COVID-19 State of Emergency: Medicaid Coverage of Services
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Directs managed care plans to modify prior authorization, service limits, cost sharing, appeals timing, enrollment/credentialing, and payment processes to ensure continuity of care for Medicaid enrollees during the COVID-19 state of emergency.
Waiver of initial and ongoing prior authorization requirements for a broad set of services and for all services (except pharmacy) necessary to evaluate and treat enrollees diagnosed with COVID-19.
Limits on medically necessary services (frequency, duration, scope) that would impede care for enrollees with COVID-19 must be waived, including specific examples (45-day inpatient limit, $1,500 outpatient limit).
Waiver of co-payments for all services during the state of emergency.
Temporary flexibility for appeals and fair hearings timing, including potential delay in scheduling and issuance of decisions when workforce shortages exist.
PASRR processes postponed and plans may not deny payment for new nursing facility admissions based on lack of PASRR completion during the emergency.
Allow nonparticipating and out-of-state or non-Florida-licensed providers to render services and require provisional enrollment process for temporary provider IDs.
Requirement for managed care plans to implement and publish a claims payment exceptions process for services rendered during the emergency that lacked prior authorization, exceeded limits, or were provided by nonparticipating providers.
Emergency coverage flexibilities during COVID-19
Emergency coverage flexibilities
Managed care plans must apply the following coverage and payment flexibilities during the state of emergency:
COVID-19 diagnosis coding reference
| Reference to official diagnosis coding guidelines published by CDC for COVID-19. |
Prior authorization and provider operational requirements
Waive initial and ongoing prior authorizations for COVID-19 care
Waive initial and ongoing prior authorization requirements for the listed settings and services and waive all prior authorizations (except pharmacy) for services necessary to evaluate and treat enrollees diagnosed with COVID-19. This applies to all managed care plan enrollees.
- Settings and services covered by the waiver: skilled nursing facilities, long term acute care hospitals, hospital services, physician services, advanced practice registered nursing services, physician assistant services, home health services, and durable medical equipment and supplies.
- For enrollees diagnosed with COVID-19, waive all prior authorization requirements for any services (pharmacy services excluded) necessary to appropriately evaluate and treat the enrollee.
- Applies to all managed care plan enrollees.
Key definitions and terms
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