2019 Member Newsletter

Welcome This is a newsletter from your health plan, Magellan Complete Care. It has important information about getting and staying healthy.

We’re here for you!

If you have any questions about your health plan—call us! Magellan Complete Care’s telephone numbers are toll-free. You can call 24/7. We can answer your questions in any language. We can also help you if you have trouble hearing or seeing.

You can also get answers on our member website. Just visit MCCofFL.com to learn more.

Our 24/7 Nurse Line

We have nurses available 24/7 to help with non-emergency health questions. These services are free. Call us at 1-800-327-8613 (TTY 711).

Need help with housing? Magellan Complete Care is proud to announce that we are offering a Health Outcomes through Meaningful Engagement (H.O.M.E.) program to help you meet your housing needs.

If you are homeless or at-risk of becoming homeless, our H.O.M.E. program will work with you to: » Take care of your health through housing supports » Connect you with services in your community » Connect you to housing resources so you can get and/or keep housing

Magellan Complete Care’s H.O.M.E. program is available for members in these six counties: Pasco, Pinellas, Orange, Osceola, Seminole and Brevard.

For more information, please call Customer Service at 1-800-327-8613 (TTY 711).

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Your member online tools and resources There are lots of tools and resources available to you at MCCofFL.com.

Online you can:• Find local resources• Get health and wellness info• View drug recalls• Request an ID card• Complete health assessments • Find out how to file appeals and grievances• Learn about covered and non-covered

services• Find information about open enrollment,

expanded benefits, advance directives and more!

You also have access to your member handbook online

If you have any questions or would rather have a copy of the member handbook mailed to you, call us at 1-800-327-8613 (TTY 711).

Other important information online

• Your rights and responsibilities—tells you what you can expect from us and what we will expect from you.

• The Florida Patient’s Bill of Rights and Responsibilities. Your doctors have a copy of this in their office.

• Notice of Privacy Practices—tells you how medical information about you may be used, disclosed and how you can get access to this information.

Health begins hereGood health begins with good information. Take a Health assessment so you can get a complete view of your health.

A Health Assessment is a questionnaire that will ask about your life choices and behaviors. It will also help us to get a better understanding of the type of care that you or your child needs. We want to help you feel better and enjoy a healthy life. Your answers will also give us an overall picture of your health and let us know how you are feeling, so we can help you to get better health.

You can complete the Health Assessment: » Online » By mail » By calling Customer Service

While the Health Assessment is not used to diagnose a health problem, it will help to show how your choices and behaviors affect your health. Health Assessments will also give you the information and tools that you need to help you lower your health risks.

You will get a Health Risk Assessment Summary of your health status. It will also include specific helpful information about your health. The Health Risk Assessment Summary will be available for print when you complete your assessment online. We can also mail it to you. Please complete your assessment online by visiting MCCofFL.com. Once you’re on the For Members tab, click on the Member materials and tools drop down menu and select Complete health assessment.

You can also contact our Customer Service number at 1-800-327-8613 (TTY 711) Monday – Friday 8 a.m. – 7 p.m. Eastern time if you have any questions or need help completing the health assessment.

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Don’t forget to renew your benefits! It’s important to renew your benefits so you don’t miss out on needed services.

We will call you 60 days before your renewal date. Your renewal date comes from the Agency for Health Care Administration, the Florida Medicaid Agency.

Medicaid benefit renewals are done through The Department of Children and Families. You can renew: » Online at www.MyFLfamilies.com » By phone at 866-762-2237

We can walk you through the steps to help you renew your benefits online. If you have any questions about renewing your Medicaid benefits, please call Magellan Complete Care at 1-800-327-8613 (TTY 711).

Public transit bus pass programWe are happy to announce that Magellan Complete Care is offering a public transit bus pass program to our members. This program is available in Duval County, Pinellas County and Orange County.

Need a bus pass for an appointment? Call the reservation line at 1-800-424-8268 at least 5 business days before a scheduled appointment to request a bus pass. Your bus pass will be sent to you in the mail. For more information about our bus pass program, please visit the member website at MCCofFL.com.

Disease management programs We have disease management programs that will help you care for your ongoing illness.

Some of the programs we offer are:• Asthma• Hypertension• Diabetes• Cancer

Your Member Handbook has information on how to opt in or out of the program.

To enroll or find out more visit MCCofFL.com or call Customer Service at 1-800-327-8613 (TTY 711).

Healthy behaviorsWe have programs to help you reach your health goals.

Our Healthy Behaviors program offers you rewards if you join a program and complete the goals. These programs can help you: • Quit smoking or other tobacco products • Get to a healthy weight • With any drug or substance misuse problem

If you join and meet certain goals you can earn gift cards.

The choice is yours to be a part of the program. Your care coordination team will work with you and your doctors to help you stay on track.

To learn more about the Healthy Behaviors program, please call our Customer Service department at 1-800-327-8613 (TTY 711).

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Get the care you need Sometimes, you might not be able to get a service from a provider in the Magellan Complete Care network. If this happens we will cover these services by an out-of-network provider in a timely manner.

These out-of-network services will be covered as long as Magellan Complete Care does not have a provider in-network to give you the services.

Our pledge about decisions and rewardsMagellan Complete Care gives a statement to all members, doctors, and employees who make utilization management (UM) decisions making sure that: » Utilization Management decision making is based on appropriate care, service and coverage » Doctors and other individuals are not rewarded for not giving service or care to members » Utilization Management decision makers (doctors, professionals, and employees) do not receive

money or other gifts to encourage decisions that result in under usage

If you have any questions, please call us at 1-800-327-8613 (TTY 711).

How to contact the department that makes decisions about services and authorizations As a member, you have the right to contact the Utilization Management department.

The Utilization Management department is the team that makes decisions about things like medical needs for healthcare services and authorizations. To find information about services that need an authorization, please visit MCCofFL.com.

If you have questions or concerns for the Utilization Management department, please call 1-800-327-8613 (TTY 711).

Second medical opinionYou have the right to a second medical opinion. If Magellan Complete Care cannot provide for a second opinion from an in network provider, arrangements can be made for a second opinion outside of the network.

Please call our Health Services department at 1-800-327-8613 (TTY 711) for prior authorization requests.

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Your pharmacy benefitsMagellan Complete Care covers most drugs. This includes injections. Drugs on the Preferred Drug List (PDL) do not need authorization. Your doctor has to authorize drugs that are not on the list.

Drug exceptions

If your doctor feels that you need a medicine that is not on the list of drugs we will pay for, you may request a Drug Exception. You may get an exception if you:• Are allergic to the other drug options on the

list• Tried the approved drug(s) and they did not

work• Cannot take the approved drug

If you have any questions, please call us at 1-800-327-8613 (TTY 711). You can also have your doctor call us to ask for an exception.

Specialty medications

Magellan Complete Care works with Magellan Rx Specialty pharmacy to make it easy for you to quickly get your specialty medicine. These medicines often need special storage or handling.

This specialty pharmacy will help you by providing written information about your condition and medicine. You get free delivery of your medicine to your home or another address. Nurses are there to answer your questions.

You can call the specialty pharmacy at 1-866-554-2673 (TTY 711) or register online. If you do not want to use Magellan Rx Specialty pharmacy, you can and let them know.

Pharmacy search tool

Magellan Complete Care has a pharmacy search tool. Use this tool to find any pharmacy in our network that is nearest to you.

Over-the-counter drug and supply benefits

You can get your over the counter medicines and supplies as part of your benefits.

All covered over-the-counter items are either:• A medicine• An ointment or spray• Used for treatment of a condition with active

medical ingredients.

Covered first aid supplies include:• Bandages• Dressings• Non-sport tapes

About the program:• Your benefit is $25 per month• Your over-the-counter funds do not carry over

to the next month• Your order total cannot go over your benefit

amount• We cannot accept payment if you want to

buy items once you have used your monthly benefit

You can order three ways:• Online • By phone at 1-888-628-2770 (TTY 711) 9 a.m.

to 5 p.m. Eastern Time, Monday through Friday.• By mail

- Clearly write your name, address, telephone number and member ID number in the space at the top of the form.

- Enter the amount of items that you want on the order form. The total must add up to your benefit amount or less.

- Fold this form and put it in an envelope. Place a first class postage stamp on the envelope and send it to:

OTC Health Solutions9675 NW 117th Avenue, Suite 202Miami, FL 33178

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Your pharmacy benefits continued

Call 1-888-628-2770 (TTY 711) for list of stores or visit www.cvs.com/otchs/magellanfl.

Please call us at 1-800-327-8613 (TTY 711) if you have questions about your pharmacy benefits. You can find more information about your benefits at MCCofFL.com.

Women have easy access to preventive healthcare services Magellan Complete Care lets women have easy access to in-network women’s health specialists for covered routine and preventive health care services.

You don’t need a referral from your primary care doctor for your yearly visit to an OB/GYN who is in the Magellan Complete Care network. Preventive healthcare services include:

Services Age group How often

Breast Cancer Screening Women ages 50 – 74 Every 3 years

Cervical Cancer Screening Women ages 21 – 64 Every 3 years

Cervical Cytology/Human Papillomavirus (HPV) Co-testing

Women ages 30 – 64 Every 5 years

Chlamydia Screening Women ages 16 – 24 who are sexually active

Every year

Ambulatory or Preventive Health Ages 20 and up Every year

If you have any questions, you can call us at 1-800-327-8613 (TTY 711).

Direct access to specialistsMagellan Complete Care lets members have direct access to specialists to help meet their special healthcare needs. This means that you can get many services without a referral from your primary care provider (PCP). Your PCP does not need to set up or approve these types of services for you.

You can also view our provider directory to search for a specialist or doctor on MCCofFL.com. Our provider network includes hospitals, doctors, specialists, urgent care facilities, home health, durable medical equipment providers, and other types of providers.

If you have any questions about how you can get direct access to specialists, or would like to get a printed copy of the provider directory mailed to you, please call us at 1-800-327-8613 (TTY 711).

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Magellan Complete Care of Florida’s Quality Improvement programOur Quality Improvement (QI) program is always looking for ways to give better care and services to our members.

We want to connect you with helpful programs and activities that are available to you. Please call us at 1-800-327-8613 (TTY 711) to update your contact information and learn more about our programs.

Here’s a look at some of our current activities:

• Keeping members healthy by connecting new members to our Healthy Behaviors program• Encouraging members to get preventive health screenings such as; mammograms, pap smears, eye

exams for those who have diabetes, and regular immunizations• Improving management of members with multiple chronic illnesses

Areas we’ve worked on in 2018:

These baselines were gathered and created for year to year comparison:• New members who receive Health Risk Assessments within first 60 days• Members who have an annual visit with their primary care doctor• Members who receive case management services for coordination of care • Quality of care reviews about our doctors • Adult members who report high satisfaction with Magellan Complete Care

Areas we’re working on in 2019:

• Reviewing and making our patient safety program better• Continuing to access doctor availability, especially specialists, by collecting data for tracking and

trending• Educating doctors on why it’s important to schedule visits within a certain number of days for sick

care, emergency care, primary care, initial prenatal care and initial family planning• Educating members and doctors about the services we provide • Learning how to get better member experiences through satisfaction surveys

For more information, please call the Quality Department at 1-800-327-8613 (TTY 711).

Have you completed the CAHPS survey?In the Spring of 2020, you may get a survey called the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. This survey will ask you to rate your experience with Magellan Complete Care and your healthcare providers. Please complete the survey. Your feedback will help us to give you better quality of care and services.

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Medicaid Fair HearingIf you do not agree with Magellan Complete Care’s decision, you can ask for a Medicaid Fair Hearing.

You do need to go through Magellan Complete Care’s appeal process before you ask for a fair hearing. You can ask for a fair hearing by calling or writing. You can ask for a fair hearing any time up to 120 days after you get our decision on your appeal. You may ask for a fair hearing by calling 1-850-488-1429 or writing to:

Agency for Health Care AdministrationMedicaid Hearing UnitP.O Box 60127Ft. Myers, FL 33906877-254-1055 (toll-free)239-338-2642 (fax)MedicaidHearingUnit@ahca.myflorida.com

Your provider can ask for a fair hearing for you, but you must give your written approval to the provider.

Complex Case Management Living with health problems and managing them can be hard. Magellan Complete Care has programs that can help.

Magellan Complete Care has a Complex Case Management program for members with difficult health problems who need extra help with their health care needs. The Complex Case Management program allows you to work with a nurse care manager. The nurse care manager can help you learn more about your health problems. He or she can teach you how to better manage them.

The nurse care manager will work with you and your doctors to create a care plan that will get you the care you need.

There are many ways you can be referred to the Complex Case Management program. One way to be referred is by your provider. You can also ask to be in the program by calling Customer Service at 1-800-327-8613 (TTY 711).

You can choose to join the program if you would like to. It is offered at no cost to you. You can choose to be removed from the program at any time.

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Peer support benefitDid you know that peer support may be a part of your health benefits?

At Magellan Complete Care, peer support is offered by Recovery Support Navigators. A Recovery Support Navigator is a person like you, who once needed help for their mental & physical health and substance use needs. They have learned how to deal with these needs to get better.

They can:• Offer hope and support to help you stay focused.• Help you meet other people who are also working toward similar health goals.• Meet with you in your home or in the community and can offer support on the phone.

MEMBERS WHO HAVE RECEIVED THIS SERVICE HAVE SAID:

“I’m really proud of myself. I feel like I got my life back.”

“I feel so much better and in control of my life.”

If you are interested in working with a Recovery Support Navigator or would like more information, please contact your care manager or call customer service at 1-800-327-8613 (TTY 711).

Mother Baby Connections Incentive Program Our Mother Baby Connections program helps pregnant members stay healthy throughout their pregnancy. This program gives rewards to pregnant Magellan Complete Care members for joining and taking care of their health during their pregnancy.

Taking care of yourself and your baby is important. Our goal is to help mother and baby have a healthy pregnancy and delivery.

As part of this program: » We will be there for you during and after

your pregnancy » We will help you make and get to your

checkups » We will help you access all of your benefits

» You will have access to education and community resources

» You will have a care coordination team to meet your needs

» You will have access to our 24/7 nurse and crisis line

To join or learn more about the Mother Baby Connections program, please call our Customer Service department at 1-800-327-8613 (TTY 711).

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Find your primary care provider A key step to getting and staying healthy is finding a primary care provider (PCP). Once you have found your primary care doctor, it is important to set up an appointment with them.

It is important for you to see your doctor at least once a year. If you are a new member, we want to help make sure that you visit your PCP within the first 90 days of enrollment with us.

Need to find or look for a new primary care provider? You can search for a provider on our website at MCCofFL.com. Once you’re on our website, click the For Members tab. Then click on the Find, view or change providers drop down menu. Click on the Provider and pharmacy search to find a provider near you or view and print a Provider Directory.

We can help you find a provider if you need help or do not have a computer. If you already have a doctor, we can help you set up your appointment. You can also call us if you have any questions. Please call us at 1-800-327-8613 (TTY 711). We can also send you a printed copy of the Provider Directory if you need it.

Well child visitsMagellan Complete Care gives coverage for well visits and shots for youth up to the age of 20. There is no cost to our members for using this service.

Your primary care doctor (PCP) helps you/ your children to keep good health. Setting and showing up for these well child visits are as important as going in to see the doctor when you are sick. In fact, there are many conditions that you can take charge of before they lead to symptoms or more serious health problems when they are found early. Your PCP is:• Your partner in getting good health• Someone to build a trusting health

relationship with—because you matter!

Once you/your child has gone in for a well visit, it can be easier and quicker to get another appointment when you need it. Please make an appointment with the primary care doctor as soon as you can for you or your child. These visits include screening, education and other services to keep you/your child healthy. If you have questions or need help making an appointment, please call us at 1-800-327-8613 (TTY 711).

Preventive care is important!It can be hard to get to the doctor—especially when you’re not sick!

Immunizations and screenings like mammography or a pap test may fall at the bottom of your list of things to do. If you do not take care of yourself in time, you may end up in long lines at the emergency room.

Magellan Complete Care believes preventive care is an important part of healthy living. There are no copays or fees to see the doctor, even when you are not sick. We can help you set up your appointments at a time that is best for you. If you have any questions or need help finding a doctor, please call us at 1-800-327-8613 (TTY 711). You can also search for a doctor online at MCCofFL.com.

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Get your Hepatitis A vaccine! Our goal is to help you get the care that you need so you can live a longer and healthier life. Since 2018, there have been more than 22,000 cases of Hepatitis A in the U.S. and over 2,500 cases in Florida.

The Florida Department of Health (FDOH) sent a Hepatitis A health advisory. This notice gave information to help everyone know more about the virus. It also talked about getting a vaccine to keep you from catching the virus. Since there are many people being affected by Hepatitis A, Magellan Complete Care is offering temporary coverage of Hepatitis A vaccines without prior authorization.

If you are a Magellan Complete Care member aged 21 or older, please see your primary care doctor for more information on how you can get the vaccine. Or call Customer Service for more information at 800-327-8613 (TTY 711).

On To Better HealthOn To Better Health is an online resource and self help tool to help you get and feel better.

On To Better Health helps you: • Identify your needs—by answering a few questions, a personal health plan is created just for you• Get help through digital cognitive behavioral therapy for common challenges such as: insomnia,

depression, anxiety, obsessions or compulsions, alcohol or substance use and ongoing pain• Read helpful tips and articles based on your interests and health needs

It’s easy to get started! To access the programs: Go to ontobetterhealth.com/mccfl

Magellan Complete Care of Florida complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Magellan Complete Care cumple con las leyes federales de derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad o sexo.

This information is available for free in other languages and formats. Please contact our customer service number at 1-800-327-8613 (TTY 711) between 8 a.m. and 7 p.m. Eastern Time, Monday – Friday.

Esta información está disponible de forma gratuita en otros idiomas y formatos. Comuníquese con nuestro número de servicio al cliente al 1-800-327-8613 (TTY 711) entre las 8 a.m. y las 7 p.m. Hora Del Este, de lunes a viernes.

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