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Important Links

Provider Payment Provisions Page: Click Here
 
COVID-19 Provisional Provider Enrollment:
Florida Medicaid Web Portal

Alerts from AHCA:

AHCA Alerts

FLMMS Portal

COVID-19 Info for Members

COVID-19 Information for Members

CDC Information on COVID-19

Florida Department of Health Information on COVID-19

 

COVID-19 Information for Providers

Message from the CEO


On behalf of our team at Miami Children’s, we thank our providers who are working on the frontline battling the coronavirus.  The safety of our members, doctors and our community is our top priority.  We are working in partnership with the Agency for Health Care Administration and will continue to revise our policies and processes in accordance with the Agency’s direction to help reduce your administrative burdens as you care for patients. We appreciate all you are doing and are here to support you. 
 

– Adriana Day

Member Care


We are aligning communication to our members with messaging provided at the Department of Health and Center for Disease Control websites.  Our telephonic care management team continue to provide ongoing support to members through our care management program.  In addition to our regular care management activities, all members engaged in care management will be outreached in order to provide education about COVID-19 and reliable resources they can access to remain aware and current.  Members are provided information about frequent hand washing, importance of medication refills, social distancing, and the availability of our 24/7 nurseline as well as telehealth options.  We reiterate to members to call ahead before showing up at a providers’ office with symptoms. 

Below are referenced websites we are utilizing:
Florida Department of Health
Centers for Disease Control
 

Medicaid Provider Funding Announcement - Act Now!

Update: Deadline Extended, Assisted Living Facilities Now Eligible



Federal COVID-19 relief funding is available for Medicaid and CHIP providers. Federal HHS has launched 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.

NEW!: The U.S. Department of Health and Human Services (HHS) has announced that assisted living facilities (ALFs) that may have been previously ineligible may now apply for funding under the Provider Relief Fund Phase 2 General Distribution allocation. Like other providers applying for Phase 2 funding, eligible ALFs will receive 2 percent of their annual revenue from patient care. ALFs, like all providers applying for the current Phase 2 General Distribution funding, will have until September 13, 2020 to begin their application.

DEADLINE EXTENDED TO SEPT. 13: The federal government has extended the deadline to apply for Medicaid/CHIP Provider Enhanced Provider Relief Fund Payments until September 13, 2020.

REMINDER!: Second Chance for Certain Medicare Providers: Starting the week of August 10, HHS began allowing Medicare providers who missed the opportunity to apply for additional funding from the $20 billion portion of the $50 billion Phase 1 Medicare General Distribution. Providers will have until September 13, 2020, to complete an application to be considered for the balance of their additional funding up to 2 percent of their annual patient revenues.

REMINDER!: Payments for Providers Who Had a Change in Ownership: Starting the week of August 10, HHS began allowing providers who experienced a change in ownership in 2019 or 2020 under Medicare Part A who did not have Medicare Fee-For-Service revenue in 2019 to submit their revenue information, along with documentation proving a change in ownership, by August 28 for consideration for a Provider Relief Fund payment.

Step by Step Provider Guide: The federal Health Resources & Service Administration has created a step by step provider guide to help providers learn more about the provider relief fund and how to apply. The Agency has posted this guide on our COVID-19 website, but it can also be accessed here http://ahca.myflorida.com/docs/PRF_Step-by-Step_Provider_Guide_8-11-2020.pdf

Relief Fund Payments for New Providers: HHS is currently working to address relief payments to new providers in 2020 along with those that have yet to receive any funding for a variety of reasons, including the fact that they may only bill commercially, or do not directly bill for the services they provide under the Medicare and Medicaid programs and thus have not receive any funding yet. HHS has advised that future announcements will be provided as additional information becomes available.

License Number Issue is Fixed: The requirement to input a license number during the application process has been resolved. Medicaid providers that are not licensed can put NA in the license field.

Previously Recorded Webinars: HHS has posted a recording of past webinars for providers who were unable to attend. These recordings can be accessed here: https://webex.webcasts.com/starthere.jsp?ei=1334682&tp_key=9dd6d30493

Updated FAQs: HHS has posted updated FAQs to address questions submitted during the previous webinars. The updated FAQs can be found here: FAQs

Funding Overview:  HHS launched an enhanced Provider Relief Fund Payment Portal that allows eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.

For more information, please visit www.HHS.gov/providerrelief


Provider Alert System


Several Provider Alerts have been issued by The Agency for Health Care Administration with regard to COVID-19.  We are working to provide these alerts on our provider portal for your convenience. 

You may also sign up for Provider Alerts directly from AHCA and access Provider Alert archives at the following Agency link:  FLMMS Portal

Provider Alerts to Date 


The alerts below are available at the following link:
https://ahca.myflorida.com/covid-19_alerts.shtml
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
Co-Payments
  • Waive all co-payment requirements
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
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
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
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
Site Visits
  • Postpone on-site or face-to-face provider site visits (including enrollment/credentialing requirements)
Fair Hearings
  • Allow enrollees more time to request a fair hearing or health plan appeals
PASRR
  • Postpone Preadmission Screening and Resident Review (PASRR) Level I and PASRR Level II activities
Eligibility
  • Extending Medicaid recipient eligibility and extending time to complete application process
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


Provider Payment Provisions


At Miami Children's Health Plan we are updating policy and procedures to meet the State guidance and to support our providers.  Click here for more information on Miami Children's Healt'h Plans payments process.
 

Miami Children's Health Plan Contacts


Although we are limiting travel to providers’ offices and curtailing face to face member visits per AHCA guidance, we are working and available to you, your staff and your patients.  For the remainder of March and through April, we will conduct provider visits telephonically.  We understand your offices are disrupted and we will work to accommodate your schedules to conduct telephonic visits.   Please share your availability at your convenience. 

We are in frequent communication with the Agency for Health Care Administration to receive direction, provide feedback and submit questions for clarification.  Please email providerservices@miamichildrenshealthplan.com if you have questions regarding AHCA directives about COVID-19 we may be able to help answer.  You may also contact your provider relations specialist.  

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