COVID-19 Information Page

**Attention ALL Medicaid and CHIP Providers**

Please be advised that the U.S. Department of Health and Human Services (HHS) has announced additional distributions from the Provider Relief Fund to eligible providers that participate in the Medicaid and Children’s Health Insurance Programs.

Please review the Provider Relief Funding Information announcement that was sent via fax blast to all providers on 06/19/2020 for more information regarding the upcoming HHS webinars and funding overview details: 

Provider Relief Funding Announcement: 

https://www.aetnabetterhealth.com/florida/assets/pdf/provider/ABHFL_Provider_Relief_Funding_Information_FaxBlast_06.2020.pdf

 

Prior Authorization Requirements – Effective June 19, 2020

Consistent with Phase 2 of Governor Ron DeSantis’ Plan for Florida's Recovery, Aetna Better Health of Florida (ABHFL) is reinstating prior authorization requirements for the following Florida Medicaid services that were waived in response to COVID-19:

  • Hospital services (including long-term care hospitals)
  • Nursing facility services
  • Physician services
  • Advanced practice registered nursing services
  • Physician assistant services
  • Home health services
  • Ambulance transportation
  • Durable medical equipment and supplies

This change is effective for dates of service on or after June 19, 2020 when prior authorization is required for the service. This change applies in both the fee-for-service and the managed care delivery systems.

Behavioral Health Exception

Aetna Better Health of Florida (ABHFL) will continue to waive prior authorization requirements and services limits (frequency and duration) for Medicaid-covered behavioral health services covered. This includes community behavioral health services, inpatient behavioral health services, and targeted case management services. ABHFL will continue this flexibility until further notice.

Florida Healthy Kids Exception

Aetna Better Health of Florida (ABFHL) will continue to waive copayments through July 31, 2020.

 

Provider Payment Provisions Related to COVID-19 

  • During the state of emergency, providers not already enrolled in Florida Medicaid (including out of state providers and providers not licensed in Florida) must complete the Agency’s provisional (temporary) enrollment process to obtain a provider identification number to be reimbursed for medically necessary services provided to members diagnosed with COVID-19. The process for provisional provider enrollment is available at http://www.mymedicaid-florida.com.

  • Aetna will implement a claims payment exceptions process for reimbursement of any medically necessary service furnished during the period of the state of emergency that normally would have required prior authorization, that were rendered by a non-participating provider, or that exceeded coverage limits for the service.

We will require notification if exceeding coverage limits as specified in the service-specific coverage policy and fee schedule. Please submit the following information:

  • Member Name
  • Member ID
  • CPT codes being exceeded or not present on fee schedule
  • ICD 10 code
  • Rendering NPI number
  • Any additional supplemental clinical documentation in support of exceeding coverage limits for the service

Please fax this information to 860-607-8056.

Please note: Aetna’s definition of medically necessary is defined in the AHCA service-specific policies which may be found here: https://ahca.myflorida.com/medicaid/review/specific_policy.shtml

  • If you have any questions regarding the exceptional claims process, please feel free to contact us via e-mail: FLMedicaidProviderRelations@Aetna.com. You can also fax us at 1-844-235-1340 or call us through our Provider Relations telephone line: 1-844-528-5815.
  • We will be following the guidance from AHCA as outlined in the Policy Transmittals below:

PT 2020-39:  COVID-19 State of Emergency: Hospital Transfer Requirements

PT 2020-35:  COVID-19 State of Emergency: Prior Authorization Reinstatement

PT 2020-34:  COVID-19 State of Emergency: Well-Child Visits Provided via Telemedicine

PT 2020-31: COVID-19 State of Emergency: Behavioral Health Service Requirements

PT 2020-30: COVID-19 Public Health Emergency: Adult Day Care (ADC) Retainer Payments

PT 2020-26: COVID-19 State-of-Emergency: COVID-19 Laboratory Testing

PT 2020-25: COVID-19 State-of-Emergency: Behavioral Health Telemedicine/Telehealth Requirements

PT 2020-24: COVID-19 State of Emergency: Prior Authorization and Claims Payment Requirements

PT 2020-23: COVID-19 State-of-Emergency: Coverage of Non-Emergency Ambulance

PT 2020-20: COVID-19 State of Emergency: Telemedicine Services

PT 2020-18: COVID-19 State of Emergency: Coverage of Services and Other Provisions

PT 2020-17: COVID-19 State of Emergency: Non-Urgent and Non-Emergent Services (Transportation)

PT 2020-16: COVID-19 State of Emergency: Temporary Expansion of Long-Term Care Provider Qualifications

PT 2020-15: COVID-19 State of Emergency: Coverage of Services

PT 2020-14: COVID-19 State of Emergency: Medicaid Coverage of Laboratory Testing, Guidance for NEMT Brokers and Providers, and Managed Care Plan Provider Credentialing

PT 2020-12: Guidance on the COVID-19 State of Emergency

 

Long-Term Care Provider Network Flexibilities During the State of Emergency Related to COVID-19

To provide greater workforce flexibility to Florida long-term care providers on the frontlines and provide continuation of services to LTC enrollees during the 2019 novel coronavirus (COVID-19) state of emergency, Aetna Better Health of Florida is expanding the provider types eligible to render LTC services.

The following service providers are temporarily eligible to render additional LTC services in the member’s home during the state of emergency:

  • Adult Day Care Centers: medication administration, medication management, adult companion, attendant care, intermittent and skilled nursing, home delivered meals, and personal care services
  • Independent Registered Nurses: homemaker, adult companion, intermittent and skilled nursing, and personal care services
  • Independent Licensed Practical Nurses: homemaker, adult companion, intermittent and skilled nursing, and personal care services
  • Community Care for the Elderly Providers: transportation, attendant care, intermittent and skilled nursing, and medical equipment and supply services
  • Nurse Registries: intermittent and skilled nursing, behavior management services
  • Older Americans Act Providers: adult companion and personal care services
  • Health Care Service Pools: attendant care, intermittent and skilled nursing, personal care, and respite services
  • Centers for Independent Living: intermittent and skilled nursing services

Providers must be authorized by Aetna Better Health of Florida before providing these services to members. Providers must contact the member’s LTC case manager to initiate the pre-screening process so that Aetna Better Health of Florida can ensure the provider is qualified to provide the service in the member’s home.

If the member’s case manager is unavailable, providers may contact the health plan directly at 1-844-645-7371.