Medicaid Providers

Temporary Medicaid Prior Authorization Waivers will expire for Behavioral Health Treatment Services on July 1, 2021

As we continue to address the COVID-19 pandemic, we want to update you on important changes for our Medicaid plans.

In response to the novel coronavirus (COVID-19) state of emergency, the Agency for Health Care Administration required Medicaid Managed Care Plans in 2020 to temporarily waive prior authorization requirements and services limits (frequency and duration) for behavioral health services (this includes targeted case management services) covered under the Medicaid program.

Staywell Health Plan instituted a temporary waiver of prior authorization for all inpatient and outpatient behavioral health services to ensure that critical care could be quickly delivered to our members during a time of heightened need. This temporary waiver also applies to Children's Medical Services Health Plan.

On June 18, 2021, AHCA issued Policy Transmittal 2021-20 which ended the temporary flexibilities granted during the COVID-19 state of emergency.

Starting July 15, 2021, these temporary waivers will expire, and our members' Medicaid plan benefits will be reinstated for the following services:

COVID-19 Treatment Related Services

• COVID-19 treatment related services (those billed with a confirmed ICD-10 diagnosis code) will continue to be eligible for coverage at this time, in accordance with the member’s plan benefits.

• Any services that can be delivered virtually, including Behavioral Health, will continue to be eligible for telehealth coverage at this time.
• Providers should reflect telehealth care on their claim form by following standard telehealth billing protocols in their state.
• For further coding guidance for telehealth services, we recommend following what is being published by:
  • Department of Health and Human Services (HHS)
  • American Medical Association (AMA)

  Behavioral Health Services

  • Prior authorization will be reinstated for dates of services on or after July 15, 2021 for inpatient, higher level of care (like residential, PHP, IOP and In Lieu of Services) and for Children's Medical Services Health Plan (KidCare) Title 21 ABA services.
  • All traditional Medicaid outpatient services including PSR and TCM will not require prior authorization.
  • Service limits will be reinstated for dates of service on or after July 1, 2021 when applicable.
  • For ongoing services that began prior to July 15, 2021 that required no prior authorization will be continued without prior authorization for no more than 60 days after July 15, 2021 for both participating and non-participating providers.

  We are working in close partnership with state, local and federal authorities to serve and protect our members and communities during the COVID-19 pandemic, including ensuring that our providers have relevant and up-to-date information. We value your partnership during these unprecedented times.

  This guidance is in response to the current COVID-19 pandemic and may be retired at a future date. For further updates, please refer to Agency for Health Care Administration or AHCA's COVID-19 Medicaid Alerts.