Florida Medicaid Health Care Alert - April 28, 2026

Provider Type(s):ALL
Children’s Medical Services (CMS) Plan Transition

Effective October 1, 2026, the operation of the Children’s Medical Services (CMS) Plan will move from Sunshine State Health Plan, Inc. to Molina Healthcare of Florida, Inc.

Certain children with special health care needs are eligible to enroll in Florida’s Children’s Medical Services Plan (CMS Plan) for enhanced services. Currently, Sunshine State Health Plan, Inc. (Sunshine) operates the CMS Plan contract for both Medicaid (Title XIX) and CHIP (Title XXI) recipients. The Agency recently awarded Molina Healthcare of Florida, Inc. (Molina) the CMS Plan contract statewide. The Agency is working closely with Molina and Sunshine to ensure a seamless transition.  After October 1, 2026, recipients and providers wanting to participate in the CMS Plan must enroll with Molina. Molina will be the single plan that offers all services in the CMS Plan.

What does this mean?

Starting on October 1, 2026, Molina will be the only SMMC plan to administer the CMS Plan. Current CMS Plan recipients will be automatically transferred to CMS Plan operated by Molina as part of the transition.

Recipients who do not wish to move to CMS Plan operated by Molina will have the option to choose another plan.

• Title XIX recipients may choose to enroll in another SMMC plan:

Florida Medicaid Choice Counseling: 1-877-711-3662. Staff are available to assist with plan changes Monday-Thursday 8 a.m. - 8 p.m. and Friday 8 a.m. – 7 p.m.

• Title XXI recipients may choose to enroll in another Florida Healthy Kids plan:

Florida KidCare: 1-888-540-KIDS (5437)Staff are available to assist with plan changes Monday through Friday, 8 a.m. - 5 p.m.

Continuity of Care

All recipients initially transitioning from Sunshine to Molina will have a continuity of care (CoC) period of up to eight months. This means recipients may continue seeing their current providers until May 31, 2027, or until their care plan is finalized and ongoing services are authorized, whichever is sooner. Molina is required to reimburse non-participating providers at the rate they received for services rendered to recipients prior to the transition for up to eight months, unless there is an agreement to an alternative rate.

All SMMC plans are required to provide CoC periods for transitioning recipients. Details regarding CoC periods for plans other than Molina can be found on the Agency website at SMMC 3.0_Continuity of Care Provisions.

The Agency has instituted the following CoC provisions:

• Health care providers should not cancel appointments with current patients.
• Providers will be paid promptly by the recipient’s new managed care plan.
• Prescriptions will be honored by the recipient’s new managed care plan.
• Existing prior authorizations approved prior to October 1, 2026, will be honored by the recipient’s new managed care plan.

Providers interested in contracting with Molina can find additional information at Molina_CMS Providers. Molina is contracting with CMS Plan providers now and will prioritize contracting inquiries that promote Continuity of Care. Molina is providing essential information, training sessions, and reference materials for support throughout this transition.

Please visit Molina’s website at Molina_CMS Providers for the most current updates and answers to Frequently Asked Questions.

Additional communications from the Agency regarding this change will be shared at CMS Plan Transition | Florida Agency for Health Care Administration.

QUESTIONS? FLMedicaidManagedCare@ahca.myflorida.com

COMPLAINTS OR ISSUES?
ON LINE ahca.myflorida.com/Medicaid/complaints/ | CALL 1-877-254-1055

Florida Medicaid Health Care Alert
March 25, 2026

Provider Type(s): ALL
Moratorium on Enrollment of New Durable Medical Equipment, Prosthetics, Orthotics, and Suppliers

On February 27, 2026, The Centers for Medicare & Medicaid Services (CMS) imposed a 6-month nationwide moratorium on the Medicare enrollment of New Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) medical supply companies. A copy of the moratorium can be found here.

The goal of the temporary moratorium is to fight fraud and safeguard taxpayer dollars, while ensuring patient access to care. Authority to impose such moratoria was included in the Affordable Care Act, and the Agency for Health Care Administration (Agency), with the approval from CMS, is exercising that authority at this time.

Effective March 20, 2026, the Agency has imposed a temporary Medicaid moratorium on enrollment of new Durable Medical Equipment DME providers (Provider Type 90) in all Florida counties.

Exclusively for purposes of the moratorium's applicability, a medical supply company is considered a business whose principal function is to furnish durable medical equipment and medical supplies (regardless of supply type) directly to another party, such as, but not limited to: (1) recipients with a medical order (for example, via mail order); (2) medical providers and suppliers; or (3) both. A pharmacy, hospital, or other medical provider that also provide DME as a secondary function are not part of this moratorium.

The statewide moratorium will remain in place for an initial 6-month period. Under the moratorium, the Agency will not accept any new applications for DME providers for Florida Medicaid enrollment that are received after March 20, 2026. The Agency will continue processing DME provider applications submitted on or before March 20, 2026.

No Medicaid recipients will go without the services they need. If any recipient is having difficulty accessing services, please encourage them to contact the Florida Medicaid Helpline at (877) 254-1055.

All existing DME providers can continue to deliver and bill for authorized services.

The Florida Agency for Health Care Administration (AHCA) is launching a new provider enrollment system in early 2026 as part of the AHCA Enterprise modernization. This modernization will streamline enrollment, renewal, and account maintenance, making the process faster, easier, and more secure for Medicaid providers.

In preparation, providers should:

• Complete pending enrollments in the current Medicaid Provider Enrollment Application Wizard.
• Review and update account information in the current Medicaid Secure Web Portal. If renewal has been triggered, complete renewal in the Medicaid Secure Web Portal.
• Active Medicaid Providers who have not created an account, should do so as soon as possible. If you do not have your PIN information, please see Password Resets and PINs for additional support.
• Subscribe to Florida Medicaid Health Care Alerts for updates.

Account Maintenance How-tos:

• Update account information: Account Management – Modify Contact Information. Review and validate name, phone number, email address, and security questions/answers.
  
• Reset password: Click Medicaid Secure Web Portal and select ‘Reset password.’
  
• Maintain an active account: Log in every 60 days before the password expires.
  
• Newly enrolled providers will receive a PIN letter within 10 business days. Go to https://public.flmmis.com/public/pinletter/ and follow the instructions provided within the letter where to activate an account and create a username and password.

Resources:

• Password Resets and PIN Instructions
  
• Account Maintenance and Reset Password Quick Reference Guide
  
• Secure Web Portal User Guide

Launching in early 2026, the new Provider Enrollment System will:

• Give providers 24/7 access to their provider account from any device.
• Provide step-by-step instructions so applications are right the first time.
• Make enrollment, renewal, and account maintenance faster and more secure.

What’s Next?

As launch day approaches in early 2026, AHCA will share everything you need to know through Florida Medicaid Health Care Alerts, including when new preparation tools become available.

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year. Physicians 2024 MIPS final score determines the MIPS payment adjustment physicians will receive in 2026. A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026. The AMA encourages physicians to review their final score as soon as possible as the deadline to file a Targeted Review is only open until November 14, 2025.

The AMA has sought clarification from CMS and they are still accepting and reviewing Targeted Reviews during the government shutdown. However, some decisions may be delayed due to the need for broader CMS staff review, and some staff are furloughed. There are no plans currently to extend the targeted review period.

For more information, please see the email blast from CMS below:

Now Available: 2026 MIPS Payment Adjustment Information

The Centers for Medicare & Medicare Services (CMS) has released Merit-based Incentive Payment System (MIPS) payment adjustment information for the 2024 performance period/2026 MIPS payment year.

• Your 2024 MIPS final score determines the MIPS payment adjustment you’ll receive in 2026.
• A positive, negative, or neutral payment adjustment will be applied to the Medicare paid amount for covered professional services furnished in 2026.

Access Your MIPS Payment Adjustment

Sign in to the Quality Payment Program (QPP) website using the same credentials that allowed you to submit your 2024 MIPS data and check your 2024 MIPS final score. Refer to the QPP Access User Guide (ZIP, 4MB) for more information.

Click “View Feedback” on the home page and select your organization (Practice, Alternative Payment Model (APM) Entity, Virtual Group).

• Practice representatives can access individual, subgroup, and group performance feedback (final scores and payment adjustments).
• APM Entity representatives can access APM Entity-level performance feedback (final scores and payment adjustments).
• Virtual group representatives can access virtual group-level performance feedback (final scores and payment adjustments).
• Third party representatives can’t access final feedback or payment adjustment information.

If you don’t have a HARP account or QPP role, please refer to the Register for a HARP Account (re: HARP account) and Connect to an Organization (re: QPP role) documents in the QPP Access User Guide and start the process now.

Medicare Shared Savings Program Accountable Care Organizations (ACOs)

Medicare Shared Savings Program ACOs are encouraged to identify at least one individual within your ACO who can obtain a HARP account with the Security Official role; additional individuals may request the Staff User role. ACO individuals can create and manage their HARP account and QPP access in the ACO Management System (ACO-MS).

Contact your ACO to find out how you can obtain a HARP account via ACO-MS. If you have any questions, please contact the ACO Information Center at SharedSavingsProgram@cms.hhs.gov or 1-888-734-6433 (Option 1).

• REMINDER: Representatives of Shared Savings Program ACO Participant Taxpayer Identification Numbers (TINs) and practices with clinicians receiving their APM Entity’s final score won’t be able to access the APM Entity’s performance feedback unless they’ve been granted the “staff user” QPP role for the APM Entity.

Payment Adjustment and Performance Feedback Resources:

• 2026 MIPS Payment Year Payment Adjustment User Guide – Reviews information about the calculation and application of MIPS payment adjustments, and answers frequently asked questions.
• 2024 MIPS Performance Feedback FAQs (PDF, 2MB) – Reviews the information available in performance feedback and how to access it. (We’re in the process of updating this resource with the Targeted Review deadline.)
• 2024 MIPS Performance Feedback Supplemental Reports Guide – Reviews the downloadable supplemental and patient-level reports for administrative claims quality and cost measures.
• 2024 Quality and Cost Benchmarks – Links to quality and cost measure benchmarks and supporting documentation. (Benchmarks determine measure scores.)

2024 Targeted Review Request Period Open Until November 14, 2025[1]

Beginning with the 2024 performance period/2026 MIPS payment year, the targeted review period closes 30 days following the release of MIPS payment adjustments (refer to 42 CFR 414.1385(a)(2)).

Who Can Request a Targeted Review?

Individual clinicians, groups, subgroups, virtual groups, APM Entities (including Shared Savings Program ACOs), designated support staff and authorized third party intermediaries may request that CMS review their MIPS final score and MIPS payment adjustment factor through a process called targeted review.

When to Request a Targeted Review

Review your MIPS performance feedback, including your MIPS final score and payment adjustment factor(s), on the Quality Payment Program website. If you believe there’s an error in the calculation of your MIPS final score or MIPS payment adjustment factor, you can request a targeted review now until November 14, 2025, at 8 p.m. ET. Be advised that our ability to respond to inquiries and resolve requests will be delayed in most cases until normal government operations resume. Examples of circumstances that could prompt a Targeted Review:

• Data were submitted under the wrong TIN or National Provider Identifier (NPI).
• You have Qualifying APM Participant (QP) status and shouldn’t receive a MIPS payment adjustment.
• Performance categories weren’t automatically reweighted even though you qualify for reweighting due to extreme and uncontrollable circumstances.

Note: This isn’t a comprehensive list of circumstances.

How to Request a Targeted Review

To access your MIPS final score, performance feedback and request a targeted review:

• Sign in using your HARP credentials (ACO-MS credentials for Shared Savings Program ACOs); these are the same credentials that allowed you to submit your 2024 MIPS data and check your 2024 final score.
• Click “Targeted Review” on the left-hand navigation.

CMS may require documentation to support a targeted review request, which varies by circumstance. A CMS representative will contact you about providing any specific documentation required.

• 2024 Targeted Review User Guide (PDF, 2MB) – Reviews the process for requesting a targeted review and examples for when you would or wouldn’t request a targeted review. (We’re in the process of updating this resource with the Targeted Review deadline.)

[1] Note: The federal government shutdown doesn’t affect your ability to submit a targeted review request by the above deadline, however it may affect our response time to resolve your request.

The Centers for Medicare & Medicaid Services published an alert on fraud schemes that are increasingly targeting Medicare providers that involve bad actors impersonating CMS and sending phishing fax requests for medical records and documentation, falsely claiming to be part of a Medicare audit.

Phishing is an example of social engineering that attempts to trick you or someone else in your workplace into giving out sensitive information. Email phishing attacks are still a common occurrence, but we are hearing about more fraudulent fax requests being sent out to medical practices by bad actors.

CMS emphasized that it does not initiate audits by requesting medical records via fax. We urge physicians and practices to take steps to protect their data. If physicians receive a suspicious request, do not respond. CMS encourages you to work with your Medical Review Contractor if you receive a questionable or suspected fraudulent request to confirm if it is real.

Florida Medicaid recipients maintaining access to critical Medicaid services (e.g., durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.) is imperative during the State of Emergency related to Hurricane Storm Milton. To this end, the Agency will ensure reimbursement for critical Medicaid services provided in good faith to eligible recipients who reside in the counties impacted by the storm.

Please continue providing services:

• The Agency will waive all prior authorization requirements for critical Medicaid services beginning October 7, 2024, until further notice.
      -Early prescription refill edits have been lifted for all maintenance medications (Note: This does not apply to controlled substances).
• If a recipient requires critical Medicaid services beyond the limits stated in policy to maintain safety and health, providers can furnish the service.
• Preadmission Screening and Resident Review (PASRR) processes are postponed until further notice by the Agency.
      -Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.
      -The Agency is waiving the PASRR process for recipients who evacuated due to an evacuation order or power outage and are admitted and discharged during the storm.
• Transportation vendors should continue providing services to all Medicaid enrollees as long as they are able.

To read Governor Ron DeSantis’ executive orders related to Hurricane Milton, please click here.

Tallahassee, Fla. — In response to Hurricane Milton, the Florida Department of Health has prepared for special needs shelter operations to begin in areas of anticipated landfall.

In an emergency, such as an evacuation for a hurricane, you may need to go to a special needs shelter. If you know or care for an individual with a disability or a special need, such as a medical condition that requires assistance but not hospitalization, it is important that you pre-register with the Florida Special Needs Shelter Registry. You will need to log in with an existing account or create a new account.

Registering through the Florida Special Needs Registry allows local emergency management officials to provide important information and quickly assist you during an emergency. For more information, contact your county’s emergency management office or visit the Florida Special Needs Registry.

If you are eligible for a special needs shelter, your kit should include:

• List of medications and dosage
• A 30-day supply of medications
• Vital medical equipment for those who may be electrically or oxygen dependent,
• Backup energy sources for essential medical equipment
• Any special dietary needs or food
• Personal information including: Photo ID, Insurance card, List of emergency contacts, Your primary care provider’s contact information

After completing the Florida Special Needs Registry, additional information will be provided to you by your local emergency management agency regarding evacuation and sheltering options available.

For more information on your local shelter status, please visit FloridaDisaster.org.

Health Care Providers

If you are a health care provider, please contact SNR@flhealth.gov to obtain a login for the special needs registry to ensure you are able to use all health care provider functions.

Effective May 30, a provider or supplier may be subjected to a stay of enrollment if they are deficient in one provider enrollment requirement which can be remedied by submitting a provider enrollment application. A stay of enrollment is a preliminary, interim status representing a pause in enrollment during which you will not be paid.

During a stay of enrollment, or pause, your provider status remains active in Medicare, but Medicare will reject all claims submitted with a date of service within the stay period.

Some examples of when a stay of enrollment may be implemented:

• Provider failed to timely report a change in address
• Supplier didn't respond to a revalidation request
• Independent diagnostic testing facility failed to comply with a supplier standard
• A supplier failed to timely report a change in address of an organizational owner
• A supplier failed to report the deletion of a managing employee

Note: If a stay of enrollment has been placed on your enrollment record, you will be notified by hard-copy mail, email, and fax, if applicable. To have the stay of enrollment removed, you must fix the non-compliance with Medicare by submitting the applicable Medicare application. Remember, if you need help, Acevedo Consulting has the expertise to assist with Medicare enrollment.

For example: Your clinic group practice recently changed practice locations and did not notify Medicare. Your MAC implemented a stay of enrollment because you did not report a change in practice location. To have the stay of enrollment removed and be able to continue billing Medicare, you will have to submit a change of information enrollment application to update your practice address.

If you believe you meet all provider enrollment requirements and the stay of enrollment should not have been imposed, you can submit a provider enrollment rebuttal. Refer to your stay of enrollment letter for instructions on how and where to submit the rebuttal. For more information, please click here.

The Agency for Health Care Administration (Agency) has adjusted the Practitioner payment methodology to include a Pediatric Rate Increase of 7.3% to the Practitioner Fee Schedule for Physicians PT25 (M.D.) and PT26 (D.O), serving recipients ages 0-20 years.

The Agency has included the 7.3% Pediatric Rate Increase as directed in the 2023-24 General Appropriations Act. This increase was implemented December 8, 2023, and the rates are effective October 1, 2023.

To receive the higher rates for fee-for-service (FFS) claims or encounter transactions with Dates of Service on or after October 1, 2023, and submitted prior to December 8, 2023, you will need to adjust the transaction. If the Billed Amount is less than the new max fee, the Billed Amount(s) must be updated. Florida Medicaid pays the lesser of the amount billed or the allowed amount (max fee). Detailed instructions are below for FFS claim and encounter adjustments.

The Practitioner Fee Schedule can be accessed on the Agency’s website at the following link:

Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes (myflorida.com)

Below are the instructions for submitting FFS claim and encounter transaction adjustments:

➢ Submit Adjustment (FFS or encounter) via X12 837 transaction:

• Adjusted claims must contain a frequency code of “7” and the 13-digit ICN of the paid claim being adjusted in the REF02 segment of the X12 837 transaction.
• For additional information on the successful processing of adjustments, please refer to the EDI companion guides on the public Web Portal.

➢ Submit FFS Adjustment via secure Web Portal:

• Open the claim and make any necessary changes (including billed amount(s)), then click the Adjust button. If there are no changes then just click the Adjust button.
• For additional information on submitting claims via the secure Web Portal, please refer to the Direct Data Entry (DDE) Claim Form Presentations on the public Web Portal.

Managed Care Plan providers should contact the plan directly for billing questions and instructions.

The DEA shared this alert about the fraud scheme attempt. If you receive a call from a person claiming to be with DEA, you should report the incident to the FBI at www.ic3.gov.

CDC and FDOH continue to investigate infections of Verona Integron-mediated Metallo-β-lactamase (VIM) and Guiana-Extended Spectrum-β-Lactamase (GES)-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-GES-CRPA). As of March 14, 2023, CDC, in partnership with state and local health departments, identified 68 patients in 16 states (CA, CO, CT, FL, IL, NC, NJ, NM, NY, NV, PA, SD, TX, UT, WA, WI) with VIM-GES-CRPA, a rare strain of extensively drug-resistant P. aeruginosa. 37 patients were linked to 4 healthcare facility clusters. One person has died and there have been 8 reports of vision loss and 4 reports of enucleation (surgical removal of eyeball). Most patients reported using artificial tears. EzriCare Artificial Tears, a preservative-free, over-the-counter product packaged in multidose bottles, was the brand most commonly reported. This was the only common artificial tears product identified across the 4 healthcare facility clusters. At this time, CDC and FDA recommend clinicians and patients stop using artificial tears products from either EzriCare or Delsam Pharma until further notice.

Please notify your local CHD (County Health Department Epidemiology Contacts) and HAI Prevention Program of any suspected VIM-CRPA cases immediately. Facilities with CRPA infections are requested to forward specimens to BPHL-Jacksonville (address below). You may reach out to our HAI Prevention Program for any questions.

Bureau of Public Health Laboratories – Jacksonville
Microbiology Department
ATTN: Kelly Tomson
1217 N. Pearl Street Jacksonville, FL 32202

Under the new rules, minors currently being treated with puberty blockers or hormone therapies would be allowed to continue the treatment. Children who have begun to socially transition but have not started puberty blockers, however, would be ineligible for such treatment. In a news release Thursday, several LGBTQ-advocacy groups said they are preparing to challenge the treatment ban in federal court. Simone Chriss, director of the Transgender Rights Initiative at Southern Legal Counsel, said the state’s policy is contradicted by evidence and science. “There is an unbelievable degree of hypocrisy when a state that holds itself out as being deeply concerned with protecting ‘parents’ rights’ strips parents of their right to ensure their children receive appropriate medical care,” Chriss said in a prepared statement. Chriss is among the lawyers in a separate case challenging a decision by the state Agency for Health Care Administration to stop Medicaid reimbursements for gender-affirming care for children and adults.

The new Board of Medicine rule took effect as lawmakers consider proposals that would enshrine the prohibition against gender-affirming treatment for minors in state law and impose other restrictions. A Senate measure would make it a felony for doctors or other health-care professionals to order puberty blockers, hormone treatment or surgery for transgender minors.

The Florida High School Athletic Association recently published new forms for the preparticipation athlete screening process. The forms are attached below for your review:

• EL3 (consent and release form): While not part of the PPE process, this form is vital for the physician to review, especially pages 2-4/. These pages attempt to educate our student-athletes and parents about specific injuries that can occur in sports and the possible consequences of these injuries. The form also tries to encourage proactive strategies for parents regarding the prevention of injury, but especially regarding cardiac health and the preparticipation ECG screenings that have become mandatory in some counties throughout the state. We recommend that physicians review this form as parents may have questions when they arrive for a sports physical with their child.
• EL2 (updated, effective 3/23): The FHSAA has now adopted a modified version of the 2019 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine PPE Form. Effective immediately, this new form will: Provide a medical history review in preparation for sports participation. Support the protection of personal, private medical information by requesting the clinician and parent to retain the first three pages of the document on file. (medical history forms and the physical exam form) Create a medical eligibility form (page 4) that is submitted to the school for sports participation. When completing this form, the physician/clinician is reminded to transfer necessary (need-to-know) medical history information to the bottom of the document to be shared with the school medical personnel.
• AT-18 (return to play after concussion): This was recently updated to emphasize a collaborative approach among medical providers when preparing a student-athlete for return to participation following a head injury.

Florida Medicaid recipients maintaining access to critical Medicaid services (e.g., durable medical equipment and supplies, home health services, hospital services, nursing facility services, chemotherapy, dialysis services, etc.) is imperative during the disaster period. To this end, the Agency will ensure reimbursement for critical Medicaid services provided in good faith to eligible recipients who reside in the counties impacted by Tropical Storm Nicole.

Please continue providing services:

• The Agency will waive all prior authorization requirements for critical Medicaid services beginning November 9, 2022, until further notice.
  -Early prescription refill edits have been lifted for all maintenance medications (Note: This does not apply to controlled substances).
•  If a recipient requires critical Medicaid services beyond limits stated in policy to maintain safety and health, providers can furnish the service.
• The Agency is postponing all Preadmission Screening and Resident Review (PASRR) processes until further notice.
  -Retroactively performed screenings or resident reviews must document the reason for delay in the completion of PASRR requirements.
  -The Agency is waiving the PASRR process for recipients who evacuated due to an evacuation order or power outage and are admitted and discharged during the storm.

Additional information for providers is located on the Agency’s website. Click the Storm Information banner at the top of the page for more information.

Governor Ron DeSantis’ emergency executive orders that identify impacted counties are available online.