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COVID-19 Medicaid Information

Medicaid Alerts

Category/Topic Brief Description of Changes During the State of Emergency Links to Full Document
Prior Authorization
  • Waive prior authorization requirements for hospital services (including long-term care hospitals), physician services, advanced practice registered nursing services, home health services, nursing facility services, and durable medical equipment and supplies
  • Waive prior authorization requirements for all services necessary to appropriately evaluate and treat Medicaid recipients diagnosed with COVID-19
  • Prohibits plans from applying prepayment and postpayment reviews on claims for services in which prior authorization requirements have been waived during the state of emergency
  • Prohibits plans from implementing prepayment and post-payment claims reviews for services in which prior authorization requirements have been waived, unless certain criteria are met
  • Waive prior authorization requirements for behavioral health services
  • Continuation of Authorization for Behavior Analysis Services
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Health Plan Policy Transmittal 2020-24
Additional Prior Authorization and Claims Payment Requirements Alert
Continued Provider Flexibilities Alert
Additional Behavioral Health Services Flexibilities Alert
Behavior Analysis Continuation of Authorization Alert
Co-Payments
  • Waive all co-payment requirements
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Continued Provider Flexibilities Alert
COVID-19 Testing and Codes
  • Add coverage of the COVID-19 lab test codes
  • COVID-19 diagnosis code guidance
  • Added coverage of the COVID-19 rapid lab test and anti-body test.
Laboratory Testing Alert
Medicaid Coverage of Coronavirus Testing Alert
Rapid Lab Test and Anti-body Test Provider Alert
Exceed Service Limits/Expand Coverage
  • Exceed service limits 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 (inpatient, home health, etc.)
  • Allow early refills of maintenance medication (excludes controlled substances)
  • Eliminate restrictions on the use of mail order delivery of maintenance medications
  • Allow recipients to request a 90-day supply of medications when that quantity is available at the pharmacy; recipients can also request a 90-day supply of their medications be delivered through mail order.
  • Waive frequency and duration service limits for behavioral health services
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Coronavirus Diagnosis Codes and
Health Plan Policy Transmittal 2020-26
Continued Provider Flexibilities Alert
Additional Behavioral Health Services Flexibilities Alert
Telemedicine
  • Expand telemedicine/telehealth services in the fee-for-service delivery system (remote patient monitoring, store and forward) for physicians, APRNs, physician assistants
  • Expand telemedicine coverage to:
    • behavior analysis services
    • therapy services
    • specified behavioral health services
    • early intervention services
  • Additional guidance to BA providers related to telemedicine services
  • Implements payment parity for services delivered via telemedicine (audio and video) in the SMMC program
  • Establishes requirements for telephone-only communications
  • Well-child visits provided via telemedicine during COVID-19 State of Emergency
Medical/Behavioral Health Telemedicine Alert
Behavior Analysis Telemedicine Alert
Therapy/Early Intervention Services Telemedicine Alert
Updated: COVID-19: Telemedicine Guidance for Behavior Analysis Services
Health Plan Policy Transmittal 2020-20
Telemedicine Flexibilities for Behavioral Health Providers Alert
Health Plan Policy Transmittal 2020-25
Updated Telemedicine Guidance for Early Intervention Services
Well-Child Visit Telemedicine Alert
Provider Enrollment Flexibilities
  • Enact provisional enrollment to quickly enroll providers currently enrolled in Medicaid
  • Waive requirement that Medicaid providers be licensed in-state
  • Extend provider enrollment revalidation
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Provider Revalidation Extension Alert
Continued Provider Flexibilities Alert
Site Visits
  • Postpone on-site or face-to-face provider site visits (including enrollment/credentialing requirements)
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Continued Provider Flexibilities Alert
Fair Hearings
  • Allow enrollees more time to request a fair hearing or health plan appeals
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Continued Provider Flexibilities Alert
PASRR
  • Postpone Preadmission Screening and Resident Review (PASRR) Level I and PASRR Level II activities
Provider Flexibilities Alert
Continued Provider Flexibilities Alert
Long-Term Care and other Home and Community-Based Waiver Flexibilities
  • Expanded provider qualifications for LTC services to allow additional providers to render services when there are workforce shortages, location closures, etc.
  • Implement advanced payments (“retention payments”) for certain individual budgeting (iBudget) waiver providers - adult day training, life skills development, person supports, and residential habilitation.
  • Provides additional guidance and direction related to the iBudget provider payment flexibility process
  • Provides additional time for Nursing Facilities and Intermediate Care Facilities to pay Quality Assessment Fees
  • Extended deadline for requesting iBudget Waiver advanced payment requests
Health Plan Policy Transmittal 2020-15
Health Plan Policy Transmittal 2020-16
iBudget Provider Payment Relief
iBudget Provider Payment Flexibility Process
NH/ICF Quality Assessment Extension Alert
iBudget Extended Deadline for May 2020 Alert
LTC Adult Day Care Provider Retainer Payments
Eligibility
  • Extending Medicaid recipient eligibility and extending time to complete application process
Recipient Eligiblity Alert
Other
  • Authorizing Prescribed Pediatric Extended Care (PPEC) centers to deliver services to Florida Medicaid recipients in the home setting
  • Waive certain electronic visit verification requirements for home health services (only)
  • Allow payment flexibility for ambulance providers when transporting individuals requiring isolation precautions related to COVID-19
  • Medicaid Interim Rate Request Threshold Change for ICF providers
  • Reminder: Providers Cannot Charge Florida Medicaid Recipients for Personal Protective Equipment
PPEC Alert
EVV Alert
Payment Flexibility for Ambulance Drivers Alert
Interim Rate Request Threshold Alert
Recipients Not Charged for PPE Alert

Medicaid Frequently Asked Questions

SMMC LTC Adult Day Care Provider Retainer Payment Request

SMMC LTC adult day care providers experiencing financial hardship due to COVID-19 may submit a request for a retainer payment using the Adult Day Care Provider Retainer Payment Request Form.

Medicaid - Developmental Disabilities Individual Budgeting Waiver Advanced Payment Request - May 2020

Providers of residential habilitation, life skills development level 1 (companion) and level 3 (adult day training), and personal supports experiencing financial hardship due to COVID-19 may submit a request for an advanced payment for the month of May using the Developmental Disabilities iBudget Advanced Payment Request Form.