State Asked To Waive Medicaid Authorization Rules

Jul 9, 2020

As the number of patients hospitalized with COVID-19 increases, Florida hospitals are asking the state to waive rules that require managed-care organizations to authorize care before it can be delivered to Medicaid beneficiaries.

In a phone call with Gov. Ron DeSantis’ top health care regulators this week, Dawn White, vice president of government and community relations for Baptist Health South Florida, asked whether the state would consider waiving Medicaid prior-authorization rules as Florida sees thousands of new COVID-19 cases each day.

“We find it would be very helpful to us as we try to move patients around. In some cases, it can cut two to three, even longer, in terms of days, that we’re waiting,” White said.

Agency for Health Care Administration Deputy Secretary Molly McKinstry, who attended the meeting in place of AHCA Secretary Mary Mayhew, didn’t directly answer the question. She asked White to send her an email naming the Medicaid managed-care plan that the hospital was having issues with.

“I know that we have handled some issues on the Medicaid side,” McKinstry said. “It may not be the payors that you are having challenges with.”

On March 16, AHCA sent an announcement to all Medicaid providers notifying them it was waiving prior-authorization requirements for medically necessary hospital services, physician services, advanced practice registered nursing services, physician assistant services, home health services and durable medical equipment and supplies “in order to reduce administrative burdens on key providers that are on the front line serving the populations most impacted by COVID-19.”

Additionally, the announcement said it was waiving the requirements for “prior authorization for all services (except pharmacy) necessary to appropriately evaluate and treat Medicaid recipients diagnosed with COVID-19.”

Another advisory was sent May 1 reiterating that prior authorization requirements had been waived. AHCA notified providers the following month that the prior authorization requirements would be in effect again beginning June 19, with the exception of behavioral health.