Tropical Storm Debby — Medicaid Information for Fee-For-Service and Managed Care Providers

Florida Medicaid recipients maintaining access to critical Medicaid services (durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.) is imperative during the state of emergency related to Tropical Storm Debby. To this end, the Agency will ensure reimbursement for critical Medicaid services provided in good faith to eligible recipients who reside in the counties impacted by the storm.

State of Emergency — Order 24-157 — includes the following counties: 

Alachua, Baker, Bay, Bradford, Brevard, Calhoun, Charlotte, Citrus, Clay, Collier, Columbia, DeSoto, Dixie, Duval, Escambia, Flagler, Franklin, Gadsden, Gilchrist, Glades, Gulf, Hamilton, Hardee, Hendry, Hernando, Highlands, Hillsborough, Holmes, Jackson, Jefferson, Lafayette, Lake, Lee, Leon, Levy, Liberty, Madison, Manatee, Marion Monroe, Nassau, Okaloosa, Okeechobee, Orange, Osceola, Pasco, Pinellas, Polk, Putnam, Santa Rosa, Sarasota, Seminole, St. Johns, Sumter, Suwannee, Taylor, Union, Volusia, Wakulla, Walton, and Washington counties.

Please continue providing services:

  • The Agency will waive all prior authorization requirements for critical Medicaid services beginning August 4, 2024, until further notice.
    • Early prescription refill edits have been lifted for all maintenance medications (Note: This does not apply to controlled substances).
  • If a recipient requires critical Medicaid services beyond the limits stated in policy to maintain safety and health, providers can furnish the service.
  • Preadmission Screening and Resident Review (PASRR) processes are postponed until further notice by the Agency.
    • Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.
    • The Agency is waiving the PASRR process for recipients who evacuated due to an evacuation order or power outage and are admitted and discharged during the storm.
  • Transportation vendors should continue providing services to all Medicaid enrollees as long as they are able.

Claims payment details posted for 2024 Tropical Storm Debby

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

Reimbursement rates

  • 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.
Providers