Florida Medicaid Prior Authorization Reinstatement June 19

The Agency for Health Care Administration (Agency) has enacted provider flexibilities to help respond to the 2019 novel coronavirus (COVID-19). As the State commences reopening, we will evaluate each flexibility that was enacted to determine the potential end date. The purpose of this provider alert is to communicate details on the the reinstatement of prior authorization for certain Medicaid covered services.

Consistent with Phase 2 of Governor Ron DeSantis’ Plan for Florida's Recovery, the Agency is reinstating prior authorization requirements for the following Florida Medicaid services that were waived in response to COVID-19:

• Hospital services (including long-term care hospitals)
• Nursing facility services
• Physician services
• Advanced practice registered nursing services
• Physician assistant services
• Home health services
• Ambulance transportation
• Durable medical equipment and supplies.

 This change is effective for dates of service on or after June 19, 2020 when prior authorization is required for the service. This change applies in both the fee-for-service and the managed care delivery systems.

Behavioral Health Exception

The Agency will continue to waive prior authorization requirements and services limits (frequency and duration) for Medicaid-covered behavioral health services covered. This includes community behavioral health services, inpatient behavioral health services, and targeted case management services. The Agency will continue this flexibility until further notice.

 General Information

For more information on the Agency’s efforts related to COVID-19, click here.

Content provided by: Agency for Health Care Administration