The Back-to-School Sales Tax Holiday begins July 27th and runs through August 7th. Florida shoppers are eligible to purchase clothing and school supplies tax-free for the next two weeks.

School-related items include:

• Clothing and shoes, priced $100 or less per item;
• Backpacks, handbags, and wallets, priced $100 or less per item;
• School supplies, priced $50 or less per item;
• Learning aids and jigsaw puzzles, selling for $30 or less;
• Personal computers or personal computer-related accessories, priced up to $1,500.

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

Governor Ron DeSantis (R) issued an Executive Order to address the cost of prescription drugs in the state. The order directs all executive agencies to include provisions in all future contracts and solicitations with PBMs (Pharmacy Benefits Managers) (Pharmacy Benefit Manager), services that include the following:  

• Prohibit spread pricing for all PBMs 
• Prohibit reimbursement claw backs for all PBMs 
• Directs agencies to include reporting requirements and data transparency, including a review of all rebates, payments, and relationships between pharmacies, insurers, and manufacturers 
• Directs all impacted agencies to amend all contracts with these same provisions. 

Also in Florida, the Agency for Health Care Administration (Agency) has been implementing Referring, Ordering, Prescribing, and Attending (ROPA) requirements as directed by the 21st Century Cures Act (Cures Act) and by the Centers for Medicare and Medicaid Services (CMS). Previous provider alerts on National Provider Identifier (NPI) requirements for ROPA providers can be found on the Agency’s website in the Provider Message Archive. Providers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b). 

In accordance with CMS requirements, all Fee-For-Service claims submitted October 1, 2022, or after from a non-exempt provider type that do not have a ROPA provider listed on the claim will be denied. The exempted provider types that will not require a ROPA on the claim are listed below, all other provider type claims must have a ROPA provider identified by NPI on the claim for reimbursement by Florida Medicaid. 

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

Florida Governor Ron DeSantis (R) signed into law on June 20, 2022, House Bill 357 which requires a health insurer or health maintenance organization providing pharmacy benefits through a group health insurance policy, including a pharmacy benefit manager, must comply with audit requirements. In addition, the legislation provides a penalty for failure to register as a pharmacy benefit manager. The law takes effect July 1, 2022.

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

The Agency for Health Care Administration (Agency) has posted a Request for Information (RFI) relating to the procurement of the Statewide Medicaid Managed Care (SMMC) Program (AHCA RFI 014-21/22 Re-Procurement of the SMMC Program. The RFI may be viewed HERE.  

In preparation for the upcoming procurement, the Agency is seeking information from entities and stakeholders with direct experience in the managed health and long-term care industries regarding best practices and innovations in business models as well as service delivery for Medicaid managed care.  

The Agency is interested in innovative ideas and best practices to:  

• Leverage the managed care delivery system, either through expanded benefits or other mechanisms, to promote sustainable economic self-sufficiency among Medicaid recipients in the short and long term. 
• Improve birth outcomes for mothers and infants through and beyond 12-month postpartum coverage period. 
• Utilize value-based payment designs to simultaneously increase quality and reduce costs.
• Maximize home and community-based placement and services through proactive aging-in place strategies. 
• Improve integration of dental and primary care services for children and adolescents. 
• Align quality metrics and outcomes with the Florida State Health Improvement Plan. 
• Enhance specialty health plans services to improve outcomes for recipients. Increase the number of plans to address target populations with specific health conditions or needs. 
• Increase access to community-based pharmacists within prescription benefit manager networks.
• Improve mental health outcomes for children and adolescents. 
• Improve coordination of care for individuals enrolled in both the Medicare and Medicaid programs. 
• Decrease mortality rates for recipients with complex chronic diseases and address payment strategies for high-cost therapies and prescription drugs in development. 
• Consider innovative delivery methods, including care bundling, that empower recipients in making more informed health care decisions. 
• Improve providers’ experience with the SMMC Program.
• Improve recipients’ experience with the SMMC Program. 
• Increase timely access to providers and services. 
• Achieve cost savings throughout the SMMC Program.  

The Agency will consider information gathered from responses to this RFI in preparing the competitive procurement for the Statewide Medicaid Managed Care program which is scheduled for release in the fourth quarter of CY (Calendar Year) 2022.  

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

Gov. Ron DeSantis (R) signed into law on April 6, two bills, HB 1209,, effective July 1, 2022, which allows registered pharmacy technicians, with appropriate training, to administer vaccines to adults, and SB 544, also effective July 1, 2022, which allows a pharmacist to dispense an emergency opioid antagonist, an auto injection delivery system or intranasal application, pursuant to a pharmacist’s order or to a non-patient-specific standing order.

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

Revised PML Tip Sheet, beginning March 1, 2022, an enhancement will be applied to the NPI Mapping Logic which will affect providers and health plans who submit claims and/or encounters to Florida Medicaid. An updated Provider Master List tip sheet is now available on the Managed Care Support section of the Florida Medicaid public Web Portal that details the changes. Health plans are encouraged to review the tip sheet to understand how the enhancement will affect their encounter submissions. Health plans can stay connected by visiting the Florida Medicaid public Web Portal often for the most up-to-date information on these changes. For additional assistance, please contact the Health Plan Support team by emailing healthplan.support@gainwelltechnologies.com.

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

As part of the Agency for Health Care Administration’s (Agency) quality initiatives, the Agency requested that each Medicaid health plan develop provider resource guides with direct service lines, escalation contacts, and after-hours instructions covering a wide range of service areas. The following service areas can be found in each plan’s resource guide: 

• Behavioral Health 
• Case Management 
• Community Resources 
• Perinatal Care 
• Pharmacy 
• Subcontracted Services 
• Transportation  
• Utilization Management 

The Agency’s goals with this initiative are to improve communication and coordination between plans and providers, and more specifically: to reduce readmissions by improving communication among health plans and providers; to improve members’ access to timely and appropriate services post-discharge; and to streamline the coordination of behavioral health services for members, especially those with substance use disorder (SUD) and opioid use disorder (OUD). 

Each plan’s resource guide has been posted publicly on their respective websites, but may be easily accessed from the Florida Medicaid Health Plan Resources page on the Agency’s website. The Agency encourages providers to explore the resource guides for the health plans with which they contract and to utilize them to coordinate services for members they serve. 

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

The Agency for Health Care Administration (Agency) is in the process of updating the 2022 fee schedules, which includes updates to procedure codes and reimbursement rates for services provided in the fee-for-service Medicaid delivery system. The Agency’s fee schedule drafts are available on the Agency’s website here.  

Prior to initiating the rule making process, the Agency is requesting feedback from providers regarding inconsistencies or discrepancies that may be present in the draft fee schedules. Feedback may be provided through this survey link. The link will be active until 5:00pm EST on February 7, 2021. 

The purpose of this exercise is to identify any errors in the fee schedules. It is not an opportunity to request increases in the reimbursement rates, unless there is a valid concern that an error occurred in developing this year’s rates.

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

Effective January 1, 2022, the UnitedHealthcare of Florida, Inc., and UnitedHealthcare Insurance Company Dual-Eligible Special Needs Plans (D-SNP) changed their names to Care Improvement Plus South-Central Insurance Company d/b/a UnitedHealthcare Dual Complete. All member benefits, provider networks, and plan telephone numbers remain the same. United Healthcare continues to be responsible for the services provided to members of United Healthcare Dual Complete Plan including Medicare and Medicaid services. The website will remain www.UHCCommunityPlan.com  

Contact numbers: Member and Provider Services: 1-844-560-4944  

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