Provider Type(s): 01, 05, 91

Reinstatement of Prior Authorization and Service Limits for Behavioral Health Services Effective July 1, 2021

The State of Florida has 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.

In May and June 2020, Florida Medicaid provided guidance on several flexibilities offered to behavioral health providers and Florida Medicaid recipients.

This policy guidance notifies providers that the following flexibilities will end effective July 1, 2021, or when stated otherwise.

Frequency and Duration of Service Limits for Behavioral Health Services:In May and June 2020, Florida Medicaid announced the waiver of Medicaid prior authorization requirements and service limits (frequency and duration) for behavioral health services (this includes targeted case management services) covered under the Medicaid program, and the extension of these waivers.

Effective for dates of service beginning July 1, 2021, service limits will be reinstated for behavioral health services. Effective July 15, 2021, Medicaid prior authorization requirements will be reinstated for behavioral health services.

For services provided to managed care plan enrollees, providers must work with each managed care plan to ensure continuity of care for medically necessary courses of treatment as prior authorizations and service limits are reinstated. In the event a plan member is receiving an ongoing course of treatment with any provider, participating or non-participating, that was begun during the authorized flexibilities for COVID 19 where prior authorization was not required, the managed care plan shall be responsible for the continuation of such course of treatment, without any form of authorization and without regard to whether such services are being provided by participating or non-participating providers for up to sixty (60) days after the effective date.

For questions or further information, providers can call the Florida Medicaid Helpline at 1-877-254-1055.