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Florida MedicaidMedicaid · Coverage · Specialty Services · FL · Psychiatry, Palliative CareHigh impact

Reinstatement of Service Limits for Community Behavioral Health and Targeted Case Management Services Effective October 14, 2026

Act
by Oct 14, 2026
Effective date
Oct 14, 2026
Identified
Sep 15, 2026

Summary

Florida Medicaid is reinstating service limits (frequency and duration restrictions) for Community Behavioral Health (CBH) and Targeted Case Management (TCM) services, effective October 14, 2026. These limits were waived since March 2022 under the ARPA program but will now be enforced again. Billing teams must verify service limits on the CBH and TCM fee schedules and ensure claims comply with reinstated frequency/duration caps.

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What to do

by Oct 14, 2026 · 4 steps
01Billing team must (1) obtain the current Community Behavioral Health and Targeted Case Management fee schedules from Florida Medicaid to identify reinstated service limits; (2) update billing system rules to enforce frequency and duration limits for CBH and TCM claims; (3) audit pending and scheduled claims to identify services that will exceed reinstated limits and coordinate with providers and managed care plans for medical necessity documentation and continuity of care planning; (4) update billing templates and provider alerts to flag when service limits are approached.
02For managed care plan enrollees, providers must contact their respective managed care plans to ensure care coordination and obtain any necessary prior authorizations under the new limits.
03Claims submitted after October 14, 2026 that exceed reinstated service limits will be denied unless medical necessity justifies exceptions.
04Contact Florida Medicaid Helpline at 1-877-254-1055 or FLMedicaidManagedCare@ahca.myflorida.com for fee schedules and limit details.

Original notice

Reinstatement of Service Limits for Community Behavioral Health and Targeted Case Management Services Effective October 14, 2026
icontact-archive.com · Always check the source before changing claims.
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Florida Medicaid policiesFL policy changesPsychiatryPalliative Care

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