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Utilization Management/Prior Authorization
In February of 2020, the Florida Department of Health declared a public health emergency resulting from the COVID-19 virus.
On March 9, 2020, Governor Ron DeSantis issued Executive Order Number 20-52 declaring a state of emergency related to the 2019 novel coronavirus (COVID-19). During this state of emergency, Florida Community Care (FCC) is committed to ensure there are no gaps in care for its Medicaid enrollees, while implementing procedures and the use of routine screenings to prevent further spread of COVID-19. As a resulting, we are following the Agency for Health Care Administration (AHCA)guidance on provider payment and authorization requirements.
FCC’s payment provisions include the following:
For additional information, please click on the link below to view the payment provision notice.
Consistent with Phase 2 of Governor Ron DeSantis’ Plan for Florida’s Recovery, the Agency is reinstating prior authorization requirements for the following Florida Medicaid services that were waived in response to COVID-19:
Florida Community Care (FCC) is implementing this change effective for dates of service on or after June 19, 2020 when prior authorization is required for the service.
For more information on the Agency’s efforts related to COVID-19, please visit: http://ahca.myflorida.com/covid-19_alerts.shtml.
All CMS Benefit Policy Manuals
CMS Coverage Determination Part 1
CMS Manual System- Home Health Certification & Recertification Policy Changes
FCC Inpatient Interim Billing Policy
How to Use the Medicare Coverage Database
Local Coverage Article Manual Wheelchair Bases
Local Coverage Determination (LCD); Canes & Crutches
Local Coverage Determination (LCD); Commode Chair
Local Coverage Determination (LCD); Home Health Plans of Care; Monitoring Glucose in the Medicare Home Health Population with Type II Diabetes Mellitus
Local Coverage Determination (LCD); Hospital Beds & Accessories
Local Coverage Determination (LCD); Oxygen & Oxygen equipment
Local Coverage Determination (LCD); Patient Lifts
Local Coverage Determination (LCD); Pressure Reducing Support Surfaces – Group 1
Local Coverage Determination (LCD); Walker
Medicare Benefit Policy Manual- Chapter 15 (Covered Medical and Other Health Services)
Medicare Benefit Policy Manual- Chapter 7 (Home Health Services)
Medicare Benefit Policy Manual- Chapter 8 (SNF-Coverage of Extended Care)
Medicare Benefit Policy Manual- Chapter 9 (Coverage of Hospice Services Under Hospital Insurance)
Case Management Authorizations:
If you are a long-term care provider that needs authorization please contact your case manager or call FCC at 1-833-FCC-PLAN Ext. 2
The Availity Portal offers health care professionals free access to real-time information and confirmation of claims submissions.