Happy New Year!  Florida Medicaid Update

As FAHCS was promised by AHCA, please find the revised list below...

Florida Medicaid Health Care Alert
(December 27, 2023)

Provider Type(s): 20, 25, 26, 90

NEW Durable Medicaid Equipment and Medical Supply Services Coverage Policies

The Florida Agency for Health Care Administration (Agency) has filed six (6) new Durable Medical Equipment and Medical Supply Services Coverage Policies for adoption in the Florida Administrative Code (F.A.C.). These new policies will take effect January 10, 2024. The new policy numbers and names are as follows:

• Rule 59G–4.072 - Durable Medical Equipment and Medical Supply Services: Specialized
• Rule 59G–4.073 – Durable Medical Equipment and Medical Supply Services: Orthotic and Prosthetic
• Rule 59G–4.074 – Durable Medical Equipment and Medical Supply Services: Respiratory
• Rule 59G-4.075 – Durable Medical Equipment and Medical Supply Services: Wheelchairs, Hospital Beds, and Ambulatory Aids
• Rule 59G-4.076 – Durable Medical Equipment and Medical Supply Services: Continence, Ostomy, and Wound Care
• Rule 59G-4.077 – Durable Medical Equipment and Medical Supply Services: Enteral and Parenteral Nutrition

Changes to Incontinence Supply Coverage

The new Florida Medicaid Durable Medical Equipment and Medical Supply Services: Continence, Ostomy, and Wound Care Coverage Policy, incorporated by reference in Rule 59G-4.076, F.A.C., contains updates to the Agency’s coverage of incontinence supplies.

As initiated on August 29, 2023 through rulemaking and effective January 10, 2024, providers can bill for incontinence supplies provided to Medicaid recipients ages four (4) and above that are determined medically necessary in accordance with Agency policy, using the codes and rates as listed on the Durable Medical Equipment and Medical Supply Services Provider Fee Schedule. Once posted, the 2024 Durable Medical Equipment and Medical Supply Services Provider Fee Schedule will include updated language to align with the incontinence supplies coverage changes promulgated in Rule 59G-4.076, Durable Medical Equipment and Medical Supply Services: Continence, Ostomy, and Wound Care Coverage Policy.

Please visit the Agency’s website at  Adopted Rules - Main Page (myflorida.com) for details on the new Durable Medical Equipment and Medical Supply Services Coverage Policies.

Changes to Diabetic Supply Coverage

As first noticed in the Florida Medicaid Health Care Alert sent March 30, 2023, the Agency for Health Care Administration (Agency) has been working on modifying the way diabetic supplies are provided to Floridians served through the State’s Medicaid program by transitioning reimbursement for diabetic supplies from the durable medical equipment (DME) fee schedule to the pharmacy point of sale system.  The Agency continues to work with stakeholders on implementing these changes and plans to complete this transition in the coming months.

As part of the implementation process, the Agency plans to release the Preferred Product List as referenced inproposed rule 59G-4.250, along with a resource toolkit to assist providers with billing for diabetic supplies through the pharmacy point of sale system, including answers to frequently asked questions and information on how to seek additional support when needed.

Until further direction is given, the Agency will continue to reimburse DME providers for all currently available diabetic supplies listed on the Durable Medical Equipment and Medical Supply Services Provider Fee Schedule using the existing reimbursement process. 

All interested parties should continue to check the Agency’s Pharmacy Policywebpage periodically and read all Agency alerts that are sent out regarding these changes. Interested Parties may also email the Agency at PharmacyPolicy@ahca.myflorida.com with any questions.

QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com

COMPLAINTS OR ISSUES? ON LINE

http://ahca.myflorida.com/Medicaid/complaints/ | CALL 1-877-254-1055

 The Agency for Health Care Administration is committed to its mission of providing "Better Health Care for All Floridians." The Agency administers Florida’s Medicaid program, licenses and regulates more than 48,000 health care facilities and 47 health maintenance organizations, and publishes health care data and statistics at www.FloridaHealthFinder.gov. Additional information about Agency initiatives is available via Facebook (AHCAFlorida), Twitter (@AHCA_FL) and YouTube(/AHCAFlorida)