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Hurricane Milton: Important Information for Providers

Date: 10/08/24

(Updated November 21, 2024)

Sunshine Health is closely monitoring the ongoing storm and its impact on our communities. The safety and well-being of our members, providers and employees remain our top priority.

Medicaid Flexibilities

To support providers and help keep our members safe through Hurricane Milton, Sunshine Health is temporarily waiving all prior authorization requirements for critical Medicaid services in impacted counties for all Medicaid products: MMA, Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI), Children’s Medical Services Health Plan (CMS) and Long Term Care (LTC). These Medicaid-specific flexibilities began on October 7, 2024, and extend until December 4, 2024.

  • Prior authorization: Waived for critical medical services related to member safety in impacted areas.
  • Post acute services: Initial review and notification requirements are waived to ensure safe and timely transfers to lower levels of care.
  • Inpatient emergent: Prior authorization is not required for emergent inpatient admissions. Notification fof emergent admissions are waived at this time, and flexibility for continued stay requests is available for impacted areas. Non-emergent inpatient admissions or concurrent review is not considered a critical service as review of these authorizations is needed to assess level of care and support discharge planning needs.
  • Inpatient-to-inpatient transfer: Prior authorization is waived for transfers to higher levels of care, specialized services not available at current inpatient facility or transfer due to emergency impact (evacuation).

Early prescription refill edits have also been lifted for all maintenance medications (Note: This does not apply to controlled substances).

Additionally, if a recipient requires critical Medicaid services beyond limits stated in policy to maintain safety and health, providers can furnish the service.

All Preadmission Screening and Resident Review (PASRR) processes are postponed until further notice by the Agency for Health Care Administration (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.

Additional information for providers is located on the Agency’s website.

Marketplace and Medicare Flexibilities

Additionally, due to the severity of Hurricane Milton, Sunshine Health is extending temporary authorization flexibilities for our Marketplace and Medicare lines of business in 18 impacted counties: Charlotte, Citrus, Hernando, Hillsborough, Lake, Lee, Levy, Manatee, Marion, Orange, Osceola, Pasco, Pinellas, Polk, Sarasota, Seminole, St. Johns, and Volusia.

These flexibilities align with the Medicaid flexibilities and began on October 8, 2024, and will remain in effect through October 15, 2024.

We are extending authorization flexibilities described above for Pasco, Pinellas, Hillsborough, Manatee and Sarasota Counties through October 20, 2024.

Thank you for serving our members every day, and especially during this time.

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