PHC Florida

Robert Heglar
AHF Provider

Continuity of Care Requirements

A key goal of the Statewide Medicaid Managed Care (SMMC) program is ensuring that recipients experience continuity of care, meaning that recipients experience no break in services or care coordination while transitioning from one service delivery system to another, one health plan to another, or from one service provider to another.  The following is a reminder of the protections that apply for any Medicaid recipient and PHC Members who changes health plans:

  • Health care providers should not cancel appointments with current patients.  PHC Florida will honor any ongoing treatment that was authorized or scheduled prior to the recipient’s enrollment into PHC Florida for up to 90 days after the recipient enrolls with the plan.
  • 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. PHC Florida will pay providers for previously authorized services for up to 90 days, and must pay non-network providers at the rate previously received for up to 90 days.
  • Prescriptions will be honored. PHC Florida will allow recipients to continue to receive their prescriptions through their current provider, for up to 90 days, until their prescriptions can be transferred to a provider in the PHC Florida’s network.

For more information on continuity of care requirements in SMMC, please visit the Agency for Health Care Administration website or you may contact PHC Florida’s Utilization Management Department at (866) 990-9322.   If you have a complaint about SMMC, please contact a Medicaid representative at (877) 254-1055.