The purpose of Rule 59G-4.132 is to describe provider requirements for the Florida Medicaid Home Health Electronic Visit Verification Program.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.132Home Health Electronic Visit Verification Program

PURPOSE AND EFFECT: The purpose of Rule 59G-4.132, F.A.C. is to describe provider requirements for the Florida Medicaid Home Health Electronic Visit Verification Program.

SUBJECT AREA TO BE ADDRESSED: Home Health Electronic Visit Verification Program.

An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.132, Florida Administrative Code, will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.9132 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: January 26, 2016, 10:00 a.m. ‒ 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room D, Tallahassee, Florida 32308-5407

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Claire Anthony-Davis. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Claire Anthony-Davis, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]. Comments will be received until 5:00 p.m., on January 27, 2016.

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-4.132 Home Health Electronic Visit Verification Program.

(1) This rule applies to all 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.

(2) Definitions.

(a) Direct service provider – An individual who personally (face-to-face) provides services to recipients in accordance with Rules 59G-4.261, 59G- 4.251, or 59G-4.130, Florida Administrative Code (F.A.C.).

(b) Service encounter - A single entry into a recipient’s place of residence for the length of time required to provide home health services.

(3) Home Health Electronic Visit Verification Program.

(a) All persons or entities described in subsection (1) must comply with section 409.9132, Florida Statutes.

(b) The Agency for Health Care Administration (AHCA) contracts with a vendor to telephonically verify the delivery of home health services provided to recipients in their residence or other authorized setting.

1. Providers must enter the home health service encounter schedule for each recipient served (in accordance with the recipient’s approved plan of care) into the vendor’s verification system.

2. Direct service providers must call the vendor’s toll-free telephone line at the beginning and end of each home health service encounter using the recipient’s home telephone.

3. If a recipient does not have a home telephone, providers must notify AHCA (or its designee) and install a Fixed Visit Verification Device (FVVD) to confirm the beginning and ending times of each home health service encounter. Providers must contact AHCA (or its designee) immediately when an FVVD is defective or no longer used by a recipient.

4. Providers must submit a claim for reimbursement to the Florida Medicaid fiscal agent, through the vendor’s system, after the vendor has verified that the home health service encounter(s) were consistent with the recipient’s prior authorization for home health services.

(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.

Rulemaking Authority 409.919 FS. Law Implemented 409.9132 FS. History-New_______.