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Updates Regarding Temporary Flexibilities Due to Severe Weather

Date: 11/09/22

Fort Lauderdale, Florida

Hurricane Nicole

Prior Authorization and Early Prescription Changes

To support providers and help keep our members safe through the storm, Sunshine Health is waiving all prior authorization requirements for critical Medicaid services in impacted counties, beginning November 9, 2022, until further notice. Additionally:

  • 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 limits stated in policy to maintain safety and health, providers can furnish the service.

These guidelines apply to all Medicaid products, including MMA, Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI), Children’s Medical Services (CMS) Health Plan and Long Term Care (LTC).

Additional information for providers is located on AHCA’s website.

Facility Reporting Requests

This is a reminder for all healthcare providers to report their statuses for the storm regarding census, available beds, evacuation status and generator status into the Health Facility Reporting System by 10 a.m. Eastern daily.

If you require assistance reporting information into the system for your facility, please get in touch with your AHCA licensing unit during regular business hours from 8 a.m. to 5 p.m. Eastern.

  • Assisted Living Unit: 1-850-412-4304
  • Laboratory and In-Home Services Unit: 1-850-412-4500
  • Hospital and Outpatient Services Unit: 1-850-412-4549
  • Long Term Care Services Unit: 1-850-412-4303

Hurricane Ian

For Medicaid, Child Welfare Specialty Plan (CWSP), Serious Mental Illness (SMI), Children’s Medical Services (CMS) Health Plan and Long Term Care (LTC)

As part of Sunshine Health's continued support for our providers and members in the aftermath of Hurricane Ian, we are following the Agency for Health Care Administration's (AHCA's) updated guidance for prior authorization process flexibilities on critical services in impacted areas for the lines of business listed above.

Effective immediately per AHCA's guidance provided on November 3, 2022, prior authorization process flexibilities will continue through the Disaster Grace Period (September 29, 2022, through November 30, 2022) for only the counties designated by FEMA for Hurricane Disaster. Please find the list of counties and additional information in this Agency for Health Care Administration bulletin.

For medical services in non-impacted areas, we are now following standard prior authorization processes.  

This guidance is subject to change based upon information we receive from the state.

For Medicare (Wellcare and Wellcare by Allwell) and Marketplace (Ambetter)

Please submit prior authorizations as needed for the lines of business listed above per our pre-storm process. 

We will continue to work with providers in impacted counties to ensure our members are receiving the care they need.

Sunshine Health requests facilities continue to notify the health plan of member admission so we can help support member needs and safety.

We will continue to communicate updates to you as soon as they're available from AHCA. Thank you for serving our members every day.