Medicaid Bundle per Florida

This course for licensing reflects Florida’s current SMMC 3.0 structure, which began February 1, 2025, and operates through nine Medicaid regions. Florida home health agencies are primarily governed by Chapter 400, Part III, Florida Statutes; Chapter 408, Part II; and Rules 59A-8 and 59A-35, Florida Administrative Code. AHCA State Laws and Rules⁠, Florida SMMC 3.0⁠

FLORIDA MEDICAID HOME HEALTH APPLICATION, POLICIES & MCO CONTRACTING ACCELERATOR

Eight-Week Coaching and Mentorship Program

Turn your Florida home health agency into a Medicaid-ready, compliance-focused organization prepared to pursue managed-care contracts and serve eligible clients.

This eight-week coaching and mentorship program walks Florida home health agency owners through the Medicaid provider application process, policy-and-procedure development, operational compliance, MCO credentialing, contracting, billing readiness, and referral development.

This program is designed for licensed or license-pending Florida home health agencies providing services such as:

• Skilled nursing
• Home health aide services
• Personal care
• Private-duty nursing
• Therapy services
• Medication assistance
• Respite and related in-home support services, when authorized

WHAT YOU WILL LEARN

• How Florida Medicaid enrollment differs from AHCA licensure
• How to determine which Medicaid services your agency is qualified to provide
• How to organize your Medicaid provider application
• Florida Medicaid screening, ownership and disclosure requirements
• How to prepare state-compliant policies and procedures
• How to identify the Medicaid plans operating in your counties
• How to apply for MCO credentialing and network participation
• How to develop a professional contracting capability statement
• How to respond when an MCO says its network is closed
• How to prepare for credentialing, audits and site visits
• How authorizations, documentation, billing and claims work together
• How to build referral relationships after contracting

WEEK 1 — FLORIDA HOME HEALTH AND MEDICAID READINESS

• Florida home health agency classifications
• Licensed home health agency versus nurse registry
• Skilled versus non-skilled service models
• Understanding AHCA’s role
• Medicaid enrollment versus Medicare certification
• Medicaid fee-for-service versus managed care
• Identifying your service area and Florida Medicaid regions
• Readiness assessment and deficiency review
• Creating your agency’s Medicaid contracting roadmap

Homework: Complete the Florida Medicaid Readiness Assessment.

WEEK 2 — BUSINESS, LICENSING AND PROVIDER FILE REVIEW

• Florida AHCA home health license review
• EIN, legal business name and ownership consistency
• National Provider Identifier and taxonomy review
• Service-location verification
• Administrator and Director of Nursing documentation
• Level 2 background screening
• Exclusion and sanction screening
• Liability and workers’ compensation insurance
• W-9, electronic funds transfer and banking documentation
• Ownership, controlling-interest and managing-employee disclosures
• Preparing your master credentialing folder

Homework: Assemble the required corporate and credentialing documents.

WEEK 3 — FLORIDA MEDICAID PROVIDER APPLICATION

• Selecting the appropriate provider type and specialty
• Florida Medicaid Web Portal overview
• Creating and managing portal access
• Completing ownership and disclosure sections
• Service address and pay-to-address requirements
• Submitting licenses, certifications and supporting documents
• Provider agreements and electronic signatures
• Fingerprinting and risk-based screening
• Tracking application status
• Correcting deficiencies within the required response period
• Revalidation, reactivation and change-of-information requirements
• Avoiding common application mistakes

Homework: Complete a guided Medicaid application preparation checklist.

WEEK 4 — FLORIDA POLICIES AND PROCEDURES

Participants receive an editable Florida-focused policy-and-procedure framework addressing:

• Admission and eligibility
• Patient rights and responsibilities
• Nondiscrimination and accessibility
• Service agreements
• Patient assessments
• Plans of care and treatment orders
• Skilled nursing services
• Home health aide and personal-care services
• Medication administration and self-administration assistance
• Nurse delegation
• Clinical records and record retention
• Documentation and late-entry standards
• Staff qualifications and personnel files
• Background screening
• Orientation and annual training
• Competency evaluations
• Supervision of employees and contractors
• Infection prevention and control
• Emergency management and continuity of operations
• Abuse, neglect and exploitation reporting
• Incident and adverse-event reporting
• Complaints and grievances
• HIPAA privacy and information security
• Quality assurance and performance improvement
• Utilization management
• Prior authorization
• Medicaid eligibility verification
• Billing and claims integrity
• Overpayments and refunds
• Fraud, waste and abuse prevention
• Exclusion screening
• Conflict of interest
• Marketing and solicitation
• Gifts and patient inducements
• Compliance investigations
• Corrective action
• Discharge and transfer
• Contracted personnel and vendor monitoring

Policies must be customized to the agency’s license, services, staffing model and payer requirements before adoption.

Homework: Customize assigned policies and identify operational gaps.

WEEK 5 — DOCUMENTATION, AUTHORIZATION AND BILLING READINESS

• Understanding medical necessity
• Verifying Medicaid eligibility before service delivery
• Obtaining and tracking authorizations
• Service plans, plans of care and physician orders
• Start-of-care documentation
• Visit notes and electronic visit verification
• Supervisory visits
• Missed-visit documentation
• Changes in patient condition
• Incident documentation
• Claims documentation checklist
• Units, dates, modifiers and authorized hours
• Clean-claim preparation
• Denial prevention and corrective action
• Preventing duplicate and unsupported billing
• Preparing records for post-payment review

Homework: Complete a mock patient-file and claims-readiness audit.

WEEK 6 — FLORIDA MCO CREDENTIALING AND CONTRACTING

• Understanding Florida Statewide Medicaid Managed Care
• Managed Medical Assistance and Long-Term Care programs
• Identifying plans by county and region
• Finding provider-network and contracting contacts
• Completing provider-interest forms
• CAQH and credentialing profile preparation, when requested
• Preparing your agency roster and service-location file
• Contracting capability statement
• Writing a network-participation request
• Demonstrating geographic and specialty need
• Addressing closed-network responses
• Following up without damaging the relationship
• Reviewing credentialing requests and deadlines
• Understanding that credentialing and contracting are separate decisions

Homework: Submit or prepare contracting packets for selected health plans.

WEEK 7 — CONTRACT REVIEW AND IMPLEMENTATION

• Reviewing covered services and service areas
• Fee schedules and reimbursement terms
• Authorization requirements
• Timely filing limits
• Clean-claim definitions
• Electronic visit verification requirements
• Claims reconsiderations and appeals
• Credentialing and recredentialing
• Record-access and audit clauses
• Overpayments and recoupments
• Insurance and indemnification provisions
• Termination and renewal language
• Subcontracting restrictions
• Provider-directory accuracy
• Escalating unresolved contracting issues
• Building a contract implementation checklist

Participants will learn how to identify contract provisions that should be reviewed by a qualified Florida healthcare attorney.

Homework: Complete the MCO Contract Review Worksheet.

WEEK 8 — REFERRALS, CLIENT ACQUISITION AND 90-DAY ACTION PLAN

• Building relationships with MCO care coordinators
• Hospital and rehabilitation discharge planners
• Aging and Disability Resource Centers
• Case managers and social workers
• Physicians and medical practices
• Assisted living and senior communities
• Veteran and disability organizations
• Community outreach without prohibited inducements
• Creating a professional referral packet
• Tracking leads, referrals and admissions
• Measuring referral-source performance
• Creating a 30-, 60- and 90-day contracting and census plan

Homework: Complete your 90-Day Medicaid Contracting and Referral Plan.

WHAT IS INCLUDED

• Eight weekly live group coaching sessions
• Florida Medicaid readiness assessment
• Medicaid application document checklist
• Florida policy-and-procedure framework
• Policy customization checklist
• Medicaid credentialing folder checklist
• MCO contracting tracker
• MCO contact-research worksheet
• Provider-interest email templates
• Closed-network reconsideration template
• Credentialing follow-up scripts
• Home health capability-statement template
• Contract review worksheet
• Patient-record audit tool
• Billing-readiness checklist
• Referral-source tracker
• 90-day implementation plan
• Session recordings
• Private mentorship support during the program
• One private application and contracting strategy session

BONUS MATERIALS

• Florida Home Health Compliance Calendar
• Employee Personnel File Checklist
• Patient Admission File Checklist
• Mock Survey Preparation Checklist
• Fraud, Waste and Abuse Training Outline
• MCO Contracting Email Bundle
• Care Coordinator Introduction Script
• Home Health Referral Packet Outline

RECOMMENDED TUITION

Program Tuition: $3,500

Payment Plan:

• Four payments of $950
• Total payment-plan price: $3,800

VIP Done-With-You Option: $5,500

The VIP option includes:

• Eight-week course and mentorship
• Two additional private strategy sessions
• Individual policy customization review
• Medicaid application document review
• Review of up to four MCO contracting packets
• Personalized credentialing deficiency checklist
• Customized 90-day contracting plan

WHO THIS PROGRAM IS FOR

• Florida home health agency owners
• License-pending agency owners preparing in advance
• Existing agencies adding Medicaid as a payer source
• Agencies struggling with incomplete Medicaid applications
• Agencies seeking managed-care contracts
• Healthcare entrepreneurs who need an organized compliance roadmap

ENROLLMENT REQUIREMENTS

Participants should have, or be actively working toward:

• A legally registered Florida business
• An EIN
• A Type 2 organizational NPI
• The appropriate Florida AHCA license
• A qualified administrator and clinical leadership, when required
• Required insurance and background screening
• A business email, telephone number and service location
• The ability to provide accurate ownership and controlling-interest information

IMPORTANT DISCLAIMER

This program provides education, coaching, templates and organizational assistance. It does not provide legal advice, accounting advice or official representation before AHCA, Florida Medicaid, Medicare or any managed-care organization.

Enrollment in this program does not guarantee AHCA licensure, Medicaid enrollment, credentialing, an MCO contract, a particular reimbursement rate, referrals or clients. Every application and contracting request remains subject to the requirements and independent decisions of the applicable government agency or health plan.

Templates must be reviewed and customized for the agency’s license type, services, staffing structure, accreditation status and contractual obligations. Participants should obtain legal or professional compliance review when appropriate.

CALL TO ACTION

Stop allowing confusing applications, incomplete policies and unanswered contracting requests to keep your agency from moving forward.

Join Coach Brown for eight weeks of step-by-step guidance, accountability and mentorship. Build your compliance foundation, organize your Medicaid application and confidently pursue Florida managed-care contracts.

Click “Enroll Now” to begin building your Florida Medicaid contracting roadmap.

Florida Medicaid says complete provider applications are generally processed within 60 days or less, while deficiencies must be corrected within the stated response period. That is a processing target—not a guarantee of approval. AHCA Provider Enrollment Readiness⁠

The course should also teach mentees to identify plans by their actual county and service because Florida’s 2025 SMMC redesign moved from eleven regions to nine regions, and not every plan or program operates identically everywhere. Florida’s New SMMC Regions⁠