The Agency for Health Care Administration has rescheduled the hearing for Rule 59G-4.250, F.A.C., Prescribed Drug Services, noticed in Vol. 50, No. 31, February 14, 2024, Florida Administrative Register, for March 20, 2024, from 2:00 to 2:30 p.m. at the Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee, FL 32308. 

A call-in number or virtual option will not be available for this hearing. Official notice of the rescheduled hearing published in Vol. 50, No. 40, of the Florida Administrative Register (FAR) on February 27, 2024. A copy of the notice may be found on the FAR website. 

Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop on our Rules Web page.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Agency for Health Care Administration (Agency), along with its fiscal agent Gainwell Technologies, has updated the NPI (National Provider Identifier) Mapping Logic that is used by the Florida Medicaid Management Information System (FL MMIS). Detailed information on the upcoming NPI Mapping Logic can be viewed on the NPI Initiative FAQ. The FAQ and additional information about the NPI Initiative can be obtained by visiting the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigating to Agency Initiatives, and selecting NPI Initiative. 

The NPI to Medicaid ID Search Engine was removed from the public Web Portal and is only available to those logged into their secure Web Portal. The enhanced tool is available by clicking the NPI to Medicaid ID Search Engine link under the Quick Links box within the secure Web Portal. 

The NPI to Medicaid ID Search Engine is accessible on the public Web Portal only for those applying and entering an NPI for full, limited or ROPA (Referring, Ordering, Prescribing and Attending) enrollment through the Online Enrollment Wizard. 

For more information, visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com and navigate to Agency Initiatives, and select NPI Initiative. 

For information on how to perform a password reset for a secure Web Portal user account that is locked, refer to the Secure Web Portal Account Maintenance Quick Reference Guide (QRG) 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Ron DeSantis (R) released his Focus on Florida’s Future Budget recommendations for Fiscal Year 2024-25. The proposed budget comes in at $114.4 billion, which is a $4.6 billion decrease compared to the state’s FY 2023-24 budget. Governor DeSantis’ Focus on Florida’s Future Budget supports more than $1.1 billion in tax relief and the renewal of four traditional sales tax holidays as well as more than $153 million from the nationwide Opioid Settlement Agreement to continue support for the Office of Opioid Recovery, an accredited Graduate Medical Education program to increase the number of psychiatric residents and for other initiatives that support education, treatment and prevention for individuals with substance use disorders. The full budget highlights are available online.   

Also in Florida, the 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 took effect on January 10. 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. 

Finally in Florida, 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 plans to release the Preferred Product List as referenced in proposed rule 59G-4.002, along with a resource toolkit to assist providers with billing for diabetic supplies through the pharmacy point of sale system. 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 Policy webpage 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.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Due to a delay in verifying the Medicaid weekly funding, provider payments will not be available until November 17. Please note that the “Payment Issue Date” on the remittance advice and all other generated information will remain the same. If you need assistance or have questions about provider payments, please contact the Provider Services Contact Center at 1-800-289-7799, option 7. This is a one-time delay with the regular weekly Thursday payment schedule. Due to the holiday falling on the regular weekly Thursday schedule, payment will be made on November 22.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Eleven entities have responded to the statewide Medicaid Managed care invitation to negotiate, including all of the health plans that currently participate in the program. Two of the respondents, ImagineCare and Sentara Care Alliance, do not currently participate in the program. The Agency of Health Care Administration is soliciting comments from providers who have experience with the 11 respondents. The comments are a component of the Invitation to negotiate and are considered when the state decides which entities to award contracts. Providers have until 5:00 pm on November 9 to electronically submit their comments to the state. The agency will only consider comments submitted by providers in the same region as the plan. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

The Agency for Health Care Administration (Agency) announces that it is soliciting comments from providers which it will consider as part of the re-procurement of the Statewide Medicaid Managed Care (SMMC) program. (See Section 409.966(3)(a)(8), F.S.)  

The Invitations to Negotiate (ITNs) and information about the re-procurement, including anticipated timelines and instructions for submission of provider comments, can be found on the Department of Management Services’ Vendor Bid System at: MyFloridaMarket Place Vendor Information Portal.  

Key dates to note are: 

October 27, 2023: Anticipated Posting of ITN (invitation to negotiate) Respondent Names for Provider Comment 

November 9, 2023: Deadline for Receipt of Provider Comments, due by 5:00 PM 

The reference number for the SMMC program ITN is AHCA (Agency for Health Care Administration) ITN 010-22/23.  

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Ron DeSantis (R) and members of the Florida Cabinet approved rules to implement several provisions of the Prescription Drug Reform Act (SB 1550). The rules increase accountability among pharmaceutical middlemen known as pharmacy benefit managers (PBMs). As signed by the Governor earlier this year, SB 1550 institutes the most comprehensive reforms to Florida’s prescription drug market in state history. Additional information on the bill can be found here.

Also in Florida, the Agency for Health Care Administration (Agency), along with its fiscal agent, Gainwell Technologies, is introducing enhancements implemented as part of the new NPI initiative. A new Taxonomy Master List (TML) Tip Sheet, an updated Provider Master List (PML) Tip Sheet and an updated Pending Provider List (PPL) Tip Sheet is now available. The updated PML and PPL test examples are now available. The release of the updated PML and PPL changes will occur on October 26, 2023. After the release, a copy of the former version of the PML and PPL will remain archived on the Registration page of the Managed Care section of the Florida Medicaid Public Web Portal for reference. The release of the updated TML changes occurred on September 28, 2023. The release will replace the current version of the TML on the Florida Medicaid Public Web Portal. To access a copy of the new TML Tip Sheet and the updated PML and PPL Tip Sheets, please visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com, navigate to the Agency Initiatives tab, and select NPI Initiative.

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Ron DeSantis (R) and members of the Florida Cabinet approved rules to implement several provisions of the Prescription Drug Reform Act (SB 1550). The rules increase accountability among pharmaceutical middlemen known as pharmacy benefit managers (PBMs). As signed by the Governor earlier this year, SB 1550 institutes the most comprehensive reforms to Florida’s prescription drug market in state history. Additional information on the bill can be found here. 

Also in Florida, the Agency for Health Care Administration (Agency), along with its fiscal agent, Gainwell Technologies, is introducing enhancements implemented as part of the new NPI initiative. A new Taxonomy Master List (TML) Tip Sheet, an updated Provider Master List (PML) Tip Sheet and an updated Pending Provider List (PPL) Tip Sheet is now available. The updated PML and PPL test examples are now available. The release of the updated PML and PPL changes will occur on October 26, 2023.  After the release, a copy of the former version of the PML and PPL will remain archived on the Registration page of the Managed Care section of the Florida Medicaid Public Web Portal for reference. The release of the updated TML changes will occur on September 28, 2023.  The release will replace the current version of the TML on the Florida Medicaid Public Web Portal. To access a copy of the new TML Tip Sheet and the updated PML and PPL Tip Sheets, please visit the Florida Medicaid Public Web Portal at mymedicaid-florida.com, navigate to the Agency Initiatives tab, and select NPI Initiative. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.

Gov. Ron DeSantis (R) signed Executive Order 23-171, declaring a state of emergency in preparation for Tropical Storm/Hurricane Idalia. The Agency for Health Care Administration (AHCA) has contacted the Medicaid Managed Care Plans, to ensure they are making the necessary preparations pre- and post-storm, including allowing for early prescription refills. Fee-for-service recipients are also eligible for early refills. The Department of Health has also issued Emergency Order 23-002, which allows for mobile pharmacies and an extension of the PDMP (Prescription Drug Monitoring Program) reporting requirements. 

For more information, contact NACDS’ Leigh Knotts at 803-243-7207.