reglab/statecodes huggingface dataset:
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.300 - State Mental Health Hospital Services

Current through Reg. 50, No. 138; July 16, 2024
(1)
				This rule applies to all providers rendering Florida Medicaid state mental
				health hospital services to recipients.
(2) All providers must be in compliance with
				the provisions of the Florida Medicaid State Mental Health Hospital Services
				Coverage Policy, January 2018, incorporated by reference. The policy is
				available on the Agency for Health Care Administration's Web site at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and at
http://www.flrules.org/Gateway/refernce.asp?No=Ref-08934
.
(3) The Physician Certification State Mental
				Health Hospital Services Form - AHCA Med Serv Form 034, January 2008, is
				incorporated by reference, and available at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and
http://www.flrules.org/Gateway/reference.asp?No=Ref-08935
.
Rulemaking Authority 409.919 FS. Law Implemented 409.906,
					 409.908 FS.
New 5-29-06, Amended 6-30-10,
					 2-8-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.310 - Targeted Case Management for Children at Risk of Abuse and Neglect

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to all providers of
				targeted case management for children at risk of abuse and neglect who are
				enrolled in the Florida Medicaid program.
(2) All providers of targeted case management
				for children at risk of abuse and neglect must be in compliance with the
				provisions of the Florida Medicaid Targeted Case Management Services for
				Children at Risk of Abuse and Neglect Coverage and Limitations Handbook, May
				2014, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-03963
,
				incorporated by reference. The handbook is available from the Medicaid fiscal
				agent's website at
www.mymedicaid-florida.com
. Select
				Public Information for Providers, then Provider Support, and then Provider
				Handbooks. Paper copies of the handbook may be obtained by calling the Provider
				Services Contact Center at 1(800)289-7799 and selecting Option 7.
(3) The following forms, included in the
				Florida Medicaid Targeted Case Management Services for Children at Risk of
				Abuse and Neglect Coverage and Limitations Handbook, are incorporated by
				reference: Contractor Certification for Children's Services Council, AHCA Form
				5000-3535, revised May 2014; Case Manager Supervisor Certification, AHCA Form
				5000-3536, revised May 2014; Case Manager Certification, AHCA Form 5000-3537,
				revised May 2014; Child Certification, AHCA Form 5000-3538, revised May 2014;
				Provider Agency Certification for Children's Services Council, AHCA Form
				5000-3539, May 2014; Certification of Funds, AHCA Form 5000-3532, revised May
				2014. These forms are available by photocopying them from the Florida Medicaid
				Targeted Case Management Services for Children at Risk of Abuse and Neglect
				Coverage and Limitations Handbook. The handbook is available from the Medicaid
				fiscal agent.
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.906, 409.907, 409.908, 409.9081, 409.912, 409.913
					 FS.
New 5-1-14.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.318 - Occupational Therapy Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This
				rule applies to all providers rendering Florida Medicaid occupational therapy
				services to recipients.
(2) All
				providers must be in compliance with the provisions of the Florida Medicaid
				Occupational Therapy Services Coverage Policy, October 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 at
https://www.flrules.org/Gateway/reference.asp?No=Ref-07515
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973
					 FS.
New 11-29-16.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.320 - Physical Therapy Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This
				rule applies to all all providers rendering Florida Medicaid physical therapy
				services to recipients.
(2) All
				providers must be in compliance with the provisions of the Florida Medicaid
				Physical Therapy Services Coverage Policy, October 2016, incorporated by
				reference. The policy is available from the Agency for Health Care
				Administration's website at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and at
https://www.flrules.org/Gateway/reference.asp?No=Ref-07516
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973
					 FS.
New 5-24-92, Amended 4-12-93, Formerly 10C-7.068, Amended
					 5-4-94, 12-26-95, 3-9-99, 12-2-03, 12-3-08, 8-22-13,
					 11-29-16.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.322 - Respiratory Therapy Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This
				rule applies to all providers rendering Florida Medicaid respiratory therapy
				services to recipients.
(2) All
				providers must be in compliance with the provisions of the Florida Medicaid
				Respiratory Therapy Services Coverage Policy, August 2018, incorporated by
				reference. The policy is available on the Agency for Health Care
				Administration's Web site at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and at
http://www.flrules.org/Gateway/reference.asp?No=Ref-09634
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973
					 FS.
New 11-29-16,
					 9-24-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.324 - Speech-Language Pathology Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This
				rule applies to all providers rendering Florida Medicaid speech-language
				pathology services to recipients.
(2) All providers must be in compliance with
				the provisions of the Florida Medicaid Speech-Language Pathology Services
				Coverage Policy, October 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-07518
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973
					 FS.
New 11-29-16.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.330 - Non-Emergency Transportation Services

Current through Reg. 50, No. 138; July 16, 2024
(1)
				This rule applies to all providers rendering Florida Medicaid non-emergency
				transportation services to recipients.
(2) All providers must be in compliance with
				the provisions of the Florida Medicaid Non-Emergency Transportation Services
				Coverage Policy, November 2019, 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-11228
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.901, 409.902, 409.905, 409.907, 409.908, 409.9081, 409.912, 409.913,
					 409.973 FS.
New 1-1-77, Amended 10-1-77, 1-27-81, 8-28-84, Formerly
					 10C-7.45, Amended 4-13-93, Formerly 10C-7.045, Amended 1-7-98, 12-18-05,
					 7-23-06, 10-27-16, 11-19-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.340 - Visual Aid Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule
				applies to all providers of visual aid services who are enrolled in or
				registered with the Florida Medicaid program.
(2) All providers of visual aid services must
				be in compliance with the provisions of the Florida Medicaid Visual Aid
				Services Coverage Policy, November 2015, incorporated by reference. The policy
				is available from the Medicaid fiscal agent's website at
http://portal.flmmis.com/flpublic
,
				and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-05963
.
Rulemaking Authority 409.919 FS. Law Implemented 409.906,
					 409.908 FS.
New 7-30-80, Formerly 10C-7.521, Amended 4-20-93, 8-25-93,
					 Formerly 10C-7.0521, Amended 12-21-97, 10-13-98, 6-10-99, 4-23-00, 1-23-02,
					 2-20-03, 8-5-03, 10-12-04, 8-18-05, 5-22-06, 4-4-07, 5-31-10,
					 11-15-15.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.360 - Transplant Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule
				applies to all providers rendering Florida Medicaid transplant
				services.
(2) All providers must be
				in compliance with the provisions of the Florida Medicaid Transplant Services
				Coverage Policy, May 2019, incorporated by reference. The policy is available
				on the Agency for Health Care Administration's Web Site at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-10371
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973
					 FS.
New 6-29-16, Amended
					 5-27-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-4 - MEDICAID POLICY › Section 59G-4.370 - Behavioral Health Intervention Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to all providers
				rendering Florida Medicaid behavioral health intervention services to
				recipients.
(2) All providers must
				be in compliance with the provisions of the Florida Medicaid Behavioral Health
				Intervention Services Coverage Policy, November 2019, incorporated by
				reference. The policy is available on the Agency for Health Care
				Administration's Web site at
http://ahca.myflorida.com/Medicaid/review/index.shtml
,
				and at
http://www.flrules.org/Gateway/reference.asp?No=Ref-11248
.
Rulemaking Authority 409.919, 409.961 FS. Law Implemented
					 409.902, 409.903, 409.905, 409.908, 409.912, 409.913, 409.973
					 FS.
New 12-2-19.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-5 - PROVIDER ENROLLMENT AND PROVIDER REQUIREMENTS › Section 59G-5.010 - Provider Enrollment (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.907, 409.9071, 409.908 FS.
New 9-22-93, Formerly 10P-5.010, Amended 7-8-97, 9-8-98,
					 7-5-99, 7-10-00, 5-7-03, 7-7-05,
					 1-16-20.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-5 - PROVIDER ENROLLMENT AND PROVIDER REQUIREMENTS › Section 59G-5.020 - Provider Requirements

Current through Reg. 50, No. 138; July 16, 2024
(1) All Medicaid
				providers enrolled in the Medicaid program and billing agents who submit claims
				to Medicaid on behalf of an enrolled Medicaid provider must comply with the
				provisions of the Florida Medicaid Provider General Handbook, July 2012, which
				is incorporated by reference and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-02671
and from the fiscal agent's Web site at
www.mymedcaid-florida.com
. Select
				Public Information for Providers, then Provider Support, and then Provider
				Handbooks. A paper copy of the handbook may be obtained by calling the Provider
				Services Contact Center at 1(800) 289-7799 and selecting Option 7.
(2) The following forms that are included in
				the Florida Medicaid Provider General Handbook are incorporated by reference.
				In Chapter 3, Temporary Emergency Medicaid Identification Card, July 2008;
				CF-ES 2681, Notice and Proof of Presumptive Eligibility for Medicaid for
				Pregnant Women, Feb 2003; CF-ES Form 2014, Authorization for Medicaid/Medikids
				Eligibility, Feb 2003; AHCA Form 5240-006, Unborn Activation Form, January
				2007; CF-ES 2039, Medical Assistance Referral, Sep 2002. In Chapter 4, AHCA-Med
				Serv 038, Crossover with TPL Claim and/or Adjustment Form, July 2008; AHCA Form
				5000-3527, Medicare Part C-Medicaid CMS-1500 Crossover Invoice, June 2012; AHCA
				Form 5000-3528, Medicare Part C-Medicaid UB-04 Crossover Invoice, June 2012.
				Appendix D, AHCA Med Serv Form 2000-0016, Medicaid Out-of-State
				Prior-Authorization Request Form, January 2012. The CF-ES forms are available
				from the Department of Children and Family Services. The other forms are
				available from the Medicaid fiscal agent's Web site at
www.mymedicaid-florida.com
.
				Select Public Information for Providers, then Provider Support, and then Forms.
				Paper copies of the forms may be obtained by calling the Provider Services
				Contact Center at 1(800) 289-7799 and selecting Option 7.
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.905, 409.906, 409.907, 409.908, 409.912, 409.913
					 FS.
New 9-22-93, Formerly 10P-5.020, Amended 7-8-97, 1-9-00,
					 4-24-01, 8-6-01, 10-8-03, 1-19-05, 5-24-07, 2-25-09,
					 6-13-13.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-5 - PROVIDER ENROLLMENT AND PROVIDER REQUIREMENTS › Section 59G-5.110 - Direct Reimbursement to Recipents

Current through Reg. 50, No. 138; July 16, 2024
(1) Purpose. This rule describes the
				circumstances when the Agency for Health Care Administration (AHCA) may
				directly reimburse eligible Florida Medicaid recipients; how AHCA reimburses
				recipients; and documentation requirements for direct reimbursement.
(2) Determination Criteria. Florida Medicaid
				recipients may be eligible for direct reimbursement if:
(a) Medical goods and services were paid for
				by the recipient or a person legally responsible for their bills from the date
				of an erroneous denial or termination of Florida Medicaid eligibility to the
				date of a reversal of the unfavorable eligibility determination.
(b) The goods and services were medically
				necessary as defined in Rule
				59G-1.010, Florida
				Administrative Code (F.A.C.); rendered by a provider that is qualified to
				perform the service including meeting any applicable certification or licensure
				requirements (the provider is not required to be enrolled or registered as a
				Florida Medicaid provider); and covered by Florida Medicaid for the recipient's
				eligibility group on the date of service.
(c) Reimbursement for the medical goods or
				services is not available through any third-party payer on the date of service
				for which direct reimbursement is requested.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.005 - Reimbursement Methodology for Services Provided by Medical School Faculty

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to all providers who
				are enrolled in Florida Medicaid who:
(a) Are
				defined as practitioners under the Centers for Medicare and Medicaid Services'
				Merit-based Incentive Payment System (MIPS).
(b) Provide medical services, dental
				services, behavioral health services, hearing services, and vision services to
				Florida Medicaid recipients receiving services through the fee-for-service
				delivery system.
(c) Are employed
				by, or contracted with, a Florida public or private, non-profit, accredited
				medical, dental, or optometry school to provide supervision and teaching of
				medical, dental, or optometric students, residents, or
				fellows.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.020 - Payment Methodology for Inpatient Hospital Services

Current through Reg. 50, No. 138; July 16, 2024
(1) Reimbursement to participating inpatient
				hospitals for services provided shall be in accordance with the Florida Title
				XIX Inpatient Hospital Reimbursement Plan (the Plan), Version XLIV, effective
				July 1, 2017,
http://www.flrules.org/Gateway/reference.asp?No=Ref-09420
,
				incorporated by reference. The Plan is applicable to the fee-for-service
				delivery system.
(2) A copy of the
				Plan as revised may be obtained by writing to the Bureau of Medicaid Program
				Finance, Agency for Health Care Administration, 2727 Mahan Drive, Building 3,
				Mail Stop 8, Tallahassee, Florida 32308.
(3) The Provider Reimbursement Manual CMS
				PUB. 15-1, is incorporated by reference,
http://www.flrules.org/Gateway/reference.asp?No=Ref-08256
,
				and available at
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021929.html
.
				The following cost reports are included in the Plan and are incorporated by
				reference: CMS-2552-96, June 2003,
http://www.flrules.org/Gateway/reference.asp?No=Ref-07058
;
				and CMS-2552-10, October 2012,
http://www.flrules.org/Gateway/reference.asp?No=Ref-07059
.
				These cost reports are available on the Centers for Medicare and Medicaid
				Services website at
http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/CostReports/Hospital-1996-form.html
and
http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3P240f.pdf
,
				respectively.
Rulemaking Authority 409.919 FS. Law Implemented 409.905,
					 409.908, 409.909, 409.913, 409.9113, 409.9115, 409.9116, 409.9118, 409.9119
					 FS.
New 10-31-85, Formerly 10C-7.391, Amended 10-1-86, 1-10-89,
					 11-19-89, 3-26-90, 8-14-90, 9-30-90, 9-16-91, 4-6-92, 11-30-92, 6-30-93,
					 Formerly 10C-7.0391, Amended 4-10-94, 8-15-94, 1-11-95, 5-13-96, 7-1-96,
					 12-2-96, 11-30-97, 9-16-98, 11-10-99, 9-20-00, 3-31-02, 1-8-03, 7-3-03, 2-1-04,
					 2-16-04, 2-17-04, 8-10-04, 10-12-04, 1-10-06, 4-19-06, 12-11-06, 3-4-08,
					 6-10-08, 1-11-09, 3-24-10, 7-5-10, 7-15-10, 2-23-11, 10-30-12, 4-23-14,
					 1-19-15, 6-15-15, 7-11-16, 7-10-17,
					 7-12-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.025 - Reimbursement Methodology for Cancer Hospitals

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to Florida Medicaid
				providers that render inpatient and outpatient hospital services to recipients
				through the fee-for-service delivery system. The providers must be considered
				as a cancer hospital and:
(a) Be members of
				the Alliance of Dedicated Cancer Centers.
(b) Meet the criteria under
				Title 42, United States
				Code, section
				1395ww(d)(1)(B)(v).
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.030 - Payment Methodology for Outpatient Hospital Services

Current through Reg. 50, No. 138; July 16, 2024
Reimbursement to participating outpatient hospitals for
				  services provided shall be in accordance with the Florida Title XIX Outpatient
				  Hospital Reimbursement Plan (the Plan), Version XXVII, effective date July 1,
				  2016, incorporated by reference and available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-08175
.
				  The Plan is applicable to the fee-for-service delivery system. A copy of the
				  Plan as revised may be obtained by writing to the Bureau of Medicaid Program
				  Finance, Agency for Health Care Administration, 2727 Mahan Drive, Building 3,
				  Mail Stop #23, Tallahassee, Florida 32308.
Rulemaking Authority 409.919 FS. Law Implemented 409.905,
					 409.908, 409.913 FS.
New 10-31-85, Amended 12-31-85, Formerly 10C-7.401, Amended
					 10-1-86, 3-26-90, 9-30-90, 10-13-91, 7-1-93, Formerly 10C-7.0401, Amended
					 4-10-94, 9-18-96, 9-5-99, 9-20-00, 12-6-01, 11-10-02, 2-16-04, 10-12-04,
					 7-4-05, 4-19-06, 12-11-06, 3-4-08, 6-10-08, 1-11-09, 3-24-10, 6-24-10, 2-23-11,
					 10-30-12, 4-30-14, 9-30-14, 5-3-15, 6-15-16,
					 6-26-17.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.035 - Certified Public Expenditures Program for Emergency Transportation Services

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule
				applies to all publicly owned or operated emergency transportation services
				providers rendering Florida Medicaid emergency transportation services to
				recipients under the fee-for-service delivery system.
(2) Providers must submit AHCA Form
				5000-0035, May 2017, Emergency Medical Transportation Integrated Disclosure and
				Medicaid Cost Report General Information, incorporated by reference, and
				available at
http://ahca.myflorida.com/Medicaid/Finance/finance/LIP-DSH/PEMT/index.shtml
,
				and at
https://www.flrules.org/Gateway/reference.asp?No=Ref-08173
,
				to the Agency for Health Care Administration (AHCA) annually, to be eligible to
				use certified public expenditure funds as state match in order to receive
				federal financial participation in accordance with the state's Supplemental
				Payment for Publicly Owned or Operated Emergency Medical Transportation
				Providers, SPA 2015-014, incorporated by reference, available at
http://ahca.myflorida.com/Medicaid/Finance/finance/LIP-DSH/PEMT/index.shtml
,
				and at
https://www.flrules.org/Gateway/reference.asp?No=Ref-08178
.
				The form must be completed in accordance with AHCA Form 5000-0035A, May 2017,
				Emergency Medical Transportation Services Cost Report Instructions,
				incorporated by reference, and available at
http://ahca.myflorida.com/Medicaid/Finance/finance/PEMT/index.shtml
,
				and at
https://www.flrules.org/Gateway/reference.asp?No=Ref-08176
.
(3) Funds are appropriated from the Medical
				Care Trust Fund for the Certified Public Expenditures Program for Emergency
				Transportation Services and are supplemental to the reimbursement rates on the
				Florida Medicaid Emergency Transportation Services Fee Schedule, incorporated
				by reference in Rule 59G-4.002, F.A.C.
(4) The Provider Reimbursement Manual CMS
				PUB. 15-1, April 5, 2012, is incorporated by reference, and available at
https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Paper-Based-Manuals-Items/CMS021929.html
,
				and at
http://www.flrules.org/Gateway/reference.asp?No=Ref-08256
.
(5) Title 2, Code of Federal Regulations
				(CFR), Subtitle A, Chapter II Part 200, December 19, 2014, is incorporated by
				reference, and available at
https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl
,
				and at
http://www.flrules.org/Gateway/reference.asp?No=Ref-08177
.
Rulemaking Authority 409.919 FS. Law Implemented 409.908
					 FS.
New 6-15-17.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.040 - Payment Methodology for ICF/MR-DD Services in Publicly Owned and Publicly Operated Facilities

Current through Reg. 50, No. 138; July 16, 2024
Reimbursement to participating ICF/MR-DD facilities for
				  services provided shall be in accord with the Florida Title XIX ICF/MR-DD
				  Reimbursement Plan for Publicly Owned and Publicly Operated Facilities, Version
				  VIII, Effective Date November 21, 2004, and incorporated herein by reference. A
				  copy of the Plan as revised may be obtained by writing to Deputy Secretary for
				  Medicaid, Agency for Health Care Administration, Mail Stop 8, Tallahassee,
				  Florida 32308.
Rulemaking Authority 409.919 FS. Law Implemented 409.908,
					 409.9131(6) FS.
New 7-1-85, Amended 2-25-86, Formerly 10C-7.491, Amended
					 11-19-89, 8-14-90, 12-26-90, 9-17-91, 1-27-94, Formerly 10C-7.0491, Amended
					 11-15-94, 3-14-99, 11-21-04.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.050 - Payment Methodology for Medicaid Non-Institutional Provider Services (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.905(1), (6), (7), (9), (10), 409.906(4), (6), (7), (8), (15), (16),
					 409.908, 409.913(5)(e), (8)(h) FS.
New 5-14-92, Amended 11-3-92, 2-10-93, 9-6-93, Formerly
					 10C-7.0382, Amended 6-23-94, 12-29-94, 5-16-95, Repealed
					 7-26-09.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.080 - Payment Methodology for Federally Qualified Health Center and Rural Health Center Services

Current through Reg. 50, No. 138; July 16, 2024
Reimbursement to participating health centers for services
				  provided shall be in accordance with the Florida Title XIX Federally Qualified
				  Health Center and Rural Health Center Reimbursement Plan (the Plan), Version V,
				  effective July 1, 2014, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-05547
,
				  incorporated by reference. The Plan is applicable to the fee-for-service
				  delivery system. A copy of the Plan as revised may be obtained by writing to
				  the Office of the Deputy Secretary for Medicaid, 2727 Mahan Drive, Building 3,
				  Mail Stop #8, Tallahassee, FL 32308.
Rulemaking Authority 409.919 FS. Law Implemented 409.908
					 FS.
New 6-3-93, Formerly 10P-6.080, Amended 4-10-94, 12-26-01,
					 2-1-04, 8-10-15, 5-23-16.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-6 - REIMBURSEMENT TO PROVIDERS › Section 59G-6.090 - Payment Methodology for County Health Departments

Current through Reg. 50, No. 138; July 16, 2024
(1) This rule applies to all county health
				departments (CHD)s rendering Florida Medicaid clinic services to recipients in
				accordance with Rule 59G-4.055, Florida
				Administrative Code, (F.A.C.).
(2)
				Definitions.
(a) Allowable Cost - Cost(s)
				incurred for recipient-related health care services, except as outlined in
				subsection (5).
(b) Buy-back - A
				provision that allows a CHD to decrease the Medicaid Trend Adjustment from the
				established percent to zero percent.
(c) County Health Department (CHD) Clinic
				Services - Florida Medicaid primary and preventive health care services,
				related diagnostic services, and dental services.
(d) Encounter - A visit occurring on a
				specific day between a recipient and health care professional(s). Two
				Encounters occurring on the same day will not be reimbursed separately, even if
				the Encounters are for different types of services.
(e) Filing Due Date - Date that is no later
				than five calendar months after the close of a CHD's cost reporting year; or,
				date that is within six months of a CHD's cost reporting year, if a certified
				report is filed.
(f) Legislative
				Unit Cost - The weighted average per diem of the state anticipated expenditure
				after all rate reductions, but prior to any Buy-back.
(g) Medicaid Trend Adjustment - A
				proportional percentage rate reduction that is uniformly applied to all Florida
				Medicaid providers' Rate Period, which equals all recurring and nonrecurring
				budget reductions on an annualized basis and is applied to all components of
				the prospective per diem.
(h) Rate
				Period - July 1 of a calendar year through June 30 of the next calendar
				year.
(i) Rate Setting Due Date -
				April 15: all cost reports received by Florida Medicaid on or before April 15
				of each Rate Period will be used to establish the reimbursement rates for the
				subsequent Rate Period.
(j) Rate
				Setting Unit Cost - The weighted average per diem after all rate reductions but
				prior to any Buy-backs, which is based on submitted cost
				reports.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.003 - Medicaid Third Party Liability Responsibility and Notices (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.910 FS.
New 11-13-91, Formerly 10C-35.003, Amended 10-3-96,
					 Repealed 8-14-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.004 - Forms (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 120.53(1)(b), (c), 409.026(1), (6),
					 (8), 409.910(23), 409.919 FS. Law Implemented
					 120.52(16),
					 120.53(1),
					 409.910
					 FS.
New 11-13-91, Formerly 10C-35.004, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.007 - Health Insurance Premium Payment Program

Current through Reg. 50, No. 138; July 16, 2024
(1) Under the Health Insurance Premium
				Payment (HIPP) program, the Agency for Health Care Administration (AHCA) shall
				provide financial assistance to recipients in order to obtain or maintain
				Employer Sponsored Insurance (ESI) coverage pursuant to Sections
				409.9122(14)
				and 409.977(4),
				F.S. This includes the recipient's share of the ESI premiums, copayments,
				deductibles, coinsurance and other cost sharing obligations for Medicaid
				services and items covered under the State Plan. The amount of financial
				assistance provided for each recipient may not exceed the amount of the
				Medicaid managed care premium that would have been paid for that recipient.
(a) The recipient's health care services will
				be covered through their ESI primary coverage. Medicaid will cover the lesser
				of the ESI required copayments, deductibles, or coinsurance, up to the Medicaid
				fee when the recipient's ESI provider is also a Medicaid enrolled provider.
				Medicaid will deduct any applicable Medicaid copay for covered state plan
				services. If a recipient chooses to utilize non-Medicaid providers, only the
				ESI coverage will apply and the recipient may be subject to ESI required
				copayments, deductibles, or coinsurance.
(b) Medicaid will cover any state plan
				services that are not provided by the recipient's ESI when those services are
				provided by an enrolled Medicaid provider.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.0211 - Exchange of Medicaid Data with Health Insurers (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(22), (23), 409.919
					 FS. Law Implemented 409.910(20), 624.424(9), 641.261, 641.411
					 FS.
New 11-14-89, Formerly 10C-7.0302, Amended 11-13-91,
					 Formerly 10C-35.0211, Amended 10-3-96, Repealed
					 9-24-18.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.023 - Probable Existence of Third-Party Liability Established (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.910(1), (3) FS.
New 11-13-91, Formerly 10C-35.023, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.032 - Recovery of Reimbursement - General (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.910 FS.
New 11-13-91, Formerly 10C-35.032, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.0322 - Conflicting Claims by Medicare and Medicaid (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 120.53(1)(b),
					 (c), 409.026(8), 409.910(23), 409.919 FS. Law
					 Implemented 120.53(1)(b), (c),
					 409.910
					 FS.
New 11-13-91, Formerly 10C-35.0322, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.0331 - Small Claim Exception under Paragraph (11)(f) of the MTPLA (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 120.53(1),
					 409.026(8), 409.910(23), 409.919 FS. Law Implemented 120.53(1),
					 409.910
					 FS.
New 11-13-91, Formerly 10C-35.0331, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.0332 - All Medical Assistance; Medicaid Program Repaid First (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.910 FS.
New 11-13-91, Formerly 10C-35.0332, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.034 - Settlement Agreements (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(23),
					 409.919 FS. Law Implemented 120.53(1)(b), (c),
					 120.57,
					 120.58,
					 409.285,
					 409.902,
					 409.910
					 FS.
New 11-13-91, Formerly 10C-35.034, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.035 - Fees of Recipient's Attorney (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.910 FS.
New 11-13-91, Formerly 10C-35.035, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.051 - Required to Seek Reimbursement (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.
New 11-13-91, Formerly 10C-35.051, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.053 - Hospital Third-Party Liability Plan (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.
New 11-13-91, Formerly 10C-35.053, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.054 - Prompt Repayment (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.
New 11-13-91, Formerly 10C-35.054, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.056 - Benefits under Certain Plans (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(21), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.; 42 U.S.C. ss.
					 1396a(a)(25), (a)(27),
					 (a)(45),
					 1396k (Social Security Act ss.
					 1902(a)(25), (a)(27), (a)(45), 1912);
					 42 C.F.R. ss.
					 433.135-433.140,
					 447.15,
					 447.20,
					 447.21.
New 11-13-91, Formerly 10C-35.056, Repealed
					 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.057 - Provider Third-Party Liability Audits (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.
New 11-13-91, Formerly 10C-35.057, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.058 - Billing Statement and Medical Records (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.
New 11-13-91, Formerly 10C-35.058, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.0581 - Statements as Notice (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.902, 409.907, 409.908, 409.910, 409.912, 409.913, 409.920
					 FS.
New 11-13-91, Formerly 10C-35.0581, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.060 - Cooperation Required (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 120.53, 409.026(8), 409.910(23),
					 409.919 FS. Law Implemented
					 120.57,
					 120.58,
					 120.68,
					 409.901,
					 409.902,
					 409.910,
					 409.920(2)(a),
					 (c)
					 FS.
New 11-13-91, Formerly 10C-35.060, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.0601 - Non-cooperation (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 120.53, 409.026(8), 409.910(23),
					 409.919 FS. Law Implemented
					 120.57,
					 120.58,
					 120.68,
					 409.901,
					 409.902,
					 409.910,
					 409.920(2)(a),
					 (c)
					 FS.
New 11-13-91, Formerly 10C-35.0601, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.061 - Duty to Inform (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c)
					 FS.
New 11-13-91, Formerly 10C-35.061, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.062 - Notice of Proceedings or Claim (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c)
					 FS.
New 11-13-91, Formerly 10C-35.062, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.063 - Settlement and Notice (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.901, 409.902, 409.910, 409.920(2)(a), (c)
					 FS.
New 11-13-91, Formerly 10C-35.063, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.064 - Appearance to Provide Information (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 120.58, 409.257, 409.901, 409.902, 409.910, 409.920(2)(a), (c)
					 FS.
New 11-13-91, Formerly 10C-35.064, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-7 - THIRD-PARTY LIABILITY › Section 59G-7.073 - Proceeds of Tort Recovery Required to Be Held in Trust (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.026(8), 409.910(23), 409.919 FS.
					 Law Implemented 409.910 FS.
New 11-13-91, Formerly 10C-35.073, Amended 10-3-96,
					 Repealed 5-10-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.100 - Medicaid Contracts for Prepaid Health Plans (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.9124, 409.919 FS. Law Implemented
					 409.9124(1) FS.
New 3-9-81, Amended 7-9-84, Formerly 10C-7.524, Amended
					 4-5-89, Formerly 10C-7.0524, Amended 8-4-02, 1-23-05, 5-9-06, Repealed
					 8-18-15.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.200 - Home and Community Based Services Waivers (Transferred)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.906, 409.908, 409.910, 409.412, 409.413
					 FS.
New 4-20-82, Formerly 10C-7.527, Amended 3-22-87, 11-23-89,
					 Formerly 10C-7.0527, Amended 1-16-96, 7-23-97, 1-6-02, 10-27-02, 6-11-03,
					 11-24-03, 1-16-05, 6-23-05, Transferred to
					 59G-13.080.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.300 - Medicaid Case Management (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.919 FS. Law Implemented
					 409.906(11), 409.912(7) FS.
New 9-20-88, Formerly 10C-7.0381, Amended 2-13-96, Repealed
					 7-26-09.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.400 - Medicaid Physician Access System (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority 409.919 FS. Law Implemented 409.9121,
					 409.9122 FS.
New 6-10-91, Formerly 10C-7.067, Amended 12-18-94, Repealed
					 8-18-15.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.600 - Disenrollment from Managed Care Plans

Current through Reg. 50, No. 138; July 16, 2024
(1)
				Purpose. A Florida Medicaid recipient (herein referred to as an enrollee) who
				is required to enroll in the Statewide Medicaid Managed Care (SMMC) program,
				may request to change managed care plans. Requests must be submitted via
				telephone or in writing to the Agency for Health Care Administration (AHCA) or
				its enrollment broker. Enrollees required to enroll in SMMC programs should not
				interpret this rule as an exemption from participation in Florida Medicaid's
				SMMC program. This rule applies to the process and reasons that SMMC managed
				care plan enrollees may change plans.
(2) Requests for disenrollment must be
				completed in accordance with Section
				409.969, Florida Statutes
				(F.S.), and Title 42, Code of Federal Regulations (CFR), section 438.56
				(42 CFR
				438.56).
(3) For Cause Reasons.
(a) Reasons outlined in
				42 CFR
				438.56(d)(2) and Section
				409.969(2),
				F.S., constitute cause for disenrollment at any time from a managed care plan:
1. The managed care plan does not cover the
				service the enrollee seeks because of moral or religious objections.
2. The enrollee would have to change his or
				her residential or institutional provider based on the provider's change in
				status from an in-network to an out-of-network provider with the managed care
				plan.
3. Fraudulent
				enrollment.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.700 - Child Health Services Targeted Case Management

Current through Reg. 50, No. 138; July 16, 2024
Individuals enrolled as Child Health Services targeted case
				  managers must be in compliance with the Child Health Services Targeted Case
				  Management Coverage and Limitations Handbook, June 2012,
https://www.flrules.org/Gateway/reference.asp?No=Ref-01329
,
				  which is incorporated by reference. Medicaid will reimburse only targeted case
				  management services that are provided by enrolled individual treating providers
				  employed or contracted with an enrolled targeted case management group provider
				  or agency. Such enrolled provider or agency is not permitted to subcontract
				  with another provider or agency for service delivery. The handbook is available
				  from the Medicaid fiscal agent's Web site at mymedicaid-florida.com. Select
				  Public Information for Providers, then Provider Support, and then Provider
				  Handbooks. Paper copies of the handbook may be obtained by calling the Medicaid
				  fiscal agent at 1(800) 289-7799 and selecting option 7.
Rulemaking Authority 409.919 FS. Law Implemented 409.902,
					 409.906, 409.907, 409.908, 409.912, 409.913
					 FS.
New 8-8-12.
Florida Administrative Code › 59 - AGENCY FOR HEALTH CARE ADMINISTRATION › 59G - Medicaid › Chapter 59G-8 - MANAGED CARE › Section 59G-8.800 - Financial Compliance Audits of Medicaid Prepaid Plans

Current through Reg. 50, No. 138; July 16, 2024
(1) Pursuant to Section
				409.967(3)(b),
				Florida Statutes (F.S.), the Agency for Health Care Administration (hereafter
				referred to as Agency) shall contract with independent certified public
				accountants to conduct compliance audits of Florida Medicaid prepaid health
				plans.
(a) Certified public accountants that
				participate in the preparation of a plan's financial audits or annual
				statements submitted by the plan pursuant to Sections 409.967(3)(a)1. and 2.,
				F.S., will be deemed to have a conflict of interest and are not independent
				regarding preparation of a compliance audit for that plan pursuant to Section
				409.967(3)(c)1., F.S.
(b) The
				Agency will procure, pursuant to Chapter 287, F.S., services from Florida
				licensed certified public accountants to perform compliance audits required by
				Section 409.967(3)(b),
				F.S. Rates established for the services utilized for compliance audits will be
				established through the procurement process and will be comparable to market
				rates the Agency pays for similar accounting and auditing services.
(c) A Florida Medicaid prepaid health plan
				audited pursuant to Section
				409.967(3)(b),
				F.S., must pay the Agency costs, charges, and expenses for the compliance audit
				at the rates established by the Agency pursuant to the procurement process. The
				rates established by the Agency for compliance audits will include:
1. Travel reimbursement.
2. Compensation of professional and support
				services.
3. The Agency's
				administrative costs directly related to the
				audit.