Dear Medicaid partner:

This summer has been a busy one at the Agency. Our team has been working around the clock in order to make the transition to our new Fiscal Agent, EDS, as smooth as possible for you, and we appreciate your partnership in making this go smoothly.

Every month our Agency pays approximately 11 million claims totaling roughly $1.3 billion. Needless to say, it requires a great deal of technology to pay that many claims, and until July 1st, the computers used to run the system were 18 years old. On July 1st, our Medicaid program took a giant leap forward.

The system has changed a great deal since 1989. For example:

• In 1990/91, there were 980,000 Medicaid beneficiaries; today there are over 2.1 million.
• In 1990/91, the payments totaled $2.7 billion; today they are over $14 billion.
• In 1990/91, there were over 33 million claims; in 2006/07, there were over 130 million.

A transition of this size requires an immense amount of coordination, and our team and the EDS team have been working around the clock in order to make sure we meet your needs. If you need any assistance, please call us at (800) 289-7799 or go online to http://mymedicaid-florida.com.

Thank you for your help in making this a success, and thank you, as always, for your service to the patients of Florida.

Sincerely,

Secretary
Agency for Health Care Administration

All Providers

Reimbursement for Injectable Medications

The 2008 Florida Legislature enacted legislation which requires that reimbursement for injectable medications, including immune globulins and immunizations, be set at the lesser of the average wholesale price (AWP) minus 16.4% (previously 15.4%), wholesale acquisition cost (WAC) plus 4.75% (previously 5.75%), the federal upper limit (FUL), the state maximum allowable cost (SMAC) or the usual and customary (UAC) charge billed by the provider. For the full story...

Fee Schedules Now Updated Quarterly

Fee Schedules will now be updated on a quarterly basis. Quarterly updates will be posted to the fiscal agent Web Portal, http://mymedicaid-florida.com, during the beginning of January, April, July, and October. For the full story...

How to Request Out-of-State Services for a Medicaid Recipient

Who Can Initiate the Request
What Form To Use
What Documentation to Include with PA Requests
Timeline for Authorization Process
Where to Send Requests

For the full story...

Payment Error Rate Measurement (PERM) - Update

The Federal government requires the Centers for Medicare and Medicaid Services (CMS) to review its Medicaid programs each year for improper payments, and to report its findings to Congress. The CMS does this with a program called Payment Error Rate Measurement (PERM). All states must cooperate with CMS on PERM. For the full story...

Physicians, Home Health Agencies, and Therapists

Prepaid Therapies Program

The Agency for Health Care Administration (AHCA) is implementing the Prepaid Therapy Utilization Management Program (also referred to as Prepaid Therapies program) tentatively scheduled for December 1, 2008. For the full story...

Child Health Check-Up (CHCUP)

Critical Reminder to Child Health Check-Up Providers

As licensed health care professionals you are aware that performing a blood test for lead is a federal requirement at specific intervals during the “Child Health Check-Up.” For the full story...