COVID-19 news & updates
December 16, 2020
MCCFL is receiving information from many of the insurance plans regarding prior authorization processes and other updates related to COVID-19. We will continue to provide this information via email communication, however, for the most recent information, we are recommending you visit the health plan's website or call their provider line. We will also be placing the communications from the health plans that can be accessed by visiting https://client.mccfl.us/public/ under the tools and resources tab in the Coronavirus folder. As best practice we still suggest you initiate authorization process, prior to admission. Please note that unless specified, out of network status still applies to some of their requirements, please read carefully.
The CDC has made alternate directives with discharging back to group settings, it is important to be aware of these changes when dealing with the Managed Care Plans.
Below are the individual plan directives; please be sure to follow directions from your corporate teams.
Aetna
(This applies to ALL States)
Effective 12.14.2020 through January 11,2021 Aetna is temporarily making changes to the requirement for prior authorizations for post acute care facilities including SNF's. Initial pre-certification/prior authorization for admission to SNF is being waived for all Commercial and Medicare Advantage Plans. SNF's will be required to notify Aetna of the admission within 24 hours of admission either through Availity, or by calling Aetna directly. SNF's are also required to send medical records for concurrent review within three days of the initial admit. Medical records can be uploaded directly to Availity, or sent to Aetna by fax. Be sure to include patient name, and member ID on your fax cover sheet. Please note: there has been no clarification as to whether or not this applies to both in and out of network providers.

AvMed
(This applies to Florida ONLY)
No information regarding changes to prior authorization and SNF stays at this time. Auth is still required.

BayCare
(This applies to Florida ONLY)
BayCare Plus Medicare Advantage has temporarily waived the prior authorization requirement for admission to SNF, ARU, and LTACH levels of care. Baycare is requiring notification by the facility that the member is being admitted to and clinical documentation, supporting the reason for transfer. Baycare will follow normal concurrent review process and will continue to follow our members for discharge planning needs. Notification of admission can be submitted by phone or fax. Please note: this only applies to in-work providers, out of network providers should seek authorizations.

CarePlus
(This applies to Florida ONLY)
CarePlus states normal prior authorization requirements will resume August 16, 2020.

Cigna
Cigna will waive prior authorizations through December 31. 2020 for the transfer of its non-COVID-19 customers from acute inpatient hospitals to both in-network and out of network providers - LTACH's, SNF, and AR. In place of prior authorizations, Cigna will require notification from the post-acute care provider on the next business day following the transfer.

Florida Blue
(This applies to Florida ONLY)
Florida Blue Medicare, Commercial, and Affordable Care Act is waiving prior authorization requirements for patients being transferred from inpatient acute hospital settings to post-acute care facilities through January 31, 2021 for both commercial and Medicare lines of business. Please see the attached for further details on notification to the plan.

Freedom Health & Optimum HealthCare
(This applies to Florida ONLY)
Freedom as of July 5, 2020 will begin to require authorization for SNF placement.

Humana
Humana states normal prior authorization requirements will resume August 1, 2020.

Medica
Medica states normal prior authorization requirements will resume October 1, 2020
Medicaid - AHCA
(This applies to Florida ONLY)
The Agency has lifted prior authorization for certain critical services for all Medicaid recipients and has lifted prior authorization for all services if the recipient is diagnosed with COVID-19. Please refer to the guidance published by the Agency on March 18th for a list of service categories where the prior authorization requirement has been lifted.
Clarification: 5.8.2020
Prior Auths: on or after March 1, 2020 through the termination of the emergency declaration for at least 90 days and up to 180 days (up to the last day of the emergency period under Section 1135(e) of the Act), for beneficiaries with a permanent residence in the geographic area of the public health emergency declared by the Secretary.
PASRR Level 2 exceptions were only in place for 30 days from the date initiated.  
Update: 7.14.2020
To facilitate non-emergency transportation services that may be needed to aid in transfers, the Agency is waiving the need for prior authorization for non-emergency ambulance transportation services for hospital transfer. This change applies to the fee-for-service and managed care delivery system. These provisions apply to enrollees being transferred from a hospital regardless of diagnosis (i.e., COVID-19 and non-COVID-19 patients). The Agency will continue this flexibility until further notice.
Molina
Molina will continue to waive prior authorization for in and out of network providers, notification is required within 48 hours of admission.

Preferred Care Partners
Preferred Care Partners states normal prior authorization requirements will resume
June 1, 2020.
Simply
Simply will be following the Statewide Medicaid Managed Care Policy Transmittal and will waive service authorization requirements prior to admission for hospital and skilled nursing facility transfers. This applies when the receiving facility is a participating provider or nonparticipating provider. Simply will be requiring notification from the receiving facility and the skilled nursing facility of all such admissions within 48 hours of the admission, including weekends. 

Staywell Medicaid
(This applies to Florida ONLY)
Staywell as of July 9, 2020, Sunshine Health will no longer require service authorizations for hospital transfers for Medicaid patients. This applies when the receiving facility is a participating provider or non-participating provider. The receiving facility must notify the Sunshine Health of the admission within forty-eight (48) hours of the admission. 

Sunshine
Sunshine as of July 9, 2020, Sunshine Health will no longer require service authorizations for hospital transfers for Medicaid patients. This applies when the receiving facility is a participating provider or non-participating provider. The receiving facility must notify the Sunshine Health of the admission within forty-eight (48) hours of the admission. 

United Healthcare
United HealthCare states normal prior authorization requirements will resume August 16, 2020.

WellMed
WellMed states normal prior authorization requirements will resume August 1, 2020.
Please note: Things are changing daily do not hesitate to reach out to your liaison if you have questions.
A Message from our President:
Dear Valued Clients,

MCCFL is working diligently on updates as related to the Covid-19 Crisis. We are gathering updates from the health plans as they are released to be able to provide you with the most recent information. Please note these updates and changes are very fluid and can change daily. It is best practice for out of network providers to check with the health plan for each referral to determine their current processes as they could vary based on type of product and benefits. On March 25th, 2020, President Trump declared that a major disaster exists in the State of Florida. Florida Disaster Declaration This additional declaration will most likely change the way the managed care organizations operate and how they will apply their rules regarding network operations. We are anticipating updates from the plans regarding this declaration. Medicare Advantage plans do have special requirements they must follow when such situations arise, please follow this link to review. CMS March 10, 2020
MCCFL is here to assist you and your staff with any managed care needs or questions that arise. Please do not hesitate to reach out to your Managed Care Liaison or any of our staff. We wish you and yours the best in these uncertain times. 

Destiny Quinones, BSW
President 
COVID-19
All of these articles can be found on our portal at MCCFL under tools. We will keep you abreast of this as it pertains to Managed Care.
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