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Prior authorization reinstatement

The Agency for Healthcare Administration (AHCA) is reinstating prior authorization requirements for the following Florida Medicaid services that were waived in response to COVID-19:

  • Hospital services (including long-term care hospitals)
  • Nursing facility services
  • Physician services
  • Advanced practice registered nursing services
  • Physician assistant services
  • Home health services
  • Ambulance transportation
  • Durable medical equipment and supplies

The change is effective for dates of service on or after June 19, 2020 when prior authorization is required for the service.

AHCA will continue to waive prior authorization requirements and services limits (frequency and duration) for Medicaid-covered behavioral health services covered. This includes community behavioral health services, inpatient behavioral health services, and targeted case management services. The Agency will continue this flexibility until further notice.

If you have any questions, please call us at 1-800-327-8613.


Posted on 06/18/2020