Provider Bulletin. AETNA BETTER HEALTH OF FLORIDA 1340 Concord Terrace Sunrise FL, 33323

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1 AETNA BETTER HEALTH OF FLORIDA 1340 Concord Terrace Sunrise FL, Agency Transmittal Notice Hurricane Irma Grace Period for Services and PaymentFlorida Medicaid and LTSS Provider Bulletin Date: September 25, 2017 Dear Provider, The Agency for Health Care Administration (AHCA) released a policy transmittal pertaining to the services provided during the Hurricane Irma grace period from 9/7/17 through 9/21/17. Please read the Agency s notice that is attached to this communication. You may also find this notice through the following link: 18_Provision_and_Pmt_for_Services_Hurricane_Irma.pdf Aetna Better Health of Florida is grateful for the assistance, care and service that our community providers rendered to our enrollees before and during Hurricance Irma. Our intent is to be able to reimburse for these service with minimal administrative burden regardless of your participation status in our network. Aetna Better Health of Florida will institute a claims exception process as mandated by the Agency for the dates of services within the grace period noted above, including services provided as a part of pre storm evacuation process. In order for non participating and participating providers to get reimbursed for services provided during this period the following steps are required: Participating Providers Services normally not requiring an authorization should be billed following the standard claims submission process, there is no additional information required to process these claims Services requiring prior authorization will not be denied solely on the basis of not obtaining a prior authorization during the grace period; in order for these services to be reimbursed providers must submit a copy of the medical record for review In the request, please provide a point of contact in order to provide expedited authorization information Claims should be submitted through the regular claims submission process once the authorization number is provided; claims submitted without an authorization number are subject to delayed processing Appropriate benefits, billing and coding requirements continue to be applicable FL

2 FL Non Participating Providers Our claims system requires an authorization number and basic provider information in order to pay non participating provider claims Services that typically do not require a prior authorization for participating providers will only require notification and formal written request with essential clinical information. Non participating providers must provide the following information as part of the request: Contact information, Tax Identification Number, NPI Number, Service address, Medicaid number If you have questions regarding what services require prior authorization, please contact our Provider Relations Department through the number provided below For non participating providers who are not registered with the state of Florida or out of state providers who have provided services to our displaced members during the grace period, suchproviders should be registered with Medicaid. The Agency has provided instructions on theexpedited process for providers to enroll through their portal: fault.aspx#emergent?popup=n Providers may also contact our provider relations department for guidance and direction on how to begin the registration process Services that typically require an prior authorization will require the submission of a medical record along with the essential administrative information noted above Once an authorization number is issued the claims must be submitted to the following address: Aetna Better Health of Florida PO BOX Phoenix, AZ Payer ID 128FL When applicable participating and non participating Providers must submit medical records as described above to the following address: Aetna Better Health of Florida Attention: Medicaid Utilization Management Administration Hurricane Irma Expedited Records 1340 Concord Terrace Sunrise FL Should you have questions or require additional information, please contact Provider Relations at , FLMedicaidProviderRelations@aetna.com, or fax CONFIDENTIALITY NOTICE: This message is intended only for the user of the individual or entity to which it is addressed and may contain confidential and proprietary information. If you are not the intended recipient of the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is prohibited. If you received this communication in error, please notify the sender at the phone number above. NOTICE TO RECIPIENT(S) OF INFORMATION: Information disclosed to you pertaining to alcohol or drug abuse treatment is protected by federal confidentiality rules (42 CFR Part 2), which prohibit any further disclosure of this information by you without express written consent of the person to whom it pertains of as otherwise permitted by 42 CFR Part 2. A general authorization for the release of medical or other information is NOT sufficient for this purpose. The federal rules restrict any use of the information to criminally investigate or prosecute any alcohol or drug abuse patient.

3 RICK SCOTT GOVERNOR JUSTIN M. SENIOR SECRETARY Statewide Medicaid Managed Care (SMMC) Policy Transmittal Policy Transmittal: Applicable to: Comprehensive Long-term Care (LTC) Plan Managed Medical Assistance Health Maintenance Organization Managed Medical Assistance Provider Service Network Managed Medical Assistance Specialty Plan Children s Medical Services (CMS) Plan Applicable to enrollees in: Managed Medical Assistance (MMA) Long-term Care (LTC) Re: Provision of and Payment for Services During and Outside the Disaster Grace Period for Hurricane Irma The purpose of this policy transmittal is to notify the managed care plan of requirements for continuity and payment of services during and outside of the disaster grace period for Hurricane Irma. Section (s.) , Florida Statutes (F.S.), defines a disaster as: [A]ny natural, technological, or civil emergency that causes damage of sufficient severity and magnitude to result in a declaration of a state of emergency by a county, the Governor, or the President of the United States. For the purposes of this policy transmittal, the Agency is defining the disaster grace period for Hurricane Irma as 12:01 a.m. on September 7, 2017 through 11:59 p.m. on September 21, Requirements During the Disaster Grace Period The managed care plan must furnish covered services to an enrollee during the disaster grace period: Without any form of authorization; Without regard to whether such services are provided by a participating or nonparticipating provider; and Without regard to service limitations Mah an Dri ve Mail S top #8 Tallahassee, FL AHCA.MyFl ori da.com Facebo ok.com /AHCAFlorida Youtub e.com /AHCAFlori da T witter.com /AHCA_FL SlideShar e.net/ahcaflorida

4 Medicaid Managed Care (SMMC) Policy Transmittal Re: Provision of Services During and After the Disaster Grace Period for Hurricane Irma Page 2 of 3 The managed care plan must ensure that providers not known to Florida Medicaid that rendered services during the disaster grace period complete the Agency s provisional (temporary) enrollment process to obtain a provider identification number. The managed care plan must reimburse non-participating providers at the rates established in the applicable Medicaid fee schedules incorporated by reference in Rule 59G-4.002, F.A.C. and the provider reimbursement rates/reimbursement methodologies published on the Agency s web page for services rendered to the enrollee during the disaster grace period, unless other rates are mutually agreed upon by the provider and the managed care plan. Requirements Outside the Disaster Grace Period Beginning Friday, September 22, 2017, the managed care plan may resume its normal operations, except as specified below: Managed care plans licensed by the Office of Insurance Regulation must comply with s , F.S., governing the suspension of early refill edits. The managed care plan must implement expedited authorization processes (as described in Attachment II, Section VII.G.) for new authorization requests submitted beginning September 22, 2017 through September 30, 2017, for durable medical equipment and supplies (DME) and home health services. The managed care plan must reimburse for services furnished outside of the disaster grace period without prior authorization and without regard to service limitations or whether such services are provided by a participating provider in those instances where the provider and/or enrollee could not comply with policy requirements because of storm-related impacts. Services provided before the disaster grace period qualifying under this provision must be attributable to early evacuations in parts of the state which resulted in the enrollee receiving care in a different region or out-of-state. Claims Payment Exceptions Process The managed care plan must develop and implement a claims payment exceptions process for reimbursement of any medically necessary service furnished to impacted enrollees during and outside the disaster grace period that normally would have required prior authorization, that were rendered by a non-participating provider, or that exceeded normal policy limits for the service. The managed care plan s claims payment exceptions process must include the following minimum elements and be made publicly available on the managed care plan s website: Submission instructions for providers that include provider enrollment requirements, including waiver of non-applicable provider credentialing requirements; Minimum documentation requirements for managed care plan decision making; Claims submission requirements; and Telephone and contact information for a specific unit or division within the managed care plan that is familiar with the claims payment exceptions process for Hurricane Irma.

5 Medicaid Managed Care (SMMC) Policy Transmittal Re: Provision of Services During and After the Disaster Grace Period for Hurricane Irma Page 3 of 3 The managed care plan must post information related to Hurricane Irma and the exceptions process on its website. The managed care plan must provide a direct link to its Hurricane Irma web page to its Agency contract manager by September 25, If you have any questions, please contact your Agency contract manager at (850) Sincerely, SH/dp Shevaun Harris Assistant Deputy Secretary for Medicaid Policy and Quality