reglab/statecodes huggingface dataset:
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.007 - Data Standards (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 88-394, Laws of Florida,
					 408.061,
					 408.072, 408.08, 408.15 FS. Law
					 Implemented 408.061, 408.072,
					 408.08
					 FS.
New 1-23-92, Formerly 10D-7.007,Repealed
					 12-15-96.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.008 - Hospital Patient Data Release (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 88-394, Laws of Florida, 408.15 FS.
					 Law Implemented 120.33, 408.15 FS.
New 9-28-92, Formerly 10D-7.008,Repealed
					 12-15-96.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.011 - Definitions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061 FS.
New 12-15-96, Amended 7-11-01, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.012 - Inpatient Data Reporting Instructions

Current through Reg. 50, No. 138; July 16, 2024
A facility must register through the FDDC portal to submit
				  its data file according to the specifications in subsections (1) through
				  (2).
(1) The Internet address for
				submitting inpatient data files is
https://apps.ahca.myflorida.com/Fddc/
.
(2) Beginning with the fourth quarter 2022
				data reporting period as defined in paragraph
				59E-7.023(1)(d),
				F.A.C., inpatient patient data must be submitted using the Inpatient Data XML
				PD10-5 Schema available at: http://ahca.myflorida.com/xmlschemas/PD10-5.xsd.
				The Inpatient Data XML PD10-5 Schema (effective January 2023) is incorporated
				by reference at
https://www.flrules.org/Gateway/reference.asp?No=Ref-15080
.
(3) The data in the XML file shall contain
				the data elements, codes and standards required in Rules
				59E-7.027,
				59E-7.028 and
				59E-7.030,
				F.A.C.
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061, 408.062, 408.063
					 FS.
New 12-15-96, Amended 1-4-00, 7-11-01, 7-12-05, 5-22-07,
					 1-1-10, 10-1-15, 1-1-18, 2-16-23.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.013 - Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061(13), (16) FS.
New 12-15-96, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.014 - Inpatient Data Format - Data Elements, Codes and Standards (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061 FS.
New 12-15-96, Amended 7-11-01. 7-12-05, 5-22-07, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.015 - Public Records (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 119.07(1)(a), (2)(a), 408.061(8)
					 FS.
New 12-15-96, Amended 7-12-05, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.016 - General Provisions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061 FS.
New 12-15-96, Amended 7-11-01, 7-12-05, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.020 - Purpose of Inpatient Data Reporting (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.062, 408.063, 408.05, 408.07, 408.08
					 FS.
New 1-1-10, Repealed
					 5-3-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.021 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) "Acute Care" means inpatient general
				routine care provided to patients who are in an acute phase of illness, which
				includes the concentrated and continuous observation and care provided in the
				intensive care units of an institution.
(2) "Comprehensive Rehabilitation" means
				services provided in a Specialty Rehabilitation Hospital licensed under Chapter
				395, F.S., or services provided in a hospital rehabilitation distinct part
				unit.
(3) "Distinct Part Unit"
				means a unique unit or level of care at a hospital requiring the issuance of a
				separate claim to a payer.
(4)
				"ECMORB" means a Supplementary Classification of External Causes of Morbidity
				and Poisoning, ICD-10-CM, where environmental events, circumstances, and
				conditions are the cause of injury, poisoning, and other adverse effects as
				specified in the ICD-10-CM manual and the conventions of coding.
(5) "Executive Officer" means a reporting
				facility's chief executive officer, chief financial officer, chief operating
				officer, president, or any vice president of the hospital in charge of a
				principal business unit, division or function (administration or
				finance).
(6) "Inpatient" means a
				patient who has an admission order given by a licensed physician or other
				individual who has been granted admitting privileges by the hospital.
				Observation patients are excluded.
(7) "Newborn" means a baby born within the
				hospital or the initial admission of an infant to any hospital within 24 hours
				of birth. Excludes babies born in a different hospital and transferred to the
				reporting hospital.
(8) "NPI" means
				National Provider Identification. An NPI is a unique identification number
				assigned to a provider by the Centers for Medicare & Medicaid
				Services.
(9) "NUBC" means National
				Uniform Billing Committee. A national body that defines the data elements that
				are reported on the Uniform Bill UB-04 and annually publishes an Official UB-04
				Data Specifications Manual.
(10)
				ISO 3166 - The International Standard for Organization is a standardized list
				of country names and codes first published in 1974 and updated 2008. ISO 3166
				is available at:
http://www.iso.org/iso/english_country_names_and_code_elements
.
(11) "FDDC" means Florida Discharge Data
				Collection system. An online portal for all data collection applications
				including, but not limited to, quarterly data file submissions, facility
				contact information, exemption requests, resubmission requests, and
				certification.
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061 FS.
New 1-1-10, Amended 12-5-10, Formerly
					 59E-7.011, Amended 10-1-15,
					 1-1-18, 2-16-23.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.022 - Inpatient Data Reporting and Audit Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) Hospitals licensed under Chapter 395,
				F.S., except state-operated hospitals, in operation for all or any of the
				reporting periods described in subsection
				59E-7.023(1),
				F.A.C., below, shall submit hospital inpatient discharge data to the Agency
				according to the provisions in Rules
				59E-7.012 and
				59E-7.021 through
				59E-7.030, F.A.C.
(2) Each hospital shall submit a separate
				report for each location per Section
				408.061(3),
				F.S.
(3) All acute, intensive care,
				long term acute care, short term and long term psychiatric, substance abuse and
				comprehensive rehabilitation live discharges and deaths, including newborn live
				discharges and deaths, shall be reported. Submit one record per inpatient
				discharge, to include all newborn admissions, transfers and deaths. Patients
				receiving rehabilitation services while in the acute care setting (not
				discharged or transferred to a distinct part unit) are included in the
				inpatient reporting for service type 1. Report all rehabilitation services
				provided in either a rehabilitation hospital or in a non-acute distinct part
				unit in the inpatient reporting for service type 2.
(4) Upon notification by the Agency staff,
				all hospitals shall provide access to all required information from the medical
				records and billing documents underlying and documenting the hospital inpatient
				discharge reports submitted, as well as other inpatient related documentation
				deemed necessary to conduct complete inpatient data audits of hospital data,
				subject to the limitations as set forth in Section
				408.061(1)(d),
				F.S. No inpatient discharge records that support inpatient discharge data are
				exempt from disclosure to the Agency for audit purposes.
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.062, 408.063, 408.05, 408.08(1)
					 FS.
New 1-1-10, Formerly
					 59E-7.012, Amended
					 1-1-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.023 - Schedule for Submission of Inpatient Data and Extensions

Current through Reg. 50, No. 138; July 16, 2024
(1) All hospitals reporting their inpatient
				discharge data shall report according to the following schedule:
(a) Each data file submitted for the 1st
				quarter covering inpatient discharges occurring between January 1 and March 31
				inclusive, of each year, may be submitted no later than June 1 of the calendar
				year during in which the discharge occurred. This is considered to be the first
				quarter, regardless of the hospital's fiscal year. First quarter data must be
				certified by August 31 of the same calendar year.
(b) Each data file submitted for the 2nd
				quarter covering inpatient discharges occurring between April 1 and June 30
				inclusive, of each year, may be submitted no later than September 1 of the
				calendar year during in which the discharge occurred. This is considered to be
				the second quarter, regardless of the hospital's fiscal year. Second quarter
				data must be certified by November 30 of the same calendar year.
(c) Each data file submitted for the 3rd
				quarter covering inpatient discharges occurring between July 1 and September 30
				inclusive, of each year, may be submitted no later than December 1 of the
				calendar year during in which the discharge occurred. This is considered to be
				the third quarter, regardless of the hospital's fiscal year. Third quarter data
				must be certified by February 28 of the following calendar year.
(d) Each data file submitted for the 4th
				quarter covering inpatient discharges occurring between October 1 and December
				31 inclusive, of each year, may be submitted no later than March 1 of the
				calendar year following the year in which the discharge occurred. This is
				considered to be the fourth quarter, regardless of the hospital's fiscal year.
				Fourth quarter data must be certified by May 31 of the next calendar
				year.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.025 - Certification, Audits and Resubmission Procedures

Current through Reg. 50, No. 138; July 16, 2024
(1) Submission of data files for all
				hospitals must be in compliance with Rules
				59E-7.012 and
				59E-7.021 through
				59E-7.030, F.A.C. The executive
				officer, administrator, or authorized designee shall certify the data quarterly
				as accurate, complete and verifiable by completing the electronic certification
				in FDDC. The electronic certification attests the inpatient patient data report
				has been examined and, to the best of the submitter's knowledge and belief, the
				information contained in this data file is true, accurate, and complete, and
				has been prepared from the books and records of this facility. The data is
				considered "certified" for the reporting quarter upon completion of the
				facility's electronic certification.
(2) A facility whose data file is not
				certified within five (5) calendar months following the last day of the
				reporting quarter shall be subject to penalties pursuant to Rule
				59E-7.026, F.A.C. A facility
				will not be penalized for delays caused by the Agency that are documented by
				the reporting facility to include online reporting system downtime.
(3) Changes or corrections to certified data
				may be accepted from a facility for a period of twelve (12) months following
				the first date of the affected quarter. The Agency may grant approval if it
				determines that resubmission will significantly impact data quality. The
				facility must submit an electronic resubmission request in FDDC. The electronic
				request must explain the cause contributing to the inaccurate reporting, and
				include the reason for the corrections or changes, the total number of records
				affected by quarters and years, the data type and the date that the replacement
				file will be submitted to the Agency. Any changes to a hospital's data after
				this twelve (12) month period shall be subject to penalties pursuant to Rule
				59E-7.026, F.A.C. Resubmission
				of previously certified data must be certified within thirty (30) days
				following receipt of the data file from the facility.
(4) A facility must electronically update
				their facility contact information in FDDC when a change of the facility
				contact responsible for handling the data file submission or the facility CEO
				or Administrator occurs. Information must include full names, title, applicable
				phone and fax numbers, and email address.
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
					 408.062, 408.063, 408.15(11), 408.08(1)(2)
					 FS.
New 1-1-10, Formerly
					 59E-7.012, Amended 1-1-18,
					 2-16-23.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.026 - Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies

Current through Reg. 50, No. 138; July 16, 2024
(1) For purposes of this rule chapter, a
				report or other information is "incomplete" when it does not contain all data
				required by the Agency in this rule and in forms incorporated by reference or
				when it contains inaccurate data. The Agency shall to the extent practical,
				apply the same audit standards and use the same audit procedures for all
				hospitals or audit a random sample of hospitals. The Agency will notify each
				hospital of any possible errors discovered by audit and request that the
				hospital either correct the data or verify that the data is complete and
				correct. A report or other information is "false" if done or made with the
				knowledge of the preparer or an administrator that it contains information or
				data which is not true or accurate.
(2) A hospital which refuses to file, fails
				to timely file, or files false or incomplete reports or other information
				required to be filed under the provisions of Section
				408.08(2),
				F.S., other Florida Law, or a rule adopted thereunder, shall be subject to
				administrative fines pursuant to Section
				408.813, F.S. Failure to comply
				with reporting requirements will also result in the referral of a hospital to
				the Agency's Bureau of Health Facility Regulation.
(3) Notifications will be sent to reporting
				facilities who do not submit their data file by the initial due date as
				specified in Rule 59E-7.023, F.A.C.
(4) The penalty period will begin on the
				first calendar day following the certification due date for purposes of penalty
				assessments.
(5) Any hospital which
				is delinquent for a certification deadline as specified in Rule
				59E-7.023, F.A.C., shall be
				subject to a fine of $100.00 per day of violation for the first violation,
				$350.00 per day of violation for the second violation, and $1, 000.00 per day
				of violation for the third and all subsequent violations. Following four
				consecutive non-delinquent quarters, the fine violation matrix will reset to
				the first violation rate. Violations will be considered those activities which
				necessitate the issuance of an administrative complaint by the Agency unless
				the administrative complaint is withdrawn or final order dismissing the
				administrative complaint is entered. Any hospital which files false information
				to the Agency shall be subject to a fine not exceeding $1, 000.00 per day per
				violation, in addition to any other fine imposed
				hereunder.
Rulemaking Authority 408.061(1)(e), 408.15(8), 408.813 FS.
					 Law Implemented 408.08(2), (3), (5), 408.813
					 FS.
New 1-10-10, Formerly
					 59E-7.013, Amended
					 1-1-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.027 - Header Record

Current through Reg. 50, No. 138; July 16, 2024
The first record in the data file shall be a header record
				  containing the information described below.
(1) Report Year. Enter the year of the data
				in the format YYYY where YYYY represents the year in four (4) digits. A
				required field.
(2) Report Quarter.
				Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first
				quarter of the calendar year, 2 corresponds to the second quarter of the
				calendar year, 3 corresponds to the third quarter of the calendar year, and 4
				corresponds to the fourth quarter of the calendar year. A required
				field.
(3) Data Type. Enter PD10-5
				for Inpatient Data. A required field.
(4) Submission Type. Enter I or R where I
				indicates an initial submission of a data file or resubmission of a data file
				prior to certification, R indicates a replacement submission of previously
				certified inpatient data where resubmission has been requested or authorized by
				the Agency. A required field.
(5)
				Processing Date. Enter the date that the data file was created in the format
				YYYY-MM-DD where MM represents numbered months of the year from 01 to 12, DD
				represents numbered days of the month from 01 to 31, and YYYY represents the
				year in four (4) digits. A required field.
(6) AHCA Facility Number. Enter the
				identification number of the facility as assigned by the Agency for reporting
				purposes. A valid identification number must be between one (1) digit and eight
				(8) digits. A required field.
(7)
				Medicare Number. Enter the Medicare number of the facility as assigned by
				Centers for Medicare & Medicaid Services (CMS). A valid identification
				number must contain seven (7) numeric digits. A required field.
(8) Organization Name. Enter the name of the
				hospital from which the patient was discharged, and which is responsible for
				reporting the data. All questions regarding data accuracy and integrity will be
				referred to this entity. Up to a forty (40) character field. A required
				field.
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061, 408.062, 408.063
					 FS.
New 1-1-10, Formerly
					 59E-7.014, Amended 10-1-15,
					 1-1-18, 2-16-23.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.029 - Patient Date Release

Current through Reg. 50, No. 138; July 16, 2024
(1) Agency records,
				public records under Chapter 119, F.S. (Florida's Public Records Law), are
				available for public inspection during normal business hours. Copies of such
				records may be obtained upon request and upon payment of the cost of
				copying.
(2) Patient-specific
				records collected by the Agency pursuant to Rules
				59E-7.021 -.030, F.A.C., are
				exempt from disclosure pursuant to Section
				408.061(7),
				F.S., and shall not be released unless modified to protect patient
				confidentiality as described in paragraph (2)(a), below, and released in the
				manner described in paragraphs (2)(c) and (2)(d).
(a) The patient-specific record shall be
				modified to protect patient confidentiality as follows:
1. Patient Control Number as assigned by the
				facility. Delete.
2. Patient Social
				Security Number. Delete.
3. Patient
				Birth Date. Substitute age in years and an indicator of Age < 29 Days except
				for persons 100 and older, substitute age > 100 years.
4. Admission Date. Delete. (admit month
				cannot be substituted)
5. Discharge
				Date. Substitute quarters 1-4. (discharge month cannot be
				substituted)
6. Principal Procedure
				Date. Days from admission to Principal Procedure will be substituted.
7. Other Procedure Date. Days from admission
				to Other Procedure will be substituted.
8. Infant Linkage ID. Delete.
9. Medical or Health Record Number.
				Delete.
10. ED Date of Arrival.
				Visit Time Hours (VTH) will be substituted. The VTH will calculate the number
				of hours spent at the ED from registration to discharge.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.030 - General Provisions

Current through Reg. 50, No. 138; July 16, 2024
Hospitals submitting inpatient discharge data pursuant to the
				  provisions contained in these rules shall be directed by the following specific
				  general provisions for inpatient data reporting:
(1) Any inpatient who is transferred or
				discharged from the acute care setting into a rehabilitative care distinct part
				unit or free standing hospital, must be reported as a separate record from the
				patients acute care record. The acute care discharge record is assigned data
				type one (1), and the comprenhensive rehabilitative therapy discharge record is
				assigned data type two (2).
(2) If
				inpatients are administratively transferred or formally discharged from the
				acute care setting into a distinct-part Medicare certified skilled nursing unit
				or to hospice care, reporting accountability ceases at the time of discharge or
				transfer. Patient's receiving sub-acute care in these setting are excluded from
				inpatient reporting requirements.
(3) Observation patients are not included in
				the inpatient reported unless admitted to the hospital as an
				inpatient.
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law
					 Implemented 408.061, 408.062, 408.063
					 FS.
New 1-1-10, Formerly
					 59E-7.016, Amended
					 1-1-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.101 - Reports of Information by Health Insurers Required (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15 FS. Law Implemented 408.006,
					 408.061 FS.
New 3-9-89, Formerly 10N-1.035, Amended 2-17-92, Formerly
					 10N-7.101,Repealed 9-20-94.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.201 - Submission of Comprehensive Inpatient Rehabilitation Hospital Patient Data (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a) -(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.202 - Schedule for Submission of Patient Data and Extensions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.203 - Reporting Instructions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.204 - Certification Procedures (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.205 - Patient Data Format - Data Elements and Codes (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.206 - Patient Data Format - Record Layout (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.207 - Data Standards (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-7 - INPATIENT DATA COLLECTION › Section 59E-7.208 - Notice of Potential Future Additional Data Requirements (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3),
					 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085
					 FS.
New 3-31-94, Repealed
					 1-1-10.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-8 - FEES FOR INFORMATION SERVICES › Section 59E-8.001 - Determination of Fees

Current through Reg. 50, No. 138; July 16, 2024
(1) The Florida
				Center for Health Information and Transparency will periodically, but no less
				frequently than biannually, calculate the average time required to access,
				merge, validate, and prepare standard information sets for delivery to the
				requester. These average times will be used to establish the fees for
				information services described in the Price List.
(2) Requests for information not addressed in
				the Price List, ad hoc custom requests, will be priced based on the time
				required to analyze the request and write the query, and the time required to
				access, merge, validate and prepare the information for delivery to the
				requester.
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.05(5)(b) FS.
New 1-3-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-8 - FEES FOR INFORMATION SERVICES › Section 59E-8.002 - Price List

Current through Reg. 50, No. 138; July 16, 2024
(1) The Price List
				of the Florida Center for Health Information and Transparency is posted at
				http://www.floridahealthfinder.gov/Researchers/OrderData/order-data.aspx.
(2) The Price List dated 8-1-07 is
				incorporated by reference as AHCA Form FC4200-003.
Rulemaking Authority 408.15(8) FS. Law Implemented
					 408.05(5)(b) FS.
New 1-3-08.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59E - Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals › Chapter 59E-9 - CLAIMS DATA COLLECTION › Section 59E-9.010 - Claims Data Collection

Current through Reg. 50, No. 138; July 16, 2024
(1) Definitions.
(a) "Affiliate" means an entity that
				exercises control over or is directly or indirectly controlled by the insurer
				through equity ownership of voting securities; common managerial control; or
				collusive participation by the management of the insurer and affiliate in the
				management of the insurer or the affiliate as defined in Section
				624.10(1),
				F.S.
(b) "Agency" means the Florida
				Agency for Health Care Administration (AHCA) as defined in Section
				408.032(1),
				F.S.
(c) "Claims Data" means
				complete and accurate eligibility data, medical claims data, and pharmacy
				claims data of Covered Lives held by Payers as specified in the Submission
				Guide.
(d) "Covered Lives" means
				individuals for whom Florida Claims Data is held by the Payer inclusive of
				insureds, individual policyholders, group certificate-holders, subscribers,
				members and dependents.
(e)
				"Facility" means Florida licensed facility pursuant to Chapter 395,
				F.S.
(f) "HIPAA" means the federal
				Health Insurance Portability and Accountability Act of 1996,
				Public Law
				104-191 and its implementing regulations (45
				C.F.R. Parts 160-164), and any requirements of the Health Information
				Technology for Economic and Clinical Health Act, as incorporated in the
				American Recovery and Reinvestment Act of 2009 and its implementing
				regulations.
(g) "Payer" means
				health insurers as defined in Chapter 624, F.S., or Health Maintenance
				Organizations as defined in Chapter 641, F.S., including their Affiliates, that
				participate in the Florida state group health insurance plan created under
				Section 110.123, F.S., or Medicaid
				managed care pursuant to Part IV of Chapter 409, F.S.
(h) "Service or Care Bundle" means a typical
				treatment plan for a medical condition that consists of one or more procedures,
				tests and services. Bundles are broken down into treatment steps and those
				steps may include one or more procedures, tests or services.
(i) "Submission Guide" means the document
				entitled "Florida Claims Data Submission Guide, " November 2017, that sets
				forth the required schedules, data file format, record specifications, data
				elements, definitions, code tables and edit specifications for Payers'
				submission of Claims Data to the Agency through its Vendor, hereby incorporated
				by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-09235
.
(j) "Vendor" means the organization that is
				under contract with the Agency pursuant to Section
				408.05(3)(c),
				F.S.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59F - Rural Health Networks › Chapter 59F-1 - RURAL HEALTH NETWORKS › Section 59F-1.002 - Definitions (Transferred)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 381.0406(17) FS. Law Implemented
					 381.0406(2), (3), (4), (11)(c) FS.
New 12-29-93, Amended 1-29-95, 8-18-96, Transferred to
					 64I-5.001.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59F - Rural Health Networks › Chapter 59F-1 - RURAL HEALTH NETWORKS › Section 59F-1.005 - Certification/Decertification of Rural Health Networks (Transferred)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 381.0406(17) FS. Law Implemented
					 381.0406(16) FS.
New 1-29-95, Amended 8-18-96, Transferred to
					 64I-5.002.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59F - Rural Health Networks › Chapter 59F-1 - RURAL HEALTH NETWORKS › Section 59F-1.006 - Rural Health Network Cooperative Agreements (Transferred)

Current through Reg. 50, No. 138; July 16, 2024
Specific Authority 381.04065(5) FS. Law Implemented
					 381.04065 FS.
New 1-24-96, Transferred to
					 64I-5.003.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.001 - Purpose

Current through Reg. 50, No. 138; July 16, 2024
The agency adopts these rules to comply with the requirements
				  of Chapter 409, F.S. All rules in Title 59G, F.A.C., must be read in
				  conjunction with the statutes, federal regulations, and all other rules and
				  regulations pertaining to the Medicaid program.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.901 - 409.9205, 409.961 - 409.985
					 FS.
New 4-29-93, Formerly
					 10P-1.001.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.002 - General Medicaid Provisions (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(1) FS. Law Implemented 409.267
					 FS.
New 1-1-77, Amended 5-7-79, 6-4-82, 7-17-83, 5-1-84,
					 Formerly 10C-7.030, Repealed
					 10-30-96.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.010 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule
				applies to all providers rendering Florida Medicaid services to
				recipients.
(2) All providers must
				be in compliance with the provisions of the Florida Medicaid Definitions
				Policy, May 2024, incorporated by reference. The policy is available on the
				Agency for Health Care Administration's website at
				http://ahca.myflorida.com/Medicaid/review/index.shtml, and at
http://www.flrules.org/Gateway/reference.asp?No=Ref-16590
.
(3) This rule is in effect for 5 years from
				its effective date.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.901-.920, 409.973 FS.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.020 - Definition of County of Residence

Current through Reg. 50, No. 138; July 16, 2024
For the purpose of county financial participation in the
				  Medicaid Program, the county of residence for inpatient hospital care and
				  nursing home care is determined by the recipient's address information
				  contained in the federally approved Medicaid eligibility system.
(1) For hospital claims, whether through
				fee-for-service or managed care, the address is based on the current living or
				residential address, with the exception of when the resident lives in a nursing
				home. When a recipient lives in a nursing home, the address is based on the
				prior address.
(2) For nursing home
				claims, whether through fee-for-service or managed care, the address is based
				on the prior address, except when a recipient is admitted to a nursing home
				directly from a place of residence outside of the State of Florida. If the
				recipient is admitted to a nursing home from another state, the nursing home
				address will be used for county billing purposes.
(3) Since address information for children in
				custody of the Department of Children and Families is unavailable, counties are
				not responsible for these payments.
Rulemaking Authority 409.919 FS. Law Implemented 409.915
					 FS.
New 1-1-77, Formerly 10C-7.31, 10C-7.031, Amended
					 10-23-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.025 - Medicaid County Billing (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.919 FS. Law Implemented 409.915
					 FS.
New 10-23-12, Repealed
					 2-23-16.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.030 - Administrative Proceedings (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 20.05, 120.53(1)(b), (c), 409.026(8),
					 409.285, 409.910(21), 409.919-.920 FS. Law Implemented 120.53(1)(b), (c),
					 120.57, 120.58, 409.285, 409.901-.920 FS.
New 1-1-77, Amended 3-30-78, Formerly 10C-7.035, Amended
					 11-13-91, Formerly 10C-7.035, Repealed
					 10-30-96.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.035 - Determining Generally Accepted Professional Medical Standards

Current through Reg. 50, No. 138; July 16, 2024
(1) Definitions.
(a) Generally accepted professional medical
				standards - Standards based on reliable scientific evidence published in
				peer-reviewed scientific literature generally recognized by the relevant
				medical community or practitioner specialty associations'
				recommendations.
(b) Health
				service(s) - Diagnostic tests, therapeutic procedures, or medical devices or
				technologies.
(c) Relevant - Having
				a significant and demonstrable bearing on the matter at
				hand.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.036 - Clinical Trials

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule
				applies to any person or entity prescribing or reviewing a request for Florida
				Medicaid covered services and to all providers of Florida Medicaid covered
				services who are enrolled in or registered with the Florida Medicaid
				program.
(2) Definitions. Clinical
				Trials - Biomedical or behavioral research studies on human participants
				designed to answer specific questions about biomedical or behavioral
				interventions, including new treatments and known interventions that warrant
				further study and comparison.
(3)
				Coverage. Florida Medicaid reimburses for services as a result of a recipient
				participating in a clinical trial in accordance with the service-specific
				coverage policy when the services:
(a) Are
				covered under the Florida Medicaid program.
(b) Would otherwise be provided to a
				recipient who is not participating in a clinical trial.
(c) Are related to complications or side
				effects arising during the clinical trial.
(d) Are not expected or unique to the
				experimental or investigational treatment.
(e) Are not covered by the clinical trial
				sponsor.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.045 - Medicaid Forms

Current through Reg. 50, No. 138; July 16, 2024
The following forms are incorporated by reference and are
				  used either by other state agencies or providers rendering Florida Medicaid
				  services to recipients. The forms are available from the Agency for Health Care
				  Administration's Web site at
http://ahca.myflorida.com/Medicaid/review/index.shtml
.
(1) Acquired Immune Deficiency Syndrome
				(AIDS) Physician Referral for Individuals at Risk of Hospitalization, AHCA Form
				5000-0607, January 2018,
http://www.flrules.org/Gateway/reference.asp?No=Ref-09057
.
(2) Adults with Cystic Fibrosis Physician
				Referral for Individuals at Risk of Hospitalization, AHCA Form 5000-0608,
				January 2018,
http://www.flrules.org/Gateway/reference.asp?No=Ref-09058
.
(3) Consent for Voluntary Suspension of
				Authorized Services for Florida Medicaid State Plan Recipients, AHCA Form
				5000-0123, August 2017,
http://www.flrules.org/Gateway/reference.asp?No=Ref-09059
.
(4) Medical Certification for Medicaid
				Long-term Care Services and Patient Transfer Form, AHCA Form 5000-3008, June
				2016,
http://www.flrules.org/Gateway/reference.asp?No=Ref-07012
.
(5) Model Waiver Physician Referral for
				Individuals at Risk of Hospitalization, AHCA Form 5000-0025, January 2018,
http://www.flrules.org/Gateway/reference.asp?No=Ref-09060
.
(6) State of Florida Abortion Certification
				Form, AHCA MedServ Form 011, June 2016,
http://www.flrules.org/Gateway/reference.asp?No=Ref-07013
.
(7) State of Florida Exception to
				Hysterectomy Acknowledgment Requirement, ETA-5001, June 2016,
http://www.flrules.org/Gateway/reference.asp?No=Ref-07014
.
(8) State of Florida Hysterectomy
				Acknowledgment Form, HAF-5000, June 2016,
http://www.flrules.org/Gateway/reference.asp?No=Ref-07015
.
(9) The United States Department of Health
				and Human Services' Consent for Sterilization Form - HHS-687 (10/12),
http://www.flrules.org/Gateway/reference.asp?No=Ref-07926
.
(10) Unborn Activation Form, AHCA Form
				5240-006, (February 2017),
http://www.flrules.org/Gateway/reference.asp?No=Ref-07915
.
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.905, 409.912 FS.
New 9-28-15, Amended 7-11-16, 4-5-17,
					 2-8-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.050 - General Medicaid Policy

Current through Reg. 50, No. 138; July 16, 2024
(1) Purpose. This
				rule specifies requirements that apply to all providers rendering Florida
				Medicaid services to recipients.
(2) Billing the Recipient. Providers must
				inform a recipient of his or her responsibility to pay for services that are
				not covered by Florida Medicaid, and document in the recipient's file that the
				recipient was informed of his or her liability, prior to rendering each
				service.
(a) Providers may seek reimbursement
				from a recipient under the following circumstances:
1. The recipient is not eligible for Florida
				Medicaid on the date of service.
2.
				The service rendered is not covered by Florida Medicaid, if the provider seeks
				reimbursement from all patients for the specific service.
3. The provider verifies that the recipient
				has exceeded the Florida Medicaid coverage.
4. The recipient is enrolled in a Florida
				Medicaid managed care plan (plan) and is informed that:
a. The plan denies authorization for the
				service.
b. The treating provider
				is not in the plan's provider network (with the exception of emergency
				services).
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.052 - Third-Party Liability Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1)
				This policy applies to all persons who are required to notify Florida Medicaid
				of any third-party benefits a recipient may have and to providers rendering
				Florida Medicaid services to recipients.
(2) Purpose. Third-party liability (TPL)
				refers to the legal obligation of third-parties to pay part, or all, of the
				expenditures for medical assistance furnished under the Florida Medicaid
				program. In accordance with Title 42, Code of Federal Regulations (CFR),
				section 433, Subpart D, all other available third-party resources must meet
				their legal obligation to pay claims before the Florida Medicaid program pays
				for a recipient's health care services.
(3) Definitions.
(a) Dually Eligible Recipient. As defined in
				rule 59G-1.010, Florida
				Administrative Code (F.A.C.).
(b)
				Rate. As defined in rule 59G-1.010, F.A.C.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.053 - Authorization Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule
				applies to providers rendering Florida Medicaid services to
				recipients.
(2) All providers must
				comply with the provisions of the Florida Medicaid Authorization Requirements
				Policy, June 2016, incorporated by reference. The policy is available on the
				Agency for Health Care Administration's website at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-06927
.
Rulemaking Authority 409.919 FS. Law Implemented 409.908,
					 409.912, 409.9127, 409.913 FS.
New 7-11-16.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-1 - GENERAL MEDICAID › Section 59G-1.054 - Recordkeeping and Documentation Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to providers rendering
				Florida Medicaid services to recipients.
(2) Documentation Requirements.
(a) All Florida Medicaid providers must:
1. Ensure medical records establish the
				medical necessity for and the extent of services provided.
2. Sign and date each medical record within
				two business days from the date and time of service, or otherwise authenticate
				the record by signature, written initials, or computer entry. Electronic
				signatures are permissible as defined in Chapter 668, Part I, F.S.
3. Initial rubber stamped
				signatures.