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Florida Administrative Code (Last Updated: October 28, 2024) |
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59. Agency for Health Care Administration |
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59G. Medicaid |
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59G-4. Medicaid Policy |
1(1) This rule applies to providers enrolled directly in the Florida Medicaid program that furnish home health services (home health visits, private duty nursing, and personal care services) to recipients through the fee-for-service delivery system as specified on the Agency for Health Care Administration’s (AHCA) website at 48http://ahca.myflorida.com/Medicaid/home_health/dmv.shtml in accordance with Section 53409.9132, 54Florida Statutes (F.S.).
57(2) Definition. Direct service provider – An individual who personally (face-to-face) provides services to recipients in accordance with Rule 59G-4.261, 59G-4.215 or 7959G-4.130, 80Florida Administrative Code (F.A.C.).
84(3) Home Health Electronic Visit Verification Program.
91(a) All providers must comply with Section 98409.9132, F.S.
100(b) The Agency for Health Care Administration contracts with a vendor to electronically verify the delivery of home health services provided to recipients in their residence or other authorized setting.
1301. Providers must document the home health service encounter for each recipient served (in accordance with the recipient’s approved plan of care) and verify the delivery of the services rendered using AHCA’s designated vendor’s electronic visit verification (EVV) system.
1692. Direct service providers must verify delivery of the service using the vendor’s system at the beginning and end of each home health service encounter.
1943. Providers must submit claims through AHCA’s designated vendor’s system to the Florida Medicaid fiscal agent for services rendered and verified in accordance with the prior authorization in the Florida Medicaid Management Information System.
228(4) Providers that fail to comply with the Home Health Electronic Visit Verification Program are subject to potential denial or non-payment of claims, sanctions, fines, and suspension or termination from the Florida Medicaid program, in accordance with Rule 26659G-9.070, 267F.A.C.
268Rulemaking Authority 270409.919 FS. 272Law Implemented 274409.9132 FS. 276History–New 2-22-17.
