Hurricane
Helene & Milton
Managed Care
Waiver News
October 9, 2024
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As we are currently in hurricane season, insurance companies are responding by rolling out insurance waivers to provide coverage for those affected by the storm. Watch this space to stay informed about the latest updates and information regarding these waivers. Stay safe! | |
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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 here
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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
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Disaster Alerts!
Some health plans have put disaster blanket statements in place see those links below.
Be advise the below are not waivers.
Aetna view here
CarePlus view here
Wellmed view here
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Florida Blue is giving special consideration to those anticipating being impacted by Hurricane Milton. We are relaxing prior authorization requirements for all service types excluding pharmacy at this time. If you are unable to obtain an authorization and care is required, please proceed with providing treatment and submitting claims for reimbursement. • All services will be subject to medical necessity review and benefit limitations when the claim is submitted. • Coverage at out-of-network facilities will be provided for Florida Blue members who have evacuated from affected counties and require medical care. • BlueCard is excluded.
View Waiver here
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The Health Plan has established a Disaster and Emergency Declaration policy in accordance with state and federal laws and related regulations.
Plan Counties Affected: Brevard, Broward, Charlotte, Citrus, Collier, DeSoto, Flagler, Glades, Hardee, Hendry, Hernando, Highlands, Hillsborough, Indian River, Lake, Lee, Manatee, Marion, Martin, Miami-Dade, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, St. Lucie, Sumter, and Volusia.
- Effective October 7, 2024 and until further notice, for all facilities located in the state of emergency counties, prior authorization will be waived for transfers between hospitals and discharges to skilled nursing facilities (SNFs), as well as transfers between acute inpatient rehabilitation facilities or discharges to SNFs or transfers between long-term acute care hospitals (LTACs). Transfers from acute hospitals to acute inpatient rehab and LTACs continue to require prior authorization.
Plan website
View waiver here
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Humana is here to help support our members and providers impacted by Hurricane Milton. In response to the potential devastation from Hurricane Milton throughout the state of Florida, Humana is suspending authorization requirements (and referrals where applicable) for acute inpatient hospitalization, outpatient procedures, skilled nursing facilities (SNFs), home health, long-term acute care (LTAC) and inpatient rehabilitation facilities (IRFs) for participating and nonparticipating providers for Medicare Advantage, Group Medicare, commercial fully insured and level funded premium (LFP) members residing in Florida through Oct. 14, 2024.
Important details:
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Authorization suspension, as outlined herein, will be in effect for dates of services from Oct. 7, 2024 through Oct. 14, 2024.
- No other services requiring prior authorization are included in this suspension.
- Humana retains the right for post-pay claim review and audit rights for services where authorizations are temporarily suspended.
This applies to Home Health and SNF.
Plan website
View waiver here
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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
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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
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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
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- 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
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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 10/21/2024
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 10/21/2024
View Helene Waiver here
View Milton Waiver here
Home Health Waiver
There is now a waiver in place for out of network benefits for the MA plans for UHC in all hurricane impacted states. This means members will not be responsible to pay out of network penalties on their plans.
View Waiver here
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As always please reach out to us if you have questions. | | |
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