59H-1.0065. Covered Services


Effective on Thursday, August 25, 2016
  • 1(1) Covered services are limited to hospital services as defined in Rules 1359G-4.160 14and 1559G-4.150, 16F.A.C., and the Florida Medicaid – Outpatient Hospital Services Coverage Policy, incorporated by reference in Rule 3259G-4.160, 33F.A.C., unless otherwise specified in this rule. Copies of the policy may be obtained at 48https://www.flrules.org/Gateway/reference.asp?No=Ref-0697950.

    51(2) The county of residence shall be liable for the cost of emergency services and care or treatment for emergency medical conditions in a hospital emergency room, as defined in the Florida Medicaid – Outpatient Hospital Services Coverage Policy, unless otherwise specified in this rule.

    96(3) Elective or non-emergency services or admissions require written pre-authorization and pre-approval if the county of residence has established written procedures to authorize and approve admissions to an out-of-county hospital for such services and admissions. The procedures shall include requirements for hospitals to request and obtain written authorization and approval for elective and non-emergency admissions or services.

    153(4) Elective or non-emergency admissions or services are not covered when a county provides funding for such services and the services are available at a local hospital within the county where the individual resides.

    187Rulemaking Authority 189154.3105 FS. 191Law Implemented 193154.306, 194154.31 FS. 196History–New 3-29-89, Amended 12-24-90, Formerly 10C-26.0065, Amended 6-7-00, 12-9-03, 8-25-16.

     

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