COVID-19 news & updates
June 18, 2020
MCCFL is receiving information from many of the insurance plans regarding prior authorization processes and other updates related to COVID-19. We will continue to provide this information via email communication, however, for the most recent information, we are recommending you visit the health plan's website or call their provider line. We will also be placing the communications from the health plans that can be accessed by visiting https://client.mccfl.us/public/ under the tools and resources tab in the Coronavirus folder. As best practice we still suggest you initiate authorization process, prior to admission. Please note that unless specified, out of network status still applies to some of their requirements, please read carefully.
We would also like to point out all notices and links state that the provider is still at risk of denial or non-payment of services if the admission was not deemed medically necessary or otherwise meet level of care criteria. There is the potential of being audited for medical necessity.
Below are the individual plan directives; please be sure to follow directions from your corporate teams.
Aetna
Aetna is resuming our standard prior authorization protocols for inpatient admissions effective May 29, 2020 


AvMed
(This applies to Florida ONLY)
No information regarding changes to prior authorization and SNF stays at this time. Auth is still required.

 BayCare
(This applies to Florida ONLY)
Effective June 8, 2020 Baycare is now waiving authorization for both in and out of network providers.

CarePlus
(This applies to Florida ONLY)
CarePlus is resuming our standard prior authorization protocols for inpatient admissions effective May 18, 2020 .
Cigna
Cigna will continue to allow emergent or urgent direct transfers to skilled nursing facilities, without prior authorization until July 31, 2020 for both commercial and Medicare lines of business.

Florida Blue
(This applies to Florida ONLY)
Florida Blue Medicare, Commercial, and Affordable Care Act is waiving prior authorization requirements for patients being transferred from inpatient acute hospital settings to post-acute care facilities for Through June 30, 2020 . Beginning July 1, 2020 Florida Blue return to normal business processes. Post-acute care facilities are still required to notify CareCentrix of FloridaBlue Medicare members of an admission by the end of the next calendar day. This timely notification and review is still required to determine medical necessity of continued stay and ensure Florida Blue can assist with discharge planning for its members. Please see the attached for further details on Commercial and Affordable Care Act members.

Freedom Health & Optimum HealthCare
(This applies to Florida ONLY)
Freedom clarified saying this only applies when a hospital system has been recognized as having a high volume of Covid-19 cases and bed availability is needed please note this is being handled on case by case. Freedom is asking providers to continue with the ‘normal authorization process’ as best as you possibly can. They still have staff working during the day and after-hours, who can provide authorizations effective April 6, 2020 for 90 days .

Humana
Humana is resuming our standard prior authorization protocols for inpatient admissions effective May 22, 2020 .
Medica
Medica will continue to waive prior authorization through September 30, 2020.

Medicaid - AHCA
(This applies to Florida ONLY)
The Agency has lifted prior authorization for certain critical services for all Medicaid recipients and has lifted prior authorization for all services if the recipient is diagnosed with COVID-19. Please refer to the guidance published by the Agency on March 18th for a list of service categories where the prior authorization requirement has been lifted .
Clarification: 5.8.2020
Prior Auths: on or after March 1, 2020 through the termination of the emergency declaration for at least 90 days and up to 180 days (up to the last day of the emergency period under Section 1135(e) of the Act), for beneficiaries with a permanent residence in the geographic area of the public health emergency declared by the Secretary.
PASRR Level 2 exceptions were only in place for 30 days from the date initiated.  

Molina
Molina is now requesting SNF's gets prior authorization effective June 19, 2020.

Preferred Care Partners
Preferred Care Partners is working to reduce administrative work for health care providers. Through May 31, 2020 , providers will not need to do a prior authorization to move members to a different post-acute setting (i.e., long-term acute facilities, inpatient rehabilitation, skilled nursing facility or home health care). The admitting provider simply notifies us within 48 hours of the move.

Simply
Simply is waiving initial authorization, this provision is applicable to all managed care plan enrollees. Please note: there has been no clarification as to whether or not this applies to both in and out of network providers.
Update:4.24.2020
This applies to both in and out of network providers for 90 days from March 17, 2020 expiring June 16, 2020 .

Staywell Medicaid
(This applies to Florida ONLY)
Staywell as of June 19, 2020 will begin to require authorization for SNF placement.

Sunshine
Sunshine as of June 19, 2020 will begin to require authorization for SNF placement.

United Healthcare
United Healthcare states normal prior authorization requirements will resume June 1,2020 .

WellMed
WellMed states normal prior authorization requirements will resume June 1,2020 .

Please note: Things are changing daily do not hesitate to reach out to your liaison if you have questions.
A Message from our President:

Dear Valued Clients,

MCCFL is working diligently on updates as related to the Covid-19 Crisis. We are gathering updates from the health plans as they are released to be able to provide you with the most recent information. Please note these updates and changes are very fluid and can change daily. It is best practice for out of network providers to check with the health plan for each referral to determine their current processes as they could vary based on type of product and benefits.  On March 25 th , 2020, President Trump declared that a major disaster exists in the State of Florida. Florida Disaster Declaration This additional declaration will most likely change the way the managed care organizations operate and how they will apply their rules regarding network operations. We are anticipating updates from the plans regarding this declaration. Medicare Advantage plans do have special requirements they must follow when such situations arise, please follow this link to review. CMS March 10, 2020
MCCFL is here to assist you and your staff with any managed care needs or questions that arise. Please do not hesitate to reach out to your Managed Care Liaison or any of our staff. We wish you and yours the best in these uncertain times. 

Destiny Quinones, BSW
President 
COVID-19
All of these articles can be found on our portal at MCCFL under tools. We will keep you abreast of this as it pertains to Managed Care.