Effective October 1, 2021, fee-for-service (FFS) pharmacy claims must identify prescribers by their National Provider Identifier (NPI) and the prescribers must be actively enrolled with Florida Medicaid or the claims will be denied at the point of sale. Prescribers must be enrolled with Florida Medicaid in accordance with Title 42, Code of Federal Regulations, Section 455.410(b). This requirement does not pertain to pharmacists, state-authorized pharmacy interns, and qualified pharmacy technicians who administer pediatric and COVID-19 immunizations under the Public Readiness and Emergency Preparedness (PREP) Act. Pharmacy claims must continue to identify the administering pharmacist by Florida pharmacist license number (i.e., PSXXXXXXX), submitted as the prescriber ID in the National Council for Prescription Drug Programs (NCPDP) field 411-DB for the following vaccines and immunizations covered under the PREP Act, in accordance with or identified by the Advisor Committee on Immunization Practices (ACIP CDC vaccines). More information can be found here.

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

Effective 10-1-21 WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida, Inc. (Staywell) Members will Transfer to Sunshine State Health Plan, Inc. (Sunshine). The WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida, Inc. (Staywell) legal entity will be merging with Sunshine State Health Plan, Inc. (Sunshine Health).  The Agency for Health Care Administration will move Staywell’s Medicaid membership, including Serious Mental Illness (SMI) Specialty Plan membership, to the Sunshine Health plan effective October 1, 2021.  In addition, Children’s Medical Services (CMS) Health Plan, which has been operated by WellCare through a contract with the Florida Department of Health, will be operated by Sunshine Health effective October 1, 2021. Sunshine Health will be issuing new Medicaid ID cards.  All billing and claims reimbursement will be provided by Sunshine Health for dates of service beginning October 1, 2021.  All Staywell claims for service dates prior to October 1, 2021, must continue to be submitted through Staywell and related questions may be directed to Staywell at 1-866-334-7927 (TTY 711) Monday-Friday, 8 a.m. to 7 p.m.

Providers that are out of network as of October 1, 2021, will be eligible for a 120-day continuity of care period where claims will be payable to allow time for members to transition to a new provider, if necessary. The continuity of care period ends on January 31, 2022.

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

Magellan Complete Care Members will transfer to Molina Healthcare of Florida, Inc. Molina Healthcare of Florida, Inc. (Molina) acquired Florida MHS, Inc., D/B/A Magellan Complete Care (Magellan), a Medicaid specialty plan specializing in the care of those with Serious Mental Illness (SMI). The Agency for Health Care Administration will move Magellan’s membership to Molina effective September 1, 2021. Molina will be issuing new Medicaid ID cards. All billing and claims reimbursement will be provided by Molina for dates of service beginning September 1, 2021. All claims for service dates prior to September 1, 2021, must continue to be submitted through Magellan and related questions may be directed to Magellan at 1-800-327-8613. Providers that are out of network as of September 1, 2021, will be eligible for a 60-day continuity of care period where claims will be payable to allow time for members to transition to a new provider, if necessary. The continuity of care period ends on October 31, 2021.

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

Effective immediately, the Florida Medicaid Management Information System (FMMIS) will no longer pay for services billed to Medicaid for recipients enrolled in a Fully Liable Medicare Advantage Plan. On May 3, 2021, the Agency issued a Medicaid Health Care Alert titled “Effective July 1:  Providers Must Bill Dual Eligible Special Needs Plans (D-SNP) for All Services”, which informed providers that effective July 1, 2021, the Florida Medicaid Management Information System (FMMIS) would no longer pay for services billed to Medicaid for recipients enrolled in a Dual Eligible Special Needs Plan (D-SNP).  This alert is to clarify that this requirement also applies to Florida’s Fully Liable Medicare Advantage Plans, and that providers must bill all services to a recipient’s Fully Liable Medicare Advantage Plan. 

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

The Florida Division of Disease Control intends to amend regulations under FAC 64D-3 to establish reporting requirements for all practitioners and enrolled coronavirus (Covid-19) vaccine providers administering such vaccines.

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

The Florida Division of Disease Control intends to amend regulations under FAC 64D-3 to establish reporting requirements for all practitioners and enrolled coronavirus (Covid-19) vaccine providers administering such vaccines.

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

The Department of Health proposed to amend regulations under FAC 64D-3 to add the coronavirus (COVID-19) to the list of reportable diseases and conditions. Comments and hearing requests are due July 21. 

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

An emergency rule of the Department of Health adopts regulations under FAC 64DER21-9 to require all health care practitioners and other enrolled coronavirus (COVID-19) vaccine providers to report to the online immunization information system within 72 hours the administration of any COVID-19 vaccine with an emergency use authorization from the FDA. The rule replaces a March 17, 2021, emergency rule on the same topic. The rule is effective June 11, 2021 and expires September 9, 2021.

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

The Board of Pharmacy issued a Final rule to repeal regulations under FAC 64B16-28 to remove outdated requirements for automated pharmacy systems in community pharmacies. The rule is effective June 24, 2021.  

Also in Florida, the Board of Pharmacy issued a Final rule to amend regulations under FAC 64B16-28 to increase to 120 days the maximum beyond-use date requirement for labels of customized patient medication packages. The rule also requires pharmacies using customized patient medication packages to have policies and procedures addressing patient medication regimens. The rule is effective June 24, 2021.

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