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COVID-19 Medicaid Information

Important Information for All Medicaid Providers – Act Now!
Federal HHS has announced Phase 3 for General Distributions from the CARES Act Provider Relief Fund.

Addtional federal COVID-19 relief funding is now available for Medicaid and CHIP providers. Federal HHS has established a Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue. This will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider is expected to be at least 2 percent of reported gross revenue from patient care. Restrictions apply, and providers should carefully read the posted materials.

  • Applications for Phase 3 funds will be accepted beginning October 5, 2020
  • The deadline for Phase 3 applications is November 6, 2020
  • Please visit the CARES Act Provider Relief Fund page for additional 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
  • Reinstatement of prior authorization for non-behavioral health services on June 19, 2020
  • Updated Waiver of Prior Authorization Requirements for Hospital Transfers
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
Reinstatement of Prior Authorization Alert
Continued Flexibilities Alert - 7/1/2020
Update: Waiver of Prior Authorization Requirements for Hospital Transfers Alert - 7/14/2020
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 antibody test
  • Additional guidance on coverage of COVID-19 antibody testing
Laboratory Testing Alert
Medicaid Coverage of Coronavirus Testing Alert
Rapid Lab Test and Antibody Test Provider Alert
Additional Guidance on Antibody Testing 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
Continued Flexibilities Alert - 7/1/2020
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
  • Restart of Medicaid provider enrollment revalidation process
Provider Flexibilities Alert
Health Plan Policy Transmittal 2020-15
Provider Revalidation Extension Alert
Continued Provider Flexibilities Alert
Continued Flexibilities Alert - 7/1/2020
Medicaid Provider Enrollment Revalidation Process Restart Alert, 10/5/2020
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
Continued Flexibilities Alert - 7/1/2020
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
Continued Flexibilities Alert - 7/1/2020
PASRR
  • Postpone Preadmission Screening and Resident Review (PASRR) Level I and PASRR Level II activities
Provider Flexibilities Alert
Continued Provider Flexibilities Alert
Continued Flexibilities Alert - 7/1/2020
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
  • CMS guidance limiting the provision of retainer payments to no more than three 30-day periods
  • Reduction in number of calendar days recipient must be present for iBudget Residential Habilitation Service providers to bill at the monthly rate for services.
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
iBudget Provider Retainer Payment – July 2020 Alert
HCBS Provider Retainer Payment Limitatons Alert
iBudget Residential Habilitation Services Alert
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