunity: September 25, 2018
  • NEW! Summer 2018 Provider Newsletter
  • CMS Plan Provider Satisfaction Surveys
  • Physician Attestation for Clinical Eligibility
To lean more about the provider transition.

Did you receive this message? Here’s what it means for you: On December 18, 2018, the Florida Department of Health announced its intent to award WellCare with a statewide contract to implement a new service delivery model for the Children’s Medical Services Health Plan (CMS Health Plan). The Florida Department of Health (DOH) will partner with WellCare to offer the CMS Plan as of February 1, 2019. This partnership will bring about positive changes that will greatly benefit children and youth with special health care needs and providers.

 

The Notice of Termination you received means that your contract with our current partner will end, but you will still be able to provide services to CMS Health Plan members for a continuity of care period. After that, you may continue to serve CMS Health Plan members under contract with WellCare.

 

Providers should not cancel appointments with current CMS Plan patients. We will honor ongoing treatment that was authorized prior to February 1st, for up to 180 days.

Providers will be paid. Providers should continue providing services that were previously authorized, regardless of whether the provider is participating in our CMS Health Plan network. We will use information provided by DOH to identify whether a member had services authorized. We will pay for these previously authorized services for up to 180 days.

Providers will be paid promptly. We will follow all timely claims payment contractual requirements.

Prescriptions will be honored. We will allow CMS Health Plan members to continue to receive their prescriptions through their current provider, for up to 180 days, until their prescriptions can be transferred to a provider in our network.

 

If you have questions about becoming a network provider with CMS Health Plan (operated by WellCare) including credentialing, claims, and navigating our systems, please contact your Provider Relations representative. If you do not know your Provider Relations representative, you may contact FloridaProviderRelations@wellcare.com or call 1-407-551-3200, option 2.

Medicaid health and dental plans are required to ensure continuity of care (COC) during the transition period for Medicaid recipients enrolled in the SMMC program. COC requirements ensure that when enrollees transition from one health or dental plan to another, one service provider to another, or one service delivery system to another (i.e., fee-for-service to managed care), their services continue seamlessly throughout their transition. The Agency has instituted the following COC provisions which is applicable to CMS Plan:

  • Health care providers should not cancel appointments with current patients. Health plans must honor any ongoing treatment that was authorized prior to the recipient’s enrollment into the plan for up to 60 days after the roll-out date in each region.
  • Providers will be paid. Providers should continue providing any services that were previously authorized, regardless of whether the provider is participating in the plan’s network. Plans must pay for previously authorized services for up to 60 days after the roll-out date in each region, and must pay providers at the rate previously received for up to 30 days.
  • Providers will be paid promptly. During the continuity of care period, plans are required to follow all timely claims payment contractual requirements. The Agency will monitor complaints to ensure that any issues with delays in payment are resolved.
  • Prescriptions will be honored. Plans must allow recipients to continue to receive their prescriptions through their current provider, for up to 60 days after the roll-out date in each region, until their prescriptions can be transferred to a provider in the plan’s network.

More information about COC provisions can be referenced on the COC program highlight document, which is posted on the Agency’s website. Once on the page, click Program Changes, then the Outreach and Presentations link.

Additional questions can be directed to your provider relations liaison for assistance.

SMMC Medicaid Dental

For more information about the SMMC dental plans, call 1-877-711-3662 or visit Florida Medicaid's website.

For Medicaid dental appointments already scheduled or services authorized, the Medicaid dental plan will honor these for up to 90 days after your enrollment in the Medicaid dental plan. For active orthodontic services, the Medicaid dental plans must also honor the entire course of authorized treatment. This is true regardless of whether the provider is in the Medicaid dental plan’s network.

Your CMS Plan (KidCare/Title XXI) dental agreement will remain in effect, there are no changes to CMS Plan (KidCare) coverage benefits and services or authorization and claims processes.

SMMC Health and Dental Plan Roll-out Schedule

In anticipation of the upcoming Martin Luther King holiday and related bank closure, CMS Plan will run payment batch on Wednesday, January 16th instead of Saturday, January 19th.  This batch will include claims fully adjudicated through January 16th.  There will be no change to the payment release schedule the week of January 21st.

The Florida Department of Health’s Children’s Medical Services Plan (CMS Plan) and Specialty Programs is proud to serve Florida’s population of children and youth with special health care needs (CYSHCN). Over the decades, CMS Plan has changed, adapted and grown, always with the goal of providing the best possible care for the children we serve.

The national landscape for health care delivery models continues to change. Florida is well positioned to implement a national model for serving CYSHCN within Medicaid and CHIP and through our Title V initiatives. Rumors have circulated that CMS Plan is “going away” or “closing.” Neither of these is true. While CMS Plan is again in a time of transition, we remain working for the health, safety and quality of life of the children and families we serve.

At this time, there are no immediate changes for providers in our network or for the families we serve. Families do not need to do anything differently, and credentialed providers are still able to see CMS Plan members. Please continue to visit our website for updates (www.CMSPlanFlorida.gov), and rest assured we will contact our members and provider network directly with any changes that will affect them.

Earn up to 1 hour of CME/CE!

Integration of Behavioral Health and Trauma-Informed Care in Patient Centered Medical Homes in the Context of Telepsychiatry
September 25, 2018, 1:00pm – 2:00pm

Presenter: Tommy Schechtman, MD, MSPH, FAAP

Details on the flyer.

CMS Plan SOURCE
(PDF, 810kB)

CMS Plan SOURCE, summer 2018 edition, includes information on the future of the CMS Plan, managing asthma care for CMS Plan members, behavioral health integration in primary care, and more.If you're a CMS Plan provider, you won't want to miss this one.

We need your input! Some CMS Plan providers received a survey by mail regarding their satisfaction with being a CMS Plan provider. Your response is very important as it helps shape the experience of and relationship with the CMS Plan for all providers. For your convenience, the Institute for Child Health Policy (ICHP) is mailing a second copy of the survey to your location. CMS Plan is very grateful for your participation.

Effective Tuesday, September 27, 2016, the Florida Department of Health revised Rule 64C-2.002 of the Florida Administrative Code. Changes include adding certain codes to the clinical eligibility screening from and adding additional options for physicians to utilize a medical review panel to determine clinical eligibility. The rule also clarifies that families may request a re-screening to determine clinical eligibility if clinical eligibility was not previously established. Go to our CMS Plan Physician Attestation Process document to learn more.

If you are a treating physician with questions about the attestation form or process, please call 1-855-901-5390.

Become a CMS Plan Provider 

The CMS Plan, and its panel of distinguished providers, has been dedicated to serving children with special healthcare needs and their families since 1929. We thank you for your interest in participating with the plan and invite you to begin the provider application process.

  • Join
  • Join Early Steps or Child Protection Team
  • Provider Relations Liaison

All CMS Plan providers must be credentialed and contracted with the Plan. To begin a new application process, please review the CMS Letter of Interest Requirements document for instructions.

Early Steps - Please contact you Local Early Steps Office in the county for which you would like to provide services.

Child Protection Team - Please contact Marceller Hines at the CPT State Office 1-850-558-9553.

If you need assistance with the credentialing or contracting process, please contact your local provider relations liaison.

Resources 

  • Credentialing Resources
  • Provider Resources & Handbooks
  • CMS Cultural Competency Plan
  • Prior Authorization and Claims Submission

To renew your contract for CMS Plan Title XIX or Title TXXI, please contact the provider relations liaison serving your area.

Cultural competency is one the main ingredients in providing quality health care to our children. It is the way families and providers can come together and talk about health concerns without cultural differences hindering the conversation. Visit the CMS Cultural Competency Plan to learn more.

The CMS Cultural Competency Plan includes provisions for language and communication. This could include language lines, translation services or TTY/TTD services.

According to Title III of the Americans with Disabilities Act (ADA), health care providers are required to provide interpreters for medical visits and other medical-related situations. To learn how health care providers can help meet their patients communication needs, please read the following information regarding ADA requirements.

CMS is contracted with MED3000, a division of McKesson, to serve as the Third Party Administrator to facilitate provider information, client information, service authorizations and claims payment. For more information, please go to MED3000 Enrollment, Authorizations, and Claims.

For questions and technical assistance, providers and CMS staff may contact MED3000 Customer Service at 1-800-664-0146. Families should contact their local CMS Area Office for assistance.

CMS Provider FAQs 

  • Why should I become a CMS provider?
  • How do I become a provider with CMS?
  • How does a provider bill for compensable services to CMS enrollees?
  • How do I submit claims for services rendered?
  • Where can I find a list of CMS approved providers?
At Children's Medical Services, we recognize that our providers are the foundation of the health care services we deliver. As a member of the CMS network, providers have the opportunity to work with the professionals committed to providing the highest quality services to children with special health care needs. Through our partnership with two Integrated Care Systems, Ped-I-Care, and the Community Care Plan (CCP), CMS recruits the most talented physicians and other health care providers to meet the needs children with special health care needs.

Provider enrollment in the CMS plan consists of a two-step process. First, a provider must be credentialed through the CMS Plan. Next, providers must be contracted through one of our two ICS partners. Ped-I-Care serves provider in the panhandle and central Florida counties, and the Community Care Plan (CCP) serves providers in the southern part of Florida.

Once a provider contracts with one of our two ICSs, their information will be registered in the CMS third party administrator data base (Med3000/McKesson). Providers will then have access to the provider portal, E-InfoSource, which gives the provider the ability to:

  • Verify enrollment;
  • Verify approval of prior authorization (when required); and,
  • Review the status of submitted claims.

Approved and registered CMS providers may submit claims electronically through one of the following two electronic Claims Clearinghouses:

  1. Emdeon
  2. Availity

Providers wishing to submit paper claims may do so by mailing claims to the following address:

CMS MMA Specialty Plan Title XIX
P. O. Box 981648
El Paso, TX 79998-1648

You may access a list of CMS approved providers by using our CMS Provider Locator.