Hurricane Helene Waiver News

Aetna Better Health of Florida (ABHFL) will wave all prior authorization requirements for critical Medicaid services during the State of Emergency related to Tropical Storm Helene in impacted counties for Managed Medicaid Assistance (MMA) and Long-Term Care (LTC). The extended temporary flexibilities to our prior authorization requirements will begin September 25, 2024, until further notice.

This applies to Home Health and SNF.

See the waiver and prior authorization list here

Emergent services DO NOT require authorization. AvMed follows the Medicare Plan EOC regarding “How to get services when you have an emergency or urgent need for care or during a disaster.” For procedures on the prior authorization list, AvMed will review up to 5 (five) days after the procedure for medical necessity.

• Medicare members may access non-contracted Medicare facilities for covered benefits with the same cost-share as plan-contracted facilities during a state of emergency/disaster.

This applies to Home Health and SNF.



See the waiver and prior authorization list here

AvMed website

For Commercial:

Prior authorization is waived for initial placement and for subacute facilities that need to evacuate so members can be safely transferred as expeditiously as possible. This is an evolving situation that is frequently being reviewed and potentially updated by our leadership. While we do not have an official flyer, facilities can outreach their network representatives for confirmation or clarification. Our priority is and will continue to be ensuring the wellbeing of our members and providing an efficient way for our providers to move patients. Each hospital has an assigned concurrent review nurse who is happy to support you.

For Medicare:

No Prior auth for transfers due to evacuations will be required, however we will still need notification of the transfer as soon as possible.

Care Centrix has been notified.

View Waiver here

For right now all of the counties except for Indian River, Martin, St. Lucie and Palm Beach are able to admit without auth until the state of emergency is over. 

View waiver here

Molina providers are reminded to continue providing critical Medicaid services that are life-sustaining (examples include durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.) during the disaster period, including those that may need prior authorization, regardless prior authorization status.

This applies to Home Health and SNF.

View Waiver here

This waiver applies to Simply Healthcare members. Authorizations are being waived for SNF admission for any designated State of Emergency counties. Authorization request needs to be initiated, and notification to plan needs to happen within 24 hours.

This applies to Home Health and SNF.

View Waiver here

Sunshine Health is waiving all prior authorization requirements for critical Medicaid services in impacted counties for all Medicaid products: MMA, Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI), Children’s Medical Services Health Plan (CMS) and Long Term Care (LTC).

The extended temporary flexibilities to our prior authorization requirements began on September 25, 2024, and extend until further notice.

This applies to Home Health and SNF.

View Waiver here

• Waive prior authorization requirements for covered and critical life-sustaining services such as oxygen, nebulizer, ventilator, feeding pump, dialysis, insulin/insulin administration, DME, skilled nursing facility services, and chemotherapy.
• Will not deny a continued inpatient facility stay for late submission of clinical information and will accept verbal concurrent reviews.

View Waiver here

Prior Authorization Waiver – Facility-to-Facility Transfers

• We will not require prior authorization for facility-to-facility member transfers for same level of care, e.g., hospital – to – hospital;
• Services remain subject to concurrent & post-service medical necessity reviews.
• Applies to dates of service from 09/24/2024 through 10/08/2024

Prior Authorization Waiver – Skilled Nursing Facility Level of Care

• Will not require PA for admission or transfer to INN SNF. The waiver does NOT include LTAC or AIR.
• Services remain subject to concurrent & post-service medical necessity reviews.
• Applies to dates of service from 09/24/2024 through 10/08/2024

View Waiver here