Florida Medicaid Health Care Alert

April 28, 2026

Provider Type(s):ALL

Children’s Medical Services (CMS) Plan Transition

Effective October 1, 2026, the operation of the Children’s Medical Services (CMS) Plan will move from Sunshine State Health Plan, Inc. to Molina Healthcare of Florida, Inc.

Certain children with special health care needs are eligible to enroll in Florida’s Children’s Medical Services Plan (CMS Plan) for enhanced services. Currently, Sunshine State Health Plan, Inc. (Sunshine) operates the CMS Plan contract for both Medicaid (Title XIX) and CHIP (Title XXI) recipients. The Agency recently awarded Molina Healthcare of Florida, Inc. (Molina) the CMS Plan contract statewide. The Agency is working closely with Molina and Sunshine to ensure a seamless transition. After October 1, 2026, recipients and providers wanting to participate in the CMS Plan must enroll with Molina. Molina will be the single plan that offers all services in the CMS Plan.

What does this mean?

Starting on October 1, 2026, Molina will be the only SMMC plan to administer the CMS Plan. Current CMS Plan recipients will be automatically transferred to CMS Plan operated by Molina as part of the transition.

Recipients who do not wish to move to CMS Plan operated by Molina will have the option to choose another plan.

• Title XIX recipients may choose to enroll in another SMMC plan:

Florida Medicaid Choice Counseling: 1-877-711-3662. Staff are available to assist with plan changes Monday-Thursday 8 a.m. - 8 p.m. and Friday 8 a.m. – 7 p.m.

• Title XXI recipients may choose to enroll in another Florida Healthy Kids plan:

Florida KidCare: 1-888-540-KIDS (5437)Staff are available to assist with plan changes Monday through Friday, 8 a.m. - 5 p.m.

Continuity of Care

All recipients initially transitioning from Sunshine to Molina will have a continuity of care (CoC) period of up to eight months. This means recipients may continue seeing their current providers until May 31, 2027, or until their care plan is finalized and ongoing services are authorized, whichever is sooner. Molina is required to reimburse non-participating providers at the rate they received for services rendered to recipients prior to the transition for up to eight months, unless there is an agreement to an alternative rate.

All SMMC plans are required to provide CoC periods for transitioning recipients. Details regarding CoC periods for plans other than Molina can be found on the Agency website at SMMC 3.0_Continuity of Care Provisions.

The Agency has instituted the following CoC provisions:

• Health care providers should not cancel appointments with current patients.
• Providers will be paid promptly by the recipient’s new managed care plan.
• Prescriptions will be honored by the recipient’s new managed care plan.
• Existing prior authorizations approved prior to October 1, 2026, will be honored by the recipient’s new managed care plan.

Providers interested in contracting with Molina can find additional information at Molina_CMS Providers. Molina is contracting with CMS Plan providers now and will prioritize contracting inquiries that promote Continuity of Care. Molina is providing essential information, training sessions, and reference materials for support throughout this transition.

Please visit Molina’s website at Molina_CMS Providers for the most current updates and answers to Frequently Asked Questions.

Additional communications from the Agency regarding this change will be shared at CMS Plan Transition | Florida Agency for Health Care Administration.

The American Medical Association (AMA) released an April 10 advocacy update outlining the CY 2027 Medicare Advantage final rule and its implications for physicians.

Key highlights include:

• More accurate risk score calculations through the exclusion of unlinked chart review records
• New continuity-of-care protections for certain Medicare Advantage enrollees
• A 2.48% average payment increase for plans

The update also notes ongoing concerns:

• Reduced oversight and accountability for Medicare Advantage plans
• Changes to prior authorization and utilization management requirements
• Continuing administrative challenges for physicians

Read more on the AMA website.

QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com

COMPLAINTS OR ISSUES? ON LINE ahca.myflorida.com/Medicaid/complaints/ | CALL 1-877-254-1055

The Agency for Health Care Administration is committed to its mission of providing "Better Health Care for All Floridians." The Agency administers Florida’s Medicaid program, licenses and regulates more than 48,000 health care facilities and 47 health maintenance organizations, and publishes health care data and statistics at FloridaHealthFinder.gov. Additional information about Agency initiatives is available via Facebook (AHCAFlorida) and  Twitter (@AHCA_FL)

Florida Medicaid Health Care Alert

November 13, 2025

Provider Type(s): ALL

Medicaid Modernization: Start Preparing for New Provider Enrollment System

Source: State of Florida Agency for Health Care Administration

The Florida Agency for Health Care Administration (AHCA) is launching a new provider enrollment system in early 2026 as part of the AHCA Enterprise modernization. This modernization will streamline enrollment, renewal, and account maintenance, making the process faster, easier, and more secure for Medicaid providers.

In preparation, providers should:

• Complete pending enrollments in the current Medicaid Provider Enrollment Application Wizard.
• Review and update account information in the Medicaid Secure Web Portal. If renewal has been triggered, complete renewal there.
• Active Medicaid providers who have not created an account should do so as soon as possible. If you do not have your PIN information, see Password Resets and PINs for support.
• Subscribe to Florida Medicaid Health Care Alerts for updates.

Account Maintenance How-tos:

• Update account information: Account Management – Modify Contact Information.
• Reset password: Visit the Medicaid Secure Web Portal and select “Reset password.”
• Maintain an active account: Log in every 60 days before the password expires.
• Newly enrolled providers will receive a PIN letter within 10 business days. Visit https://public.flmmis.com/public/pinletter/ to activate your account.

Resources:

• Password Resets and PIN Instructions
• Account Maintenance and Reset Password Quick Reference Guide
• Secure Web Portal User Guide

Launching in early 2026, the new Provider Enrollment System will:

• Give providers 24/7 access to their provider account from any device.
• Provide step-by-step instructions so applications are right the first time.
• Make enrollment, renewal, and account maintenance faster and more secure.

What’s Next?

As launch day approaches in early 2026, AHCA will share updates through Florida Medicaid Health Care Alerts, including when new preparation tools become available.

As Congress returns home for the annual August recess, physician advocates have unique opportunities to engage with their members of Congress "back home" in the district.

Find out how you can take advantage of the August recess and tell Congress to Fix Medicare Now!

This summer the American Medical Association's top federal priority remains reforming Medicare's broken physician payment system, and we need your help!

According to an AMA analysis of Medicare Trustees data, Medicare physician payment has been reduced 29% adjusted for inflation from 2001–2024. The Medicare physician payment system lacks an adequate annual physician payment update, unlike those that apply to other Medicare provider payments.

Unfortunately, CMS' recent proposed rule has physicians slated for an additional 2.8 percent Medicare payment reduction on January 1.  This latest inexcusable cut looms despite the fact that CMS also projects the increase to the MEI to be 3.6 percent in 2025.

That's why it's so urgent that Congress work with the physician community to develop long-term solutions to the systematic problems with the Medicare physician payment system and preserve patient access to quality care.

Recently, the AMA hosted a webinar featuring Jason Marino, AMA Director of Congressional Affairs, who provided an update on the current state of Medicare physician payment legislation and what lies ahead during the 118th Congress and advocacy expert David Lusk of Key Advocacy who provided best practices for engaging legislators in-district including how to prepare for in-district legislative meetings, host Members of Congress at site visits, and interacting with elected officials online.

To make these interactions with your legislators as impactful as possible, the AMA has developed an online August recess resources site that is your one-stop-shop for toolkits, legislative calls to action, issue briefs, infographics and detailed information on scheduling and preparing for legislative meetings and other in-district opportunities.

Please join us this August recess and let Congress know that it's time to Fix Medicare Now - everyone agrees that the Medicare physician payment system is broken – let's do something about it!

The AMA has created a specialty impact table for the Federation's advocacy on Medicare physician payment reform and feedback on the 2025 proposed rule. Unlike CMS' tables, this one details the effects of expiring legislation at a granular level.  Click here to view.

Effective May 30, a provider or supplier may be subjected to a stay of enrollment if they are deficient in one provider enrollment requirement which can be remedied by submitting a provider enrollment application. A stay of enrollment is a preliminary, interim status representing a pause in enrollment during which you will not be paid.

During a stay of enrollment, or pause, your provider status remains active in Medicare, but Medicare will reject all claims submitted with a date of service within the stay period.
 
Some examples of when a stay of enrollment may be implemented:

• Provider failed to timely report a change in address
• Supplier didn't respond to a revalidation request
• Independent diagnostic testing facility failed to comply with a supplier standard
• A supplier failed to timely report a change in address of an organizational owner
• A supplier failed to report the deletion of a managing employee

Note: If a stay of enrollment has been placed on your enrollment record, you will be notified by hard-copy mail, email, and fax, if applicable. To have the stay of enrollment removed, you must fix the non-compliance with Medicare by submitting the applicable Medicare application. Remember, if you need help, Acevedo Consulting has the expertise to assist with Medicare enrollment.
 
For example: Your clinic group practice recently changed practice locations and did not notify Medicare. Your MAC implemented a stay of enrollment because you did not report a change in practice location. To have the stay of enrollment removed and be able to continue billing Medicare, you will have to submit a change of information enrollment application to update your practice address.

If you believe you meet all provider enrollment requirements and the stay of enrollment should not have been imposed, you can submit a provider enrollment rebuttal. Refer to your stay of enrollment letter for instructions on how and where to submit the rebuttal.
 
 
For more information, click here. 

Source: Acevedo Consulting 

https://www.acevedoconsultinginc.com/

In addition to payment cuts, the agency proposed changes to the Quality Payment Program and the Medicare Shared Savings Program.

July 14, 2023 - CMS has proposed payment cuts in its calendar year (CY) 2024 Medicare Physician Fee Schedule (PFS), including a 3.34 percent decrease to the conversion factor that would reduce payment rates by 1.25 percent.

The proposed CY 2024 PFS conversion factor is $32.75 compared to $33.89 in CY 2023. This change reflects the end of the 2.5 percent statutory payment increase for CY 2023, a 1.25 percent statutory payment increase for 2024, and a 2.17 percent reduction for budget neutrality.

The agency has said that proposed payment increases for primary care and other direct patient care providers meant that payment cuts must occur in other specialties to achieve budget neutrality. While specialties like internal medicine (1 percent) and family practice (3 percent) would see reimbursement increases, others are facing cuts, including radiation oncology (-2 percent) and emergency medicine (-2 percent).

The rule included a proposal to implement a new add-on code to recognize the costs associated with evaluation and management (E/M) visits for primary care and longitudinal care of complex patients. The code would result in additional payments to providers for outpatient office visits.

CMS also proposed additional payments for caregiver training services and separate payments for services that address health-related social needs when community health workers, care navigators, and peer support specialists are involved.

Provider organizations have decried the proposed payment cuts.

“Medicare already largely fails to cover the cost of furnishing care to beneficiaries, and the proposed cut to the 2024 conversion factor compounds the problem. Implementation of a new add-on code (G2211) for complex patients highlights CMS’ flawed approach to addressing inadequate Medicare payments for primary care services using a budget neutral methodology,” Anders Gilberg, SVP of Government Affairs at MGMA, said in a statement emailed to RevCycleIntelligence.

“Congress must reexamine existing law to provide an annual physician payment update commensurate with inflation and do away with Medicare’s ‘robbing Peter to pay Paul’ budget neutrality requirements to provide much-needed financial stability for medical practices.”

The American Society for Radiation Oncology (ASTRO) also expressed concern with the PFS.

“The ongoing cuts to radiation oncology reimbursement, coupled with broader cuts to Medicare services, threaten to decrease patients’ ability to receive vital, high-value cancer care close to home by driving practice consolidation and undermining the viability of smaller practices. These cuts also underscore the need for long-term, overarching reimbursement reform that will ensure patients can access the care they need,” Geraldine M. Jacobson, MD, MBA, MPH, Chair of the ASTRO Board of Directors, said in a statement.

The proposed rule also included changes to the Quality Payment Program (QPP) and the Medicare Shared Savings Program (MSSP).

For the QPP, CMS proposed five new optional Merit-based Incentive Payment System (MIPS) Value Pathways for reporting:

• Focusing on Women’s Health
• Quality Care for the Treatment of Ear, Nose, and Throat Disorders
• Prevention and Treatment of Infectious Disorders Including Hepatitis C and HIV
• Quality Care in Mental Health and Substance Use Disorders
• Rehabilitative Support for Musculoskeletal Care.

The agency also proposed to increase the quality data completeness threshold and the performance threshold score that MIPS participants must achieve to see positive payment adjustments.

For MSSP, CMS proposed changes that shift accountable care organizations (ACOs) toward digital quality measurement by establishing a new Medicare Clinical Quality Measure (CQM) collection type.

The rule also included amendments to the financial benchmarking methodology. ACOs will be able to apply the same CMS-Hierarchical Condition Categories risk adjustment methodology to both the benchmark and performance years, minimizing the impact of negative regional adjustments on the benchmark.

“[CMS] showed its commitment to supporting value-based care and growing participation in accountable care organizations in this proposed rule,” Clif Gaus, ScD, president and CEO of the National Association of ACOs (NAACOS), said in a statement. “It addresses several issues that NAACOS has been advocating for, including improvements in quality reporting, more fair benchmarking policies, a smooth transition to a new risk adjustment model, keeping advanced payments for new ACOs who transition to risk, helping ACOs who serve high-cost beneficiaries and others.”

The proposed rule also included provisions to improve access to behavioral healthcare services and expand telehealth waivers.

Source: https://revcycleintelligence.com/news/cms-proposes-payment-cuts-in-cy24-medicare-physician-fee-schedule 

Specifically, in response to concerted advocacy by organized medicine, Congress reduced the 4.5% cut to Medicare physician payment by increasing the 2023 conversion factor by 2.5%.

The updated 2023 Medicare physician payment schedule conversion factor will be $33.8872.

The previously finalized conversion factor was $33.0607. The 2022 conversion factor was $34.6062.

Source: AMA

We've been sounding the alarm bell for months that if Congress didn't act by the end of the year, physicians would face devastating Medicare payment cuts from regulatory changes enacted by the Centers for Medicare and Medicaid Services. Unfortunately, as you can see by the countdown timer above, Congress has only a few precious days left to pass legislation to stave off these harmful cuts.

It's now or never – Tell Congress to protect America's Medicare patients and stop the cuts!

If Congress fails to act, physician Medicare payments are scheduled to be cut by 4.5 percent on January 1,2023.Cuts of this magnitude would severely impede patient access to care by forcing many physician practices to close and thereby putting further strain on those that remained open during the pandemic.

These scheduled cuts will come in the form of:

• Centers for Medicare & Medicaid Services (CMS) regulation. CMS has proposed a 4.5% cut for all physician services in 2023 to offset payment policy improvements in office and facility-based visits.
• No inflationary update. Physicians are the only providers whose Medicare payments do not automatically receive an annual inflationary update; during this time of record inflation and coming on the heels of a highly disruptive pandemic, this statutory flaw amplifies the impact of proposed payment cuts.

When adjusted for inflation, Medicare physician payments have dropped by 22% from 2001 to 2021. Physicians simply cannot afford to operate under the current payment system. Congress must reform the Medicare physician payment system to make it simpler, more reflective of real-world physician practice costs and stable for both physicians and patients before it's too late!

The "lame duck" session of Congress is always a chaotic time with numerous priorities and interests vying to be included in the final must-pass package. With so much at stake, America's patients and physicians cannot afford to get lost in the shuffle.

Time is running out - Contact Congress NOW and demand that they protect our patients and practices by canceling these devastating Medicare cuts in their entirety before the clock strikes zero!

Many physicians in Florida — even those who do not participate in the Medicare fee-for-service program — stand to be affected by an 8.42% Medicare physician payment cut that will take effect in 2023 unless Congress intervenes. As explained in a recent FMA update, “Since commercial payment rates are generally a function of Medicare rates, any reduction in the value of Medicare payments will also likely spill over to the commercial rates paid to many physician practices.”

You can support our efforts to prevent this egregious payment cut by sending a pre-written, customizable letter to your Congress members. Read our update for details about the potential impact on Florida’s Medicare beneficiaries and physicians.

Click here to send your letter now.

• The Agency will waive all prior authorization requirements for critical Medicaid services beginning September 27, 2022, until further notice.
• Early prescription refill edits have been lifted for all maintenance medications (this does not apply to controlled substances).
• If a recipient requires critical Medicaid services beyond limits stated in policy in order to maintain safety and health, providers can furnish the service.
• All Preadmission Screening and Resident Review (PASRR) processes are postponed until further notice by the Agency.
• Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.
• The PASRR process is waived for recipients who are evacuated due to an evacuation order or power outage and are admitted and discharged during the storm.

The AMA’s Recovery Plan outlines a five-point strategy to strengthen our physician workforce, recover from the trauma of this pandemic, and improve health care delivery by eliminating some of the most common pain points that threaten to drive physicians from practice. The AMA’s comprehensive approach includes:

• Supporting telehealth to maintain gains in coverage and payment.
• Reforming Medicare payment to promote thriving physician practices and innovation.
• Stopping scope creep that threatens patient safety.
• Fixing prior authorization to reduce the burden on practices and minimize dangerous care delays for patients.
• Reducing physician burnout and addressing the stigma around mental health.

Each of these objectives is within our grasp, and achieving them will streamline health care delivery, improve patient care, and support innovation while simultaneously allowing us to respond more effectively to future public health emergencies. Let’s take a brief look at each component of the overall strategy.

Supporting telehealth expansion

The widespread adoption of telehealth services and technology throughout the pandemic allowed physicians to serve patients’ needs in a comprehensive and cost-effective manner. The AMA is working to build upon that success by permanently eliminating pre-pandemic coverage restrictions, ensuring that physicians have the tools and resources they need to seamlessly integrate telehealth into their practices, and enabling patients to access telehealth services from wherever they are.

Medicare payment reform

Diverting the Medicare physician payment system from its current unsustainable path and steering it instead toward physician practice sustainability will protect patient access to quality, evidence-based care while easing administrative burdens. When inflation in practice costs is considered, Medicare physician payment plunged 20% from 2001 to 2021. Medicare spending on physician services per enrollee retreated by 1% between 2010 and 2020, even as spending per enrollee for other parts of Medicare jumped by 3.6% to 42.1%. The AMA’s Recovery Plan tackles Medicare physician reimbursement by emphasizing simplicity, relevance, alignment and predictability.

Stopping scope of practice creep

Patients rely on physicians to direct the care they receive, and the Recovery Plan presses our AMA’s vigorous opposition to inappropriate scope of practice expansions by nonphysicians. Patients are at the center of everything physicians do, and ensuring their protection and well-being in the modern health care environment continues to drive our emphasis on physician-led teams. Every member of health care teams brings important skills to patient care, and nonphysicians made major contributions during the pandemic. That said, patient safety demands that we lift up physicians for their expertise as leaders of health care teams, and their ability to draw out valuable contributions from each professional on that team.

Fixing prior authorization

Prior authorization programs that insurers often use to deny care and increase their own profits have grown out of control. The AMA Recovery Plan will press the fight against this archaic process that delays necessary medical care and routinely causes patients to abandon treatment entirely, often with disastrous results. We intend to right-size prior authorization through multiple reform initiatives underway at both the state and federal levels while offering physicians the resources and tools needed to slash the burden this process imposes on their practices.

Reducing physician burnout

Physicians struggled with professional burnout long before the pandemic pressed them to the very limits of human endurance. Although each physician may experience burnout differently, the cause is nearly universal: An overly bureaucratic and burdensome work environment that steals time from patient care and finds physicians feeling powerless to change it. The well-known resiliency that physicians routinely display is not without limits – but we know that a sizable percentage do not seek counseling or other help for anxiety, depression or even suicidal ideation for fear of being judged inadequate by colleagues, or having to disclose this action to a state licensing board. The recovery plan includes action at the state and national levels to strip away outdated language on applications for medical licensing, health care sector employment and credentialing that promotes stigmatization of behavioral health care.

The AMA’s Recovery Plan for America’s physicians is ambitious, yet achievable. Prioritizing and meeting the needs physicians will improve patient care and health outcomes. Working closely with all members of the Federation of Medicine, the AMA intends to reach these goals and help fulfill our mission to promote the art and science of medicine, and the betterment of public health.

https://insidehealthpolicy.com/daily-news/becerra-hopes-work-congress-reform-medicare-doc-pay 

Source: First Coast Service Options Inc. 

Provider Requirements Under the No Surprises Act Special ODF — December 8

Wednesday, December 8 from 2 – 3 pm ET

CMS will host a Special Open Door Forum (SODF) to explain provider requirements under the No Surprises Act. Starting January 1, 2022,consumers will have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. These requirements generally apply to items and services provided to people enrolled in group health plans, group or individual health insurance coverage, Federal Employees Health Benefits plans, and the uninsured.

These requirements don’t apply to people with coverage through programs like Medicare, Medicaid, Indian Health Services, Veterans Affairs Health Care, or TRICARE that have other protections against high medical bills.

This SODF will include:

·  Background and purpose

·  Requirements for providers, facilities, and providers of air ambulance services starting January 1

·  Enforcement provisions

·  Resources and definitions

·  Q&A session

How to Participate:

·  Dial: 1-888-455-1397; conference ID # 8604468

·  TTY services: Dial 7-1-1 or 800-855-2880

More Information:

·  Presentation

·  Provider Requirements and Resources webpage

·  Questions: provider_enforcement@cms.hhs.gov

Due to ongoing discussions and advocacy the AMA has being having with CMS on the impact the COVID-19-PHE is having on physician practices, CMS will apply the Automatic Extreme and Uncontrollable Circumstances Exemption Policy (EUC) for the 2021 MIPS performance year. This 2021 policy change recognizes the continued challenges physicians face with providing care during the PHE and reduces administrative burden. Therefore, if a physician participates in MIPS as an individual, they don’t need to take any action to have the automatic EUC policy applied to them. CMS will automatically identify and re-weight all 4 MIPS performance categories reweighted to 0% and receive a neutral payment adjustment for the 2023 MIPS payment year unless the physician 1) submit data in 2 or more performance categories, or 2) have a higher final score from group or APM Entity participation.

Unfortunately, due to a systems issue if a physician or small practice participates in the 2021 MIPS program by submitting Part B quality measures through claims and has submitted quality data codes on their 2021 Medicare claims, they will need to still file a 2021 MIPS Hardship EUC to avoid a 2023 payment adjustment and be exempt from the 2021 MIPS program.

If a group practice that typically participates in MIPS as a group has not submitted 2021 data, then the automatic EUC policy will apply to the individual physicians within the group. If the group has submitted any 2021 data, then they will need to apply for the EUC to avoid a 2023 payment adjustment.

Essentially, if the physician or practice has not submitted any 2021 MIPS performance data, then the automatic EUC will apply to the physician.

PY2021 EUC Exception Applications can be submitted by signing in to qpp.cms.gov and clicking Exception Applications on the left-hand navigation.

For more detailed information on the automatic EUC policy and CMS announcement, please see email below.

Source: AMA

Source: AMA

Source: First Coast Service Options Inc.

Biden-Harris Administration to Expand Vaccination Requirements for Health Care Settings

New action will protect patients of the 50,000 providers and over 17 million health care workers in Medicare and Medicaid certified facilities

The Biden-Harris Administration will require COVID-19 vaccination of staff within all Medicare and Medicaid-certified facilities to protect both them and patients from the virus and its more contagious Delta variant. Facilities across the country should make efforts now to get health care staff vaccinated to make sure they are in compliance when the rule takes effect.

The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), announced that emergency regulations requiring vaccinations for nursing home workers will be expanded to include hospitals, dialysis facilities, ambulatory surgical settings, and home health agencies, among others, as a condition for participating in the Medicare and Medicaid programs. The decision was based on the continued and growing spread of the virus in health care settings, especially in parts of the U.S. with higher incidence of COVID-19.

"There is no higher priority for us than patient health and safety. As the Delta variant strengthens, the Biden-Harris Administration is committed to doing everything we can to keep patients, and those who care for them, safe," said U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra. "There is no question that staff, across any health care setting, who remain unvaccinated pose both direct and indirect threats to patient safety and population health. Ensuring safety and access to all patients, regardless of their entry point into the health care system, is essential."

Nursing homes with an overall staff vaccination rate of 75% or lower experience higher rates of preventable COVID infection. In CMS’s review of available data, the agency is seeing lower staff vaccination rates among hospital and End Stage Renal Disease (ESRD) facilities. To combat this issue, CMS is using its authority to establish vaccine requirements for all providers and suppliers that participate in the Medicare and Medicaid programs. Vaccinations have proven to reduce the risk of severe illness and death from COVID-19 and are effective against the Delta variant. CMS will continue to work closely with all Medicare and Medicaid certified facilities to ensure these new requirements are met.

"We know that those working in health care want to do what is best for their patients in order to keep them safe," said CMS Administrator Chiquita Brooks-LaSure. "As the Delta variant continues to spread, we know the best defense against it lies with the COVID-19 vaccine. Data show that the higher the level of vaccination rates among providers and staff, the lower the infection rate is among patients who are dependent upon them for care. Now is the time to act. I’m urging everyone, but especially those fighting this virus on the front lines, to get vaccinated and protect themselves, their families, and their patients from COVID-19."

CMS is developing an Interim Final Rule with Comment Period that will be issued in October. CMS expects certified Medicare and Medicaid facilities to act in the best interest of patients and staff by complying with new COVID-19 vaccination requirements. Health care workers employed in these facilities who are not currently vaccinated are urged to begin the process immediately. Facilities are urged to use all available resources to support employee vaccinations, including employee education and clinics, as they work to meet new federal requirements.

For more information:

• View the FDA announcement
• CMS COVID-19 Provider Toolkit

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.

Today, the Centers for Medicare & Medicaid Services (CMS) announced that the 2020 MIPS Cost Performance Category will be reweighted to 0% of the final score even if eligible physicians or groups submitted 2020 data in other MIPS categories in light of the impact of the COVID-19 pandemic. For over a year, the AMA has been recommending that CMS zero out this category during the pandemic for several reasons, including concerns that decreases in patient visits and increases in the costs of caring for patients with COVID-19 could unfairly penalize physicians. We applaud CMS for holding physicians harmless from unfair evaluations in the MIPS Cost Performance Category as a result of the COVID-19 pandemic.

The AMA also strongly supports CMS’ decision to release the 2018 and 2019 cost measure benchmark files, which we will review closely to identify the target spending for those years, how the benchmarks capture any variations in spending, and whether the benchmarks are leading to fair and valid comparisons among physicians. Again, the AMA has been recommending to CMS for a while that the agency should publish the data.  In April, the AMA and 47 national medical specialty societies sent a letter urging CMS to immediately release the MIPS cost benchmarks to increase transparency in how the agency evaluates physician performance in the Cost Performance Category in MIPS and to allow physicians and other stakeholders to assess the measures for validity and opportunities to reduce spending. We anticipate this information will be informative for specialty societies that are engaged in the ongoing development of new episode-based cost measures and MIPS Value Pathways (MVPs).