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Coronavirus and Medicare/Medicaid

Medicare and Medicaid Resources

AHCA has set up a link to all Medicaid Provider and managed care organization guidance letters.  This site is updated as new alerts are posted here .

Prior authorizations and maintenance prescriptions: In order to reduce administrative burdens on key providers, 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. 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.  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 and managed care plans will pay for a 90-day supply of maintenance prescriptions through mail order delivery. To view the Florida Medicaid Health Care Alert click hereTo view the Statewide Medicaid Managed Care (SMMC) Policy Transmittal: 2020-15 click here .

Telemedicine Guidance

Florida Medicaid has expanded telemedicine/telehealth services in the fee- for- service delivery system for physicians, APRNs, physician assistants as well as for physical therapy, occupational therapy and speech therapyThis includes evaluation, diagnostic, and treatment services as long as the services can be delivered in a manner that is consistent with the standard of care. In addition, Florida Medicaid has expanded telemedicine coverage to:

  • Behavior analysis services
  • Specified behavioral health services
  • Early intervention services

On March 16, 2020, Florida was the first state to be granted a waiver under Section 1135. We expect that Florida Medicaid will provide further guidance on implementation of the waivers in the next few days. The waivers and modifications take effect on March 15, with a retroactive effective date of March 1, 2020.  The waiver deals with 4 key areas:

  • Provider participation
  • Waiver of Service Prior Authorization (PA) Requirements.
  • Waiver for Pre-Admission Screening and Annual Resident Review (PASRR) Level I Level II Assessments for 30 Days.
  • Waiver to allow evacuating facilities to provide services in alternative settings, such as a temporary shelter when a provider’s facility is inaccessible.
  • State fair hearing requests and appeal deadlines.

For more information on the waiver click here .


Fact Sheets

Coverage and Payment Related to COVID-19 Medicare- 3/5/20

COVID-19 Frequently Asked Questions for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies - 3/12/20


Medicare Telehealth Frequently Asked Questions (FAQs)- 3/17/20

New! Center for Connected Health Policy/Public Health Institute: Telehealth Coverage Policies in the Time of COVID-19 - 4/6/20


Press Releases and Alerts

CMS Issues Guidance to help Medicare Advantage and Part D Plans Respond to COVID-19 3/10/20

Letter to all Medicare Advantage Organizations, Part D Sponsors, and Medicare-Medicaid Plans - 3/10/20

Florida Medicaid Coverage of Services During the State of Emergency Related to COVID-19 - 3/16/20

President Trump Expands Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak - 3/17/20

CMS Approves First State Request for 1135 Medicaid Waiver in Florida - 3/17/20

AHCA COVID-19 Alerts (including Medicaid and Telemedicine Alerts)

Statewide Medicaid Managed Care Policy Transmittal, Re: COVID-19Telemedicine Services

Update: Telemedicine Guidance for Early Intervention Services - 4/27/20

AHCA: Additional Prior Authorization and Claims Payment Requirements for Providers Rendering Services in the Statewide Medicaid Managed Care Program - 4/29/20

New! COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers - 5/11/2020
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