FLORIDA UPDATES EVELYN LEADBETTER, MPA NETWORK SERVICES MANAGER HOMETOWN HEALTH - HTHU.net

FLORIDA UPDATES

    EVELYN LEADBETTER, MPA
NETWORK SERVICES MANAGER
        HOMETOWN HEALTH

WHEN WILL MY MEDICARE PATIENTS RECEIVE THEIR
CARDS?
Starting April 2018, CMS will begin mailing new
Medicare cards. For More Information:

• Mailing Strategy
• Questions from Patients? Guidelines
• New Medicare Card overview and provider webpages

Beginning in October 2018, through the transition period,
when providers submit a claim using a patient’s valid and
active Health Insurance Claim Number (HICN), CMS will
return both the HICN and the MBI on every remittance
advice.

WHEN WILL MY MEDICARE PATIENTS RECEIVE THEIR
CARDS?

Here are examples of different remittance advices:

• Medicare Remit Easy Print (Medicare Part B providers
  and suppliers)
• PC Print for Institutions
• Standard Paper Remits: FISS (Medicare Part
  A/Institutions), MCS (Medicare Part B/Professionals),
  VMS (Durable Medicare Equipment)

Find more new information on the New Medicare Card
provider webpage.

NOTIFICATION OF CHANGES MADE TO THE 270/271
HEALTH CARE ELIGIBILITY INQUIRY AND RESPONSE
COMPANION GUIDE
The following updates have been added to the 270/271 Eligibility Inquiry and
Response Companion Guide:

• Until 10/1/2018: the Health Insurance Claim Number, (HICN) will continue
  to be returned in the 271 response.
• Beginning 10/1/2018 -12/31/2019: the Medicare Beneficiary Identifier,
  (MBI) will be returned in the 271 response, if known to Florida Medicaid,
  otherwise the HICN will be returned.
• Beginning 1/1/2020: only the MBI will be returned on the 271 response, if
  the MBI is known to Florida Medicaid, otherwise spaces will be returned.

To review the modifications, please go to the Companion Guide’s page on
the Medicaid Web Portal at:
http://portal.flmmis.com/FLPublic/Provider_EDI/Provider_EDI_CompanionG
uides/tabId/62/Default.aspx.

CMS ACCEPTING PROPOSALS FOR NEW MEASURES
FOR THE MEDICARE EHR INCENTIVE PROGRAM
Submit a measure proposal submission form by June 29, 2018.

CMS is interested in adding measures that:

• Build on the advanced use of certified EHR technology
  (CEHRT) using 2015 Edition Standards and Certification
  Criteria;
• Increase health information exchange and interoperability;
• Continue improving program efficiency, effectiveness, and
  flexibility;
• Measure patient outcomes; and
• Emphasize patient safety.

Proposals must be sent to
CMSCallforMeasuresEHR@Ketchum.com.
Applicants will receive email confirmations of their submission.

FEBRUARY PATIENTS OVER PAPERWORK: CMS
CMS established an internal process to evaluate and
streamline regulations with a goal to reduce
unnecessary burden, to increase efficiencies, and to
improve the beneficiary experience. In carrying out
this internal process, CMS is moving the needle and
removing regulatory obstacles that get in the way of
providers spending time with patients.

Sign up for the Patients over Paperwork newsletter
here!

Review the February Issue

https://www.cdc.gov/flu/weekly/usmap.htm

http://www.floridahealth.gov/diseases-and-conditions/influenza/_documents/2017-18/2018-w7-flu-review.pdf

INFLUENZA ACTIVITY CONTINUES: ARE YOUR
PATIENTS PROTECTED?
For More Information:
Preventive Services Educational Tool
Influenza Resources for Health Care
Professionals MLN Matters® Article
Influenza Vaccine Payment Allowances MLN Matters
Article
CDC Influenza website
CDC Influenza Information for Health
Professionals webpage
CDC Make a Strong Flu Vaccine
Recommendation webpage
CDC Antiviral Drugs webpage

NOTIFICATION OF ENHANCED PROVIDER
SCREENING INITIATIVES
AHCA plans a Spring 2018 implementation of these
enhanced screening initiatives.

Details of these enhanced provider screening
initiatives can be found on the new Provider Screening
Initiatives page under the Agency Initiatives tab of the
Florida Medicaid Public Web Portal.

These pages will house important information for
providers to access and review the new provider
screening requirements and how these requirements
will affect providers. Please visit the initiative pages
frequently to remain up-to-date with the latest
information.

SUBSTANCE USE DISORDER TREATMENT OPTIONS
AND PREVENTION
AHCA is implementing provisions under the Florida Medicaid program to
assist in the prevention and treatment of substance use disorders.

Medication-Assisted Treatment:

1. AHCA has eliminated all prior authorization requirements for the following
medication-assisted treatment options under Florida Medicaid:
• Naltrexone tablets
• Vivitrol (naltrexone) injectable – for recipients ages 18 years of age and older
   diagnosed with alcohol and/or opioid dependence.

2. Effective February 5, 2018, Florida Medicaid will reimburse for a 7-day supply
of Suboxone (buprenorphine/naloxone) film or buprenorphine tablets (for pregnant
or nursing mothers) without prior authorization. This will allow induction therapy to
start immediately. Providers will be required to request prior authorization for
continued therapy after the initial 7-day induction period. All prior authorization
forms and criteria for prescribed drugs may be found here:

http://ahca.myflorida.com/medicaid/Prescribed_Drug/preferred_drug.shtml

SUBSTANCE USE DISORDER TREATMENT OPTIONS
AND PREVENTION
Additional Changes Related to Prescribed Drugs:

Florida Medicaid has or will implement the following additional changes to
prescribed drugs benefit:

1.   Systems modifications:
     a. Prevent Florida Medicaid reimbursement for two or more long
        acting opioids prescribed simultaneously.
     b. Alert pharmacists when an opioid and a benzodiazepine are
        prescribed in combination (this applies in the fee-for-service
        delivery system)
     c. Require prescribers order a short acting opioid prior to
        consideration of a prescription for a long acting opioid

2. Created a prior authorization form consistent with the guidelines and
recommendations from the Centers for Disease Control and Prevention.

SUBSTANCE USE DISORDER TREATMENT OPTIONS
AND PREVENTION
3. Effective February 26, 2018, prescriptions for short acting narcotics, for
the treatment of acute pain, will be limited to a maximum of 7-day supply.
Prescribers may request an increase in the 7-day supply through the prior
authorization process when medically necessary.

4. Effective March 26, 2018, prescriptions for opioids for patients who are
new to opioid treatment will be limited to a maximum dose equivalent to 90
milligrams of morphine per day.

For recipients enrolled in a Medicaid health plan, services are reimbursed
by the plan in accordance with their established agreements/contracts with
network providers. In no instance may the health plan impose limitations or
exclusions more stringent than those specified in Florida Medicaid
coverage policies. In any instance when compliance with provisions in the
Florida Medicaid promulgated rules in Chapter 59G, F.A.C. conflicts with
the terms of the health plan contract, the contract prevails. For additional
information, please contact the plan directly.

FLORIDA HIE’S ENCOUNTER NOTIFICATION SERVICE
(ENS) FOR HOSPITALS

Wednesday, March 14, 2018 10:00 AM EST register at:
https://attendee.gotowebinar.com/register/56104102019
00907521

You will also learn about funding opportunities available
to help you connect to this service.

After registering, you will receive a confirmation email
containing information about joining the webinar.

Please send any questions to
FLHII@ahca.myflorida.com

USDA LAUNCHES WEBPAGE HIGHLIGHTING
RESOURCES TO HELP RURAL COMMUNITIES
ADDRESS THE OPIOID CRISIS | USDA

https://www.usda.gov/media/press-
releases/2018/02/22/usda-launches-webpage-highlighting-
resources-help-rural-communities

IMPORTANT MESSAGE FOR BEHAVIOR ANALYSIS
(BA) PROVIDERS AND APPLICANTS
Provider Enrollment

There is no freeze or moratorium on enrollment for BA
providers. The volume of applications for BA providers
has remained unexpectedly high, and applications are
undergoing enhanced review to ensure providers qualify
for enrollment. This may cause a slowing of the provider
enrollment process. Providers that have questions about
the current status of their applications can contact
Medicaid Provider Enrollment at 1-800-289-7799, Option
4. Providers having issues with completing the
application process can request help via an email
to ProviderEnrollmentIssues@ahca.myflorida.com.

IMPORTANT MESSAGE FOR BEHAVIOR ANALYSIS
PROVIDERS AND APPLICANTS
System Edits

Those modifications addressed the following requirements:

•Claims for BA services must include a referring provider.
•Providers must report the most current and appropriate diagnosis
code to the highest level of specificity that supports medical necessity.
•BA services are not reimbursable if delivered on the same day as
therapeutic behavior on-site (TBOS) services.

Additional information regarding the CMS-1500 claim form and the
Agency’s BA services policy can be located in the Provider
Reimbursement Handbook, CMS-1500 and Behavior Analysis Services
Coverage Policy.

BA providers who have additional questions or need assistance can
contact the Medicaid Helpline at1-877-254-1055.

FLORIDAHEALTHFINDER.GOV WEBINAR

This week you have TWO opportunities to participate:

TODAY: Wednesday, February 28, 2018 at 3:00 PM EST:
https://attendee.gotowebinar.com/register/5079945319983692801
AND
TOMORROW: Thursday, March 1, 2018 at 10:00 AM EST:
https://attendee.gotowebinar.com/register/6749486656552288257

PRESTIGE INFORMATION

Click here for Provider Communications

Provider Resources

SUNSHINE HEALTH NEWS
Providers:
Provider Resources

SUNSHINE HEALTH ESTABLISHES FREE CRISIS HOTLINE
IN RESPONSE TO PARKLAND SCHOOL SHOOTING –
1-877-941-8079

WELLCARE PROVIDER NEWS

Provider News

ASPR TRACIE HTTPS://ASPRTRACIE.HHS.GOV/
Seasonal Surge Resource and Fact Sheet
New: Considerations for the Use of Temporary Care
Locations for Managing Seasonal Patient Surge

Resources on Flooding
• Lessons learned from flooding events
• Related plans, tools, and templates
• After the Flood: Mold-Specific Resources includes
  information on cleaning up after floods and preventing,
  identifying, and getting rid of mold

Wednesday, March 28, 2018 from 1:00-2:30 PM ET
Healthcare Response to No-Notice Events: Las Vegas

2018 Preparedness Summit – Atlanta, Georgia April 17-
20, 2018

WEBINAR INFORMATION

HomeTown Health Florida Medicaid Information:

http://hthu.net/florida/