(This applies to Florida ONLY)
The following temporary changes apply for all Medica members and are effective from April 2, 2020, through May 31, 2020, dates of service. We are suspending prior authorization requirements to a post-acute care setting, so no prior authorization is needed for admission to the following facilities:
- Acute inpatient rehabilitation (AIR)
- Skilled nursing facilities (SNFs)
- Home health care
Consistent with existing policy,
the admitting provider should continue to notify Medica within 48 hours, and length-of-stay reviews still apply
, including denials for days that exceed an approved length. Concurrent review will also continue.
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
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.
In response to the COVID-19 Coronavirus, Molina Healthcare of Florida will be implementing the following measure:
Prior Authorization Requirements
In compliance with State Policy, Prior Authorization requirements will be lifted for Medically Necessary services provided by: Hospitals, Home Health Agencies, DME and suppliers, Physicians, ARNPs, PAs, SNF's, and Long Term Acute Care Hospitals for all members, under all lines of business until further notice. Prior Authorization requirements will be lifted for all medically necessary services related to the evaluation and treatment of COVID-19 provided by ALL providers, under all lines of business until further notice.
Referral requirement to participating specialists will also be lifted.
Molina has clarified that the authorization process for Medicare Advantage and Commercial plans remains intact and prior authorizations are still required; the previous update was an error and the authorization process only applied to Medicaid/MMA patients.
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 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.
This applies to both in and out of network providers.
(This applies to Florida ONLY)
To reduce administrative burden on key providers that are on the frontline serving that populations most impacted by COVID-19, Staywell is waiving initial and ongoing prior authorization requirements for medically necessary SNF's, Home Health, DME and supplies.
Staywell is waiving prior authorization requirements for all services (except pharmacy services) necessary to appropriately evaluate and treat members diagnosed with COVID-19. Please refer to official diagnosis coding guidelines that have been published by the
Staywell has lifted the authorization process but technically are still requiring that an authorization be registered in their system for claims to process. Currently, Staywell is approving all SNF authorization requests that come across, so there will not be a delay. They are requiring an authorization be in place for tracking continuity of care concerns and processing of claims. Please read the below link, page ‘COVID19 Payment exception process”.
Sunshine is waiving Prior authorization for all members for these services: medically necessary hospital services, physician services, advanced practice registered nursing services, physician assistant services, home health services, skilled nursing facilities, long term acute care hospital and durable medical equipment and
The following provisions are effective March 24, 2020:
- Suspension of Prior Authorization requirements to a post-acute care setting through May 31,2020
- Waiving prior authorization for admissions to: long-term care acute facilities (LTAC), acute inpatient rehabilitation (AIR), and skilled nursing facilities (SNF).
- Consistent with existing policy, the admitting provider must notify us within 48 hours of transfer and penalties still apply.
- Length of stay reviews still apply, including denials for days that exceed approved length.
- Discharges to home health will not require prior authorization.
The admitting provider must notify United Healthcare within 48 hours of transfer or penalties still apply.
This applies to in or out of network SNFs; out of network SNF will still be considered out of network unless a GAP request is initiated due to lack of providers in an area.
Please see the link below for additional details.
The provisions listed below are effective immediately and will remain in effect until May 31, 2020.
Skilled Nursing Facilities:
- Consistent with existing policy, the admitting provider must notify within 48 hours.
- WellMed will automatically approve initial requests for all SNF providers and automatically approve up to 5 days for per diem facilities
- Maintain and review of subsequent days
- Waive qualifying hospital stay requirement
- Waive new benefit period requirement to renew SNF coverage when benefits are exhausted.
- Please contact your market WellMed Inpatient Case Manager for discharge planning needs.
- All prior authorizations requirements are suspended through May 31, 2020 for Home Health Agencies
- DME: Lost, destroyed, irreparably damaged, or otherwise rendered unusable - waive replacement requirements such that the face-to-face requirement, a new physician's order, and new medical necessity documentation are not required.
WellMed reserves the right to update these provisions based on continued developments related to the State of Emergency for COVID-19 and direction from any applicable regulatory agency.