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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!



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.

Join their webcast to learn more about the application process. Please pre-register to reserve a spot on your preferred date:

 

Download the Jun 17, 2020 provider alert by clicking here. 

 

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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