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
Update: 1.12.2021
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
(This applies to Florida ONLY)
Molina Medicaid 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
(This applies to Florida ONLY)
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, Staywell 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 back to normal prior authorization requirements will resume February 1, 2021.
WellMed
(This Florida and Texas)
WellMed states back to normal prior authorization requirements will resume
February 1, 2021.
