Disaster Grace Period for Hurricane Ian: 9/29/22 through 11/30/22

Important provider information regarding reimbursement for services rendered to AmeriHealth Caritas Florida members impacted by Hurricane Ian.

Updated 11/10/22

The purpose of this alert is to provide an update to the previous provider alert issued on 9/27/22 regards Hurricane Ian. 

As of 9/29/22, the Federal Emergency Management Agency (FEMA) issued a major disaster declaration for the following Florida counties affected by Hurricane Ian (DR-4673 [fema.gov]): Brevard, Charlotte, Collier, DeSoto, Flagler, Glades, Hardee, Hendry, Highlands, Hillsborough, Lake, Lee, Manatee, Monroe, Okeechobee, Orange, Osceola, Palm Beach, Pasco, Pinellas, Polk, Putnam, Sarasota, Seminole, St. Johns, and Volusia.

AmeriHealth Caritas Florida will ensure reimbursement for all services provided in good faith to eligible Florida Medicaid recipients in FEMA designated counties during the Disaster Grace Period. The Agency for Health Care Administration (Agency) is defining the Disaster Grace Period for Hurricane Ian as 9/29/22 through 11/30/22.

All updates in this alert apply ONLY to the FEMA designated counties.

Section A of this alert provides updated policy information and applies to providers rendering services through both the fee-for-service (FFS) delivery system and the Statewide Medicaid Managed Care (SMMC) program, unless otherwise stated.

Section B of this alert provides reimbursement and payment information and applies to services rendered in the FFS delivery system, unless otherwise specified.

Section C of this alert provides additional resources and contact information.

Section A: Policy Information

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Services Provided During the Disaster Grace Period

AmeriHealth Caritas Florida will furnish all Medicaid services during the Disaster Grace Period for enrollees whose permanent address is in the FEMA designated disaster area.

Prior Authorization Requirements:

  • AmeriHealth Caritas Florida will waive all prior authorization requirements for Medicaid services with dates of service during the Disaster Grace Period.
  • Exception: all prior authorizations for pharmacy services remain intact.

Limits on Services:

  • AmeriHealth Caritas Florida will waive limits on services (specifically related to frequency, duration, and scope) that were exceeded in order to maintain the health and safety of recipients for dates of service during the Disaster Grace Period. This applies to all AmeriHealth Caritas Florida enrollees, whether or not the enrollee has temporarily relocated to a different region or state.
    • AmeriHealth Caritas Florida lifted all limits on early prescription refills during the disaster grace period for maintenance medications, with the exception of controlled substances. The edits prohibiting early prescription refills will remain lifted until further notice by the Agency.
    • AmeriHealth Caritas Florida participating pharmacy providers may provide mobile pharmacy services, when provided in accordance with Department of Health Emergency Order 22-003 [floridahealth.gov].
    • AmeriHealth Caritas Florida transportation providers will receive reimbursement for transportation of eligible recipients to medical services, such as chemotherapy and dialysis and inter-facility transfers, when the facilities providing those services remain available. Transportation providers will receive reimbursement for eligible recipients to shelters and other temporary housing when they are displaced from the storm during the Disaster Grace Period.

Provisional Enrollment:

  • In order to be reimbursed for services rendered to eligible AmeriHealth Caritas Florida recipients on the dates of service in the Disaster Grace Period, providers not already enrolled in AmeriHealth Caritas Florida (out-of-state or in-state) must complete a provisional (temporary) enrollment application. The process for provisional provider enrollment is located at http://www.mymedicaid-florida.com.
  • AmeriHealth Caritas Florida enrollees are able to see non-participating providers if the enrollee has a permanent address in a FEMA declared disaster area and are unable to access covered services from a participating provider.

Waived Enrollment for Prescribing Providers Pharmacy:

To ensure the provision of prescribed drug services in the FEMA designated counties, the managed care plan must reimburse for services provided by a mobile pharmacy, when all requirements in the Department of Health Emergency Order 22-003 are met and when the mobile pharmacy is one of the following:

  • A participating pharmacy provider in the plan’s network and is known to Florida Medicaid (e.g., Walgreens, CVS, etc.).
  • A non-participating provider in the plan’s network but is currently a Medicare participating pharmacy provider and is provisionally (temporarily) enrolled in the Florida Medicaid program.
  • Enrollment is waived for providers not already enrolled in AmeriHealth Caritas Florida (out-of-state or in-state) to prescribe non-controlled substances during the Disaster Grace Period if the prescribing provider:
  1. holds a clear and active license
  2. holds a clear and active National Provider Identification (NPI) number
  3. provides services within their scope of practice

Services Provided Outside of the Disaster Grace Period:

  • For dates of service beginning 12/01/22, AmeriHealth Caritas Florida will return to normal business operations as it relates to the coverage and reimbursement of Medicaid services, except as described below:
    • AmeriHealth Caritas Florida will continue to reimburse for services furnished after the Disaster Grace Period without prior authorization and without regard to service limitations or whether such services are provided by a current AmeriHealth Caritas Florida enrolled provider in those instances where the provider and/or recipient could not comply with policy requirements because of ongoing storm-related impacts. Providers must have rendered services in good faith to maintain the recipient’s health and safety. Examples of such instances include:
      • The provider still does not have access to the Internet or phone services as a result of continued power outages, therefore could not request prior authorization timely;
      • The recipient continues to be displaced and must receive services in a different region of the state or out-of-state; or
      • The recipient’s assigned primary care physician or specialist’s office remains closed due to the storm and urgent care is rendered at another provider’s location without prior authorization.

Section B: Reimbursement Information

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AmeriHealth Caritas Florida has a claims payment exceptions process (PDF) for any medically necessary services furnished during the Disaster Grace Period that normally would have required prior authorization, that were rendered by a non-participating provider, or that exceeded normal policy limits for the service.

Providers that wish to receive payment for services rendered during and outside of the disaster grace period are required to be enrolled with AmeriHealth Caritas Florida or provisionally enrolled with AmeriHealth Caritas Florida prior to submitting claims. For services provided to recipients receiving services through AmeriHealth Caritas Florida, provisional providers should submit claims in accordance with the instructions located at: www.amerihealthcaritasfl.com/provider/claims-and-billing/index.

Providers Currently Enrolled with AmeriHealth Caritas Florida

Providers that furnished services to recipients AmeriHealth Caritas Florida must comply with the requirements below:

  • For services provided during the Disaster Grace Period, providers may submit electronic claims in accordance with normal HIPAA compliant transaction requirements if the service requires a prior authorization number, but prior authorization was not obtained.
  • For services provided during the Disaster Grace Period, providers may submit paper claims as described in AmeriHealth Caritas Florida claims payment exceptions process (PDF) if:
    1. the provider cannot submit electronic claims because of storm-related impacts - or -
    2. service limitations exceeded those stated in the coverage policy or the respective fee schedule.
  • For services provided outside of the Disaster Grace Period because of storm-related impacts, providers may submit paper claims as described in AmeriHealth Caritas Florida claims payment exceptions process (PDF).
  • For services beginning December 1, 2022, AmeriHealth Caritas Florida will return to normal business operations for coverage and reimbursement of services with the following exceptions:
      • AmeriHealth Caritas Florida will suspend early refill edits according to the regulation 252.358, F.S., governing the suspension of early refill edits.
      • AmeriHealth Caritas Florida will expedite the authorization processes (as described in Attachment II, Section VI.G.) for new authorization requests for durable medical equipment and supplies (DME) and home health services.
      • AmeriHealth Caritas Florida will reimburse for services furnished outside of the Disaster Grace Period without prior authorization and without regard to service limitations or whether such services are provided by a participating provider in those instances where the provider and/or enrollee could not comply with policy requirements because of storm-related impacts. Providers must have rendered services in good faith to maintain the recipient’s health and safety. Examples of such instances include:
          • The provider still does not have access to the Internet or phone services as a result of continued power outages, therefore could not request prior authorization timely;
          • The enrollee continues to be displaced and must receive services in a different region of the state or out-of-state; or
          • The enrollee’s assigned primary care physician or specialist’s office remains closed due to the hurricane and urgent care is rendered at another provider’s location without prior authorization.

Reimbursement Rates (for services provided during the disaster grace period)

  • AmeriHealth Caritas Florida will reimburse for services provided in accordance with the rates established on the Medicaid fee schedules and the provider reimbursement rates/reimbursement methodologies published on the Agency’s web page. This applies to current enrolled providers and providers that complete the provisional enrollment process.
    • The Agency’s web page includes links to the Diagnosis-Related Groups (DRG) and Enhanced Ambulatory Patient Grouping (EAPG) System rate calculator, which provisionally-enrolled providers can utilize.
  • AmeriHealth Caritas Florida will reimburse participating network providers for services provided at the rates mutually agreed upon by the provider and the plan in their contract/agreement. AmeriHealth Caritas Florida will reimburse non-participating providers for services provided in accordance with the rates established on the Medicaid fee schedules and the provider reimbursement rates/reimbursement methodologies published on the Agency’s web page, unless otherwise mutually agreed upon by the provider and AmeriHealth Caritas Florida and otherwise permitted under the contract.

Section C. Additional Information

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Agency’s Hurricane Ian Info

  • Additional information for providers is located on the Agency’s website, http://www.ahca.myflorida.com  [ahca.myflorida.com]. Click on the Hurricane banner at the top of the page for more information.

Medicaid Contact Center

  • Additional questions from providers may be directed to the Florida Medicaid Contact Center at 1-877-254-1055.

AmeriHealth Caritas Florida