Vaccines for Children (VFC)
CMS Plan Title 19 (Medicaid) members are eligible to receive vaccines through the Vaccines for Children (VFC) program. VFC vaccines should be used for all CMS Plan Title 19 members. (NOTE: VFC vaccines should NOT be used for Title 21 [CHIP] members). You may request an enrollment packet by faxing a request to the VFC program at (850) 245-4734 and providing the following information:
- Your practice name and mailing addressn Contact person, phone and fax numbers, and email address
For more information, visit the VFC webpage. Please call (800) 483-2543 or email FloridaVFC@doh.state.fl.us if you have any questions.
FDA Alert: Blood Lead Testing
From the CDC: “On May 17, 2017, the U.S. Food and Drug Administration (FDA) issued a safety communication warning about the use of Magellan Diagnostics’ LeadCare® analyzers with venous blood samples because they might result in falsely low test results. FDA is now advising that Magellan Diagnostics’ LeadCare® analyzers should no longer be used with venous blood samples. The safety alert does not apply to capillary blood lead test results collected by fingerstick or heelstick. Click here to review the announcement, ‘FDA Warns Against Using Magellan Diagnostics LeadCare Products.’”
The recommendations are also discussed in Pediatric News, in a May 17, 2017 posting at http://www.mdedge.com/pediatricnews/article/138462/neurology/fda-some-blood-lead-tests-have-reported-falsely-low-levels?channel=258&utm_source=News_PED_eNL_052217&utm_medium=email&utm_content=FDA.
July Payments Delayed
Due to the state’s fiscal year end, CMS Plan will not process and release checks the week of June 26th. The next payment batch will be released the week of July 3rd with EFT payments expected to post on Monday, July 10th.
Change to Claims Appeal Process
Effective July 1, 2017, CMS Plan and Ped-I-Care are implementing changes to the claims appeal process. The changes relate to prior authorization requirements relative to payment for services. Please see the Change to Claims Appeal Process – Effective July 1 2017 document for a full description of this change. As a reminder, Ped-I-Care has produced a series of short videos for providers, including one on preventing claims denials. The videos may be found on the Provider Videos page of our website.
eINFOsource Training Opportunities
MED3OOO will host a series of WebEx training sessions on the use of the eINFOsource web portal. The McKesson CWS Provider Portal Manual is available for use in training participation and review. In order to participate please go to mck.webex.com to register. MED3OOO may be reached by phone at (800) 664-0146 or FL-eInfoSource@McKesson.com.
Dates and Times Available for Initial Provider Training:
|Thursday, July 6||10 a.m. CST||745 075 877|
|Tuesday, July 11||10 a.m. CST||749 543 214|
|Tuesday, July 18||1 p.m. CST||746 761 837|
|Thursday, August 3||10 a.m. CST||740 458 383|
|Thursday, August 10||1 p.m. CST||749 738 618|
|Tuesday, August 15||1 p.m. CST||742 860 858|
|Thursday, September 7||10 a.m. CST||744 239 870|
|Tuesday, September 12||10 a.m. CST||740 517 074|
|Tuesday, September 19||1 p.m. CST||747 529 716|
Closing of CMS Plan North Central Region Enrollment Center
Effective December 1, the CMS Plan North Central Region enrollment center, which has been in operation for the past 10 years, has closed. New referrals for CMS Plan on the potentially eligible list in the MED3OOO system are now handled by the CMSMA Call Center. The new phone number for referrals is (855) 901-5390; fax is (850) 488-3813. Local office walk-ins, call-ins, or emergency screenings for enrollment are still available; however the majority of all screenings for initial eligibility will be handled through the call center. No changes have been made to how attestations are forwarded and handled.
Reminder: Fraud, Waste, and Abuse Training Requirement
Your organization is responsible for understanding regulatory provisions regarding Fraud, Waste, and Abuse (FWA), as required by your contract with Ped-I-Care, by the Agency for Health Care Administration (AHCA), and by the Centers for Medicare and Medicaid Services (CMMS), in accordance with 42 CFR 422.503, as amended. Completing one of items listed below will ensure compliance with this requirement:
- Ped-I-Care’s Fraud, Waste, and Abuse Training (available at http://pedicare.peds.ufl.edu/compliance/index.html);
- Training equivalent to Ped-I-Care’s Fraud, Waste, and Abuse Training that meets the requirements outlined in the Medicare Managed Care Manual Chapter 21 – Compliance Program Guidelines and/or Prescriptions Drug Benefit Manual Chapter 9 – Compliance Program Guidelines; or
- Fraud, Waste, and Abuse Certification (by enrollment into Parts A or B of the Medicare program) or accreditation as a supplier or DMEPOS by a first tier, downstream, or related entity.
Your organization must be able to provide evidence (including logs/certifications) that training has been conducted as required.
Please review the The Deficit Reduction Act of 2005 and UF COM Policy and a summary flier on How to Report Medicaid Fraud Waste or Abuse.
Zika Letter to Clinicians
CMS Plan Provider Newsletters Available
Click here to review the CMS Plan Provider Newsletter – Summer 2016.
Click here to review the CMS Plan Provider Newsletter-April 2016.
Vaccine Information Statement Update: Pneumococcal Conjugate and Multiple Vaccines
The Florida Department of Health, Immunization Section, would like to share the Centers for Disease Control and Prevention (CDC) updated Vaccine Information Statements (VIS) for pneumococcal conjugate vaccine (PCV13) and multiple vaccines (DTaP, Hib, hepatitis B, polio, PCV13) released on November 5, 2015.
All previous versions/editions of the pneumococcal conjugate and multiple vaccines VISs should be discarded. You must use the updated version/edition immediately. These two VISs reflect the latest recommendations and format are available at: www.cdc.gov/vaccines/hcp/vis/vis-statements/pcv13.html and www.cdc.gov/vaccines/hcp/vis/vis-statements/multi.html.
The VISs are also available in a variety of translations. You may find these translations at: immunize.org/vis/?f=9. These are coordinated by the Immunization Action Coalition (IAC), through a cooperative agreement with CDC.
The Florida SHOTS system displays/provides an option to print the most current VIS for participants, so this transition should be seamless. We encourage ALL providers to regularly check the VIS being distributed by their staff. Check for the current versions at: cdc.gov/vaccines/hcp/vis/current-vis.html.
Please distribute this important information to colleagues, members, coalitions, and partners who provide or have an interest in immunizations. If you have any questions regarding vaccine recommendations, please feel free to contact Dearline Thomas-Brown, MPH, BSN, RN at 850-245-4342, ext. 2384 or Dearline.Thomas-Brown@flhealth.gov.
Ped-I-Care Contracts with Concordia Behavioral Health
As of November 1, 2015, Concordia Behavioral Health will manage Ped-I-Care’s behavioral health network development, member services, and utilization management for this important category of care. Children’s Medical Services (CMS) Nurse Care Coordinators (NCCs) and social workers in the area offices will still be handling care coordination for members. Concordia has contact information for staff members in each of these offices. The provider phone number for Concordia is (877) 698-7789. Click here to access letters sent to Ped-I-Care providers regarding this change.
Notes about Provider Portal Training:
- Training will last between 30 minutes and an hour depending on length of question and answer sessions.
- All Web Ex presentations are the same, you only need to attend one.
- After Provider Portal Training is completed, a login request form will be sent to the e-mail address provided when you register for the webinar.
CMS Managed Care Plan Provider Alert:
Update on Medical Supplies, Enteral Products, and Cochlear Implants
Thank you for continuing to provide services to our CMS Managed Care Plan (CMS Plan) Title 19 and Title 21 enrollees. Below please find clarification on the reimbursement of medical supplies with non-classified procedure codes, enteral products and cochlear implants:
- Wheelchair and DME Medical Supply Non-Classified code(s), and/or codes without fees, and/or non-covered medically necessary benefits will pay at 87% of the Manufacturer’s Suggested Retail Price (MSRP).
- Enteral Products will pay the lesser of billed charges or invoice plus 15%.
- Cochlear Implants will pay the lesser of the amount billed or the Florida Medicaid maximum fee, currently $30,135.00.
Our CMS Plan Utilization Departments will review each non-priced item request and confirm that the Medicaid Fee Schedule does not contain a payable code for the requested item. The pricing methodology is effective for date of payment September 3, 2015 and forward.
- For more information regarding claims and billing, contact our third party administrator: MED3OOO at (800) 664-0146.
- For more information regarding provider contracts and provider relations, contact us at (866) 376-2456.
New Functionality Added to eINFOsource
Primary care providers now have the ability to generate a roster of their members. The link to the roster may be found on the eINFOsource Provider home page on the right navigation bar under “Manage Patients.” The link is called “View Member List.”
Provider and Member Satisfaction Reports
Health Care Transition Training
October 21, 2014 – The American Academy of Pediatrics, American Academy of Family Physicians, and American College of Physicians recommend transition planning as a standard of care for all adolescents. Health Care Transition Training for Health Care Professionals will equip you with the knowledge and tools you need to facilitate smooth transition for every patient, including those with special health care needs. Click here for more information on Health Care Transition Training available for health care professionals.
Ebola Alert for Providers
October 9, 2014 – Florida’s Agency for Health Care Administration (AHCA) released a statement to providers and health plans in the state of Florida regarding Ebola and standard reporting procedures for communicable diseases in the state of Florida. As noted in the letter, “Much of this information has already been delivered to individual providers (physicians, laboratories, hospitals, etc.) by the Florida Department of Health. It is our intent to keep our Agency partners informed and encourage the dissemination of this information as broadly as you deem appropriate.”
AHCA’s list of resources for providers includes those from the Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Florida Department of Health:
Centers for Disease Control and Prevention:
World Health Organization:
Florida Department of Health:
The following sources, taken from the Florida Department of Health, provide information regarding health care provider reporting guidelines for communicable diseases.
Additionally, DOH Letter 7-1-14 from the Florida Department of Health informs providers of the most recent changes to regulations pertaining to the reporting of communicable diseases in Florida. AHCA has asked that health organizations disseminate this information to healthcare providers and others. AHCA will continue to issue updates as appropriate.
Please make sure all Ped-I-Care patients have their CHCUPs according to the AAP’s periodicity schedule.
PCPs refer to in-network specialty providers for services needed by the child; specialists may also make referrals to other specialists. It is not necessary to obtain a referral number from the third-party administrator; however many specialists do require a referral or consultation request from the requesting provider. This does NOT eliminate the requirement for authorizations to be obtained for services and procedures that require a prior authorization. Information regarding these processes and forms are contained within the Utilization Management section of our provider manuals, listed above.
For dates of service after August 1, 2013, in order to view Ped-I-Care member eligibility, submit authorization and referral requests, and view claims status providers will be required to access this information using a new portal. The new provider portal is referred to as CMS-Kids and is accessed at https://cms.einfosource.med3000.com/tzg/cws. All authorization requests for services to be provided after August 1, 2013 for Ped-I-Care members must be entered in the new CMS-Kids portal. If you need to request a retroactive authorization for services that were provided to a T21 member prior to August 1, 2013 please do so by calling the MED3OOO authorization request line at (800) 492-9634. Additionally, you may continue to submit all authorizations via phone [(800) 492-9634] and fax [(866) 256-2015].
If you have not already requested and received a CMS-Kids portal login, please attempt to use your existing Ped-I-Care login when signing into the CMS-Kids portal. Wherever possible those logins remained the same. If you have difficulty logging in and need a new login assigned, or if you would like Webex training on how to navigate within the new portal, please contact the MED3OOO Customer Service line at (800) 664-0146. The former Help Desk phone number, (866) 703-1444, is no longer a valid number at which to make these requests.
Please note that you will receive two separate reimbursements for claims that include a date span of both pre- and post-August 1, 2013.
All Title 21 members have new Member IDs. We are no longer using social security numbers to identify our Title 21 members, and all Ped-I-Care members will receive new Member ID cards that reflect their Florida Healthy Kids ID. Please be aware that you should no longer search for members using their social security number, but rather by using a combination of their first name, last name, and date of birth.
Medicaid Alert Regarding State Licensure for Health Care Clinics
State licensing laws requires that health care clinics, unless specifically exempt from the requirement, be licensed by the Agency pursuant to Chapter 400, Part X, Florida Statutes. The statute defines a clinic as “an entity at which health care services are provided to individuals and which tenders charges for reimbursement for such services, including a mobile clinic and a portable equipment provider.” It is the responsibility of the provider to know if their clinic is required to be licensed. It is improper to operate without a health care clinic license when one is required by law.
For more information about whether a license is required or whether you qualify for an exemption, visit the Agency’s website. Specific exemptions can be found by viewing the “Health Care Clinic Act” link on the website; specifically chapter 400.9905, 4(a)-(n), F.S.
The Agency is increasing efforts to ensure compliance with these provisions of law and encourages all Medicaid providers to review the law and take appropriate action to assure compliance. Failure to comply with the licensure requirements may result in sanctions as well as recovery of any overpayments. The Agency’s licensing Division of Health Quality Assurance (HQA), also monitors compliance and take action for unlicensed activity as appropriate.
Questions specific to the increased compliance efforts by HQA may be directed to the Health Care Clinic Unit via email at HCCU@ahca.myflorida.com or by phone at (850) 412-4404.
For more information on the Medicaid program and Medicaid policies, contact your local Medicaid area office. Additionally, information about self audits and other compliance-related issues may be found on the Agency’s website, including the Medicaid Fraud and Abuse link and the Medicaid Training e-Library.
Performing a blood test for lead levels is a Federal and State requirement at specific intervals during the Child Health Check-Up (CHCUP). Ped-I-Care Title 19 Medicaid Reform children are covered by the same federal and state requirements as other Medicaid children.
The federal regulation as referenced in the Child Health Check-Up Coverage and Limitations Handbook, October 2003, pages 2-13 and 2-14, and pages 3-6, requires that all Medicaid children receive a screening blood lead test at the ages of 12 months and 24 months, and between the ages of 36 months and 72 months if they have not been previously screened for lead poisoning. When you order the blood lead test, it needs to be documented in the medical record. The result of the test also needs to be documented.
To meet the Medicaid requirement a blood test must be done. Performing a risk assessment alone does not meet this requirement. Whether you draw the blood in your office or you send the member to the lab, your office should report the additional ICD-9 code V82.5 for the blood lead screening test.
The Child Health Check-Up Coverage and Limitations Handbook can be accessed by visiting http://mymedicaid-florida.com. Click on Public Information for Providers, Provider Support, then Provider Handbooks, and select the Child Health Check-Up Handbook.
If you have any questions or need a list of members assigned to your practice that are under 3 years old, please feel free to contact us at (866) 376-2456.
Compliance Training and Support
Prevention of Fraud and Abuse Training is freely available to all providers, and we encourage those in our network (along with their staff) to complete it.
- Online Compliance Training for Providers
- AHCA video – Compliance Tips for Florida Medicaid Providers
- AHCA video – Medicaid Provider Compliance Program & Provider Self Audits
Informed Consent for Psychotherapeutic Medications
As of July 18, 2011, regulations involving informed consent for psychotherapeutic medications became effective. Florida statute 409.912(51) calls for a new informed consent form for every new prescription for medications in this class. Ped-I-Care asks all physicians in its network to additionally inform the child’s primary care provider of prescribed medications and any changes along with adverse effects, the progress with therapies and case management, hospitalizations, and recommendations. Sharing this information with PCPs and others involved in coordinating care for the member is not a violation of HIPAA or confidentiality regulations. In addition, there should be communication with other involved professionals responsible for coordinating care, including the Children’s Medical Services (CMS) staff assigned to the member. Please click here to access the full memo from Ped-I-Care’s Behavioral Health Consultant Dr. Martin Lazoritz.
Health Care Alerts & Provider Alerts Messages
Florida Medicaid enabled dual capability of 4010 and 5010 X12 transactions beginning July 11, 2011. The dual capability timeframe will allows providers time to make necessary changes to their Medicaid claims data. Additional information regarding X12 transaction testing with Ramp Manager and Companion Guide information can be found here.
Direct Secure Messaging (DSM)
The Florida Agency for Healthcare Administration encourages providers to use direct secure messaging (DSM), which has multiple benefits. Information on this topic, including education about DSM, may be found on the AHCA website at http://portal.flmmis.com/FLPublic/Provider_ProviderServices/Provider_ProviderSupport/Provider_ProviderSupport_ProviderAlerts/tabId/48/Default.aspx, or by visiting the Florida Medicaid Web Portal and searching for, ‘Direct Secure Messaging’.
Child Psychiatry Access Program – Consultation on Medication Options
The University of Florida Division of Child and Adolescent Psychiatry provides a free Child Psychiatry Access Program phone service. This helpline is to serve providers who have questions about the care of children and youth with emotional disturbances. The program allows prescribing providers access to additional consultation on medication treatment options for children with the latest psychiatric medical information to regarding the prescribing of psychotherapeutic drugs to children. Click here for details on how the program works and how you may sign up.
Important Notes for the Florida Medicaid EHR Incentive Program
The EHR Incentive Program website has recently been updated. Please look for new FAQs available under the Resource tab: http://www.ahca.myflorida.com/medicaid/ehr/.
Free Online CME/CE Course on Health Care Transition
Experts at the University of Florida recently developed the Health Care Transition Training Program to help professionals prepare their adolescent patients with chronic health conditions and disabilities (and their families) for the move from pediatric to adult health care. Through funding from Florida Health and Transition Services (FloridaHATS) – a new program located within Children’s Medical Services (CMS) – Florida physicians, nurses, dentists, social workers, and mental health counselors can take this online course and earn up to 4 CME/CE credits at no cost. The course is being offered through the Gulf Coast North Area Health Education Center (AHEC).
For more information about the course and to enroll, go to: http://www.aheceducation.com/.
For more information about the course, FloridaHATS, and other Health Care Transition resources and materials, please contact Janet Hess, MPH, Project Director, at (813) 259-8604, email@example.com, or David Wood, MD, MPH, CMS Medical Consultant, at (904) 244-9233, firstname.lastname@example.org.