Florida Medicaid Health Care Alert:  August 12, 2021

Provider Type(s): All Except 11, 12, 15, 24, 39, & 67

Providers Must Bill Fully Liable Medicare Advantage Plans for All Services

Effective immediately, the Florida Medicaid Management Information System (FMMIS) will no longer pay for services billed to Medicaid for recipients enrolled in a Fully Liable Medicare Advantage Plan.

On May 3, 2021, the Agency issued a Medicaid Health Care Alert titled “Effective July 1: Providers Must Bill Dual Eligible Special Needs Plans (D-SNP) for All Services”, which informed providers that effective July 1, 2021, the Florida Medicaid Management Information System (FMMIS) would no longer pay for services billed to Medicaid for recipients enrolled in a Dual Eligible Special Needs Plan (D-SNP). This alert is to clarify that this requirement also applies to Florida’s Fully Liable Medicare Advantage Plans, and that providers must bill all services to a recipient’s Fully Liable Medicare Advantage Plan.

The Fully Liable Medicare Advantage Plans are responsible for and cover the costs for the provision of Medicaid covered services found in the Fully Liable Medicare Advantage Plan Medicaid Covered Services, which are incurred by enrolled dual eligibles who meet the eligibility criteria for full Medicaid benefits.Please review the list to verify if you provide a service covered by the Fully Liable Medicare Advantage Plan.

Providers must check a recipient’s eligibility via the Florida Health Plan Portal to verify their Medicare and Medicaid eligibility. To identify if you provide services to a Fully Liable Medicare Advantage Plan enrollee via the Florida Health Plan Portal, in the “TPL” section, the recipient’s TPL coverage will show “Fully Liable Medicare Advantage Plan” as well as the Plan’s (Carrier) name. Please note, a recipient can also be enrolled in a Medicaid Long-Term Care Plan, which is responsible for Medicaid long-term care services. Providers will need to verify this eligibility separately.

Providers can contact the Fully Liable Medicare Advantage Plans with inquiries at the following: