Molinalogo

When your child needs care, you will always start with a call to their Primary Care Provider (PCP). Some covered services may need prior authorization once your child is enrolled with CMS Plan.

When a doctor requests an authorization, he or she must send information about your child’s health condition and treatment. This may include copies of your child's medical record, results of tests, what medications he or she has already tried, or what kind of support your child needs at home. Your child will see any CMS Plan provider for covered services.

Prior Authorization List

Children’s Medical Services (CMS) Plan by Molina Healthcare will need to approve in advance the services listed below. If your child will see a doctor who is not in the CMS Plan network, prior authorization will always be needed, except in an emergency. You will not need prior authorization for visits to the emergency room or urgent care.

Some services like Inpatient Services; Behavior Analysis; Occupational, Speech, and Physical Therapy; and Transplants must be approved in advance. Your Member Handbook details which services are available without approval and which require authorization.

If there is no prior authorization received from CMS Plan, the claim for any service noted as needing a prior authorization will be denied. This will not be a complete list of covered services. Limits and services that are not covered will be listed in Member Handbook.

If you have questions, you will be able to call your child’s care manager or Member Services at (800) 262-0750 (TTY: 711).

Children’s Medical Services (CMS) Plan by Molina Healthcare of Florida to provide managed care services to our members. Molina Healthcare of Florida is a licensed Florida health plan. CMS Plan will provide free aids and services to people with disabilities, such as qualified sign language interpreters, written information in other formats (large print, audio, accessible electronic and other formats), and free language services to people whose primary language is not English, such as qualified interpreters and information written in other languages. This information will be available for free in other languages. Please contact Member Services at (800) 262-0750 (TTY: 711) Monday - Friday, 8:00 a.m. to 7:00 p.m. local time.