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AHCA Updates Rules For Florida Medicaid’s Diabetic Supplies

Date: 12/18/24

The Agency for Healthcare Administration (AHCA) has updated the rules that govern diabetic supplies provided to patients via Florida Medicaid. Rule 59G-4.252, Diabetic Supply Services, Florida Administrative Code (FAC), took effect October 1, 2024. This rule incorporates the Florida Medicaid Diabetic Supply Services Coverage Policy, which can be found on AHCA’s Diabetic Supply Services page.

Here’s what providers need to know:

  • Effective October 1, 2024, diabetic supplies for all eligible Medicaid and Children Medical Services (CMS) recipients will be available for reimbursement through the pharmacy benefit at the point-of-sale.
  • Previously, these supplies were only available through the Durable Medical Equipment and Medical Supplies (DME) benefit.
  • To ensure continuity of care and enable recipients to receive the proper authorizations to transfer their diabetic supplies to the pharmacy benefit, reimbursement through the DME benefit will continue to be available until January 1, 2025.
  •  Effective January 1, 2025, almost all products available through the pharmacy benefit will no longer be reimbursed through the DME benefit. Please refer to the DME fee schedule, effective January 1, 2025, for products that may continue to be reimbursed through the DME benefit.

Please visit the Diabetic Supply Services page for more information.

If you need additional assistance, call the Florida Medicaid Provider Helpline at 1-877-254-1055.

Questions?

If you have any questions, please call Sunshine Health Provider Services at 1-844-477-8313 or visit the Secure Provider Portal. Our Provider Engagement staff can also answer questions. Visit the Find Your Account Manager tool to find who supports your specialty and region. Keep up with the latest Sunshine Health provider updates by reviewing and bookmarking Provider News.

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