Florida Medicaid Coronavirus/COVID-19 Health Care Alert

Medicaid Planning
March 24, 2020

Medicaid  Coverage of Services During the State of Emergency Related to COVID-19

The  Agency for Health Care Administration (Agency) is committed to ensuring that Medicaid  recipients diagnosed with the 2019 novel coronavirus (COVID-19) receive all  the care needed to address their symptoms. Florida Medicaid covers and  will cover all medically necessary services required to facilitate testing  and treatment of COVID-19.  The purpose of this alert is to provide  guidance on the flexibilities offered to providers furnishing services to  recipients impacted by COVID-19. This policy guidance applies to services  rendered through both the fee-for-service (FFS) delivery system and the  Statewide Medicaid Managed Care (SMMC) program. 

Here  is the list of modifications, effectively immediately, unless otherwise  specified. As the situation evolves, the Agency may make additional changes  to assist providers and to meet the needs of recipients. 

The Agency for Health Care Administration has created a website for all Florida COVID-19 Resources and Alerts as related to: call centers, coronavirus hotline, information about long-term care facilities and telemedicine, etc...

Prior Authorization Requirements 

In  order to reduce administrative burdens on key providers that are on the front  line serving the populations most impacted by COVID-19, Florida Medicaid is  waiving prior authorization requirements for medically necessary hospital  services, physician services, advanced practice registered nursing services,  physician assistant services, home health services, and durable medical  equipment and supplies. This will allow these provider types to redeploy  resources used to complete these functions, as needed. In addition to the  services listed above, Florida Medicaid is waiving prior authorization  requirements for all services (except pharmacy services) necessary to  appropriately evaluate and treat Medicaid recipients diagnosed with COVID-19.  Please refer to official diagnosis coding guidelines that have been published  by the Centers  for Disease Control (CDC)

Limits on Services 

     
  • Florida Medicaid will waive limits on services (specifically related to frequency, duration, and scope) that need to be exceeded in order to maintain the health and safety of recipients diagnosed with COVID-19 or when it is necessary to maintain a recipient safely in their home. Examples of services include: the 45-day hospital inpatient limit, home health services, durable medical equipment, in-home physician visits, etc. When service limits have been exceeded for recipients receiving services through the fee-for-service delivery system, providers must submit paper claims through the Agency’s exceptional claims process.
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  • Florida Medicaid lifted all limits on early prescription refills during the state of emergency for maintenance medications, except for controlled substances. The edits prohibiting early prescription refills will remain lifted until further notice by the Agency. This will assist recipients who may need to be  self-quarantined for a period of time.
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  • Florida Medicaid will reimburse for a 90-day supply of maintenance prescriptions when available at the pharmacy. The recipient must request that the pharmacy dispense a 90-day supply. In addition, Florida Medicaid is waiving any limits on mail order delivery of maintenance prescriptions. Florida Medicaid will also pay for a 90-day supply of maintenance prescriptions through mail order delivery.
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Co-Payments

Florida  Medicaid is waiving co-payment requirements for all services.

Health Plan Appeals and Fair Hearings

If  needed, recipients impacted by COVID-19 may be given more time to submit an appeal through their health plan or request a fair hearing. In addition, the  Agency has sought federal approval to temporarily delay scheduling of  Medicaid fair hearings and issuing fair hearing decisions during the  emergency period if there are workforce shortages. The Agency would limit use  of this flexibility to those instances where the recipient is continuing to receive services pending the outcome of the fair hearing.

Preadmission Screening and Resident Reviews

All Preadmission Screening and Resident Review (PASRR) processes may be postponed until further notice by the Agency.

     
  • Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.
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Provider Enrollment 

Florida  Medicaid will pay for medically necessary services provided to recipients  diagnosed with COVID-19, regardless of whether the provider is located  in-state or out-of-state. To be reimbursed for services rendered to eligible  Florida Medicaid recipients, providers not already enrolled in Florida  Medicaid (out-of-state or in-state) must complete a provisional (temporary)  enrollment application. The process for provisional provider enrollment will  be located at http://www.mymedicaid-florida.com  by Thursday, March 19, 2020. In the event of workforce shortages in the State,  practitioners that are not already enrolled in Florida can seek enrollment  following the instructions above.

Face-to-Face Provider Site Visits 

In  order to reduce community-spread of the virus, the Agency (and its Medicaid  health plans) will be postponing face-to-face provider-site visit  requirements (e.g., enrollment, credentialing, etc.) until further notice.  Whenever possible, these requirements will be met telephonically or through  audio/visual technology.

Federal Authorities 

The Centers for Medicare and Medicaid Services has issued a set  of blanket waivers that states may utilize in response to COVID-19. The  Agency has already received authority for many of these waivers related to  health care facilities and licensure requirements. The Agency is actively  working to receive the federal authority needed for many of the items listed  in this alert related to the Medicaid program. For a full list of the blanket  waivers issued by CMS, click on this link: https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf

The Agency will be issuing subsequent guidance related to  additional flexibilities or service enhancements that will be enacted to  ensure there is no disruption in care for Medicaid recipients in the event of  workforce shortages or limitations in recipients seeking care in provider  offices (e.g., telemedicine, expanding the participant directed option in the  Long-Term Care program, etc.).

Additional Resources

COVID-19 / Coronavirus Tips from the Department of Health