On July 14, the Agency for Health Care Administration issued an updated Provider Alert on “Waiver of Prior Authorization Requirements for Hospital Transfers”. The Agency for Health Care Administration (Agency) is committed to ensuring that Medicaid recipients diagnosed with the 2019 novel coronavirus (COVID-19) receive all the care needed to address their symptoms. To facilitate prompt hospital discharges and to ensure adequate inpatient hospital capacity in response to COVID-19, Florida Medicaid is waiving service authorization requirements prior to admission for hospital transfers, including:
- inter-facility transfers:
- transfers to a long-term care hospital; and
- transfers to a nursing facility.
In addition, to facilitate non-emergency transportation services that may be needed to aid in these transfers, the Agency is waiving the need for prior authorization for non-emergency ambulance transportation services for hospital transfer scenarios as described above. This change applies to the fee-for-service and managed care delivery system. These provisions apply to enrollees being transferred from a hospital regardless of diagnosis (i.e., COVID-19 and non-COVID-19 patients). The Agency will continue this flexibility until further notice.
Statewide Medicaid Managed Care
- The waiver of prior authorization applies whether the receiving facility is a participating provider or non-participating provider in the health plan’s network.
- Health plans may require the receiving facility to notify the plan of the admission within forty-eight (48) hours of the admission. At that point, the plan may request additional clinical information to begin concurrent/continued stay reviews to facilitate care coordination and discharge planning.
Fee-for-Service Delivery System
For inter-facility hospital transfers (hospital to hospital), the receiving hospital facility will need to request a simple, administrative prior authorization through eQHealth Solutions to ensure streamlined reimbursement. Clinical reviews will not take place at this time.