MM Curator summary
Florida HHS released a series of notices letting people know pre-COVID limits are going back in place for various types of Medicaid services.
The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.
June 24, 2021
Among the changes: “Wrap around” payments will go from a monthly back to a quarterly schedule and prior authorizations will resume for behavioral health services.
News Service of Florida | 6/21/2021
Gov. Ron DeSantis’ administration announced Friday that the state will next month step back from flexibilities that were offered to Medicaid providers and beneficiaries during the COVID-19 pandemic, including allowing people to receive behavioral health services without first obtaining prior authorization.
The Agency for Health Care Administration issued eight Medicaid notices announcing that the policies designed to make it easier for patients to access health care and for providers to bill for the care were being rescinded.
“The state of Florida led the national effort to distribute COVID-19 vaccines and now maintains a sufficient supply of COVID-19 vaccines for every eligible Floridian who desires to be vaccinated. The data demonstrates that Florida is positioned to transition to pre-pandemic activities,” the email alerts began.
Effective July 1, the state will once again limit the frequency and duration of Medicaid behavioral health services. And beginning July 15, the state will reinstate prior authorization requirements for behavioral health services.
Also, Medicaid “wrap around” payments made to federally qualified health centers will return to a quarterly payment schedule, effective July 1.
During the pandemic, the state was allowing the centers to request the money on a monthly basis to assist with cash flow.
Medicaid also is reinstating prior authorization requirements for hospital transfers prior to admission, including inter-facilitiy transfers, transfers to long-term care hospitals and transfers to nursing facilities.
Effective July 1, Medicaid also is reinstating preadmission screening and resident review requirements for nursing home placement.
The state also will require nursing homes to have a 95 percent occupancy limit to receive Medicaid reimbursement for what are known as “bed hold” days. While that change will take place July 1, Medicaid won’t begin evaluating the 95 percent occupancy rate until October.
Also effective July 1, prescribed pediatric extended care centers will no longer be authorized to deliver services in the home setting.