AHCA Waiver Consolidation Notice

Date: 03/01/18

Sunrise, Florida

As you are likely aware, the Agency for Health Care Administration (AHCA) consolidated three waiver programs that offer services similar to the Statewide Medicaid Managed Care program. These waiver programs include: Project AIDS Care (PAC), Traumatic Brain Injury and Spinal Cord Injury (TBI/SCI) and Adult Cystic Fibrosis (ACF).

Sunshine Health has extensive experience in serving members with complex medical needs and looks forward to working with you to coordinate care for your patient(s). Your patient(s) will not lose access to needed medical services because of this transition. In fact, your patient(s) will have access to expanded benefits that were not offered as part of the waiver programs.

Sunshine Health is committed to ensuring our new members do not experience any break in services or care coordination while transitioning to our health plan. Here are a few important things to remember during this transition:

·         Claims: Providers should continue providing any services that were previously authorized, regardless of whether the provider is in Sunshine Health’s network. Sunshine Health will pay providers for previously authorized services for up to 60 days. Sunshine Health will pay non-network providers at the rate previously received for up to 30 days. After the first 30 days and until the end of the continuity of care phase, non-network providers will be paid 100% of the Medicaid fee schedule. After that, members must utilize a provider in Sunshine Health's network.

·         Prescriptions: New members previously in one of the three mentioned waiver programs may continue to receive their prescriptions through their current provider for up to 60 days. After that period, members must utilize a provider in Sunshine Health’s network.

Please see frequently asked questions for additional information about billing, authorizations and continuity of care issues.