The purpose of the amendment to Rule 59G-4.002 is to incorporate by reference the Florida Medicaid provider reimbursement schedules and billing codes.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.002Medicaid Provider Reimbursement Schedules

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.002 is to incorporate by reference the Florida Medicaid provider reimbursement schedules and billing codes.

SUMMARY: The amendment records effective dates for reimbursement schedules and billing codes for certain Florida Medicaid services. In addition, the title of the rule will be changed to Provider Reimbursement Schedules and Billing Codes.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: February 3, 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: Monique Johnson. 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 IS: Monique Johnson, 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 February 4, 2016.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-4.002 Medicaid Provider Reimbursement Schedules and Billing Codes.

(1) This rule applies to all providers of Florida Medicaid services who are enrolled in or registered with the Florida Medicaid program.

(2) Florida Medicaid reimbursement for services is categorized based on a fee schedule, cost report, or contract. The billing codes in each fee schedule are applicable to Florida Medicaid’s fee-for-service and managed care delivery systems. However, the rates listed on the individual fee schedules only apply to services rendered through the fee-for-service delivery system, unless otherwise specified by law in Chapter 409, Florida Statutes (F.S.). The following fee schedules and billing codes are incorporated by reference:

(3) Florida Medicaid services fee schedules.

(a) Effective July 1, 2015:

1. Independent Laboratory Services Fee Schedule

2. Physician Laboratory Services Fee Schedule

(b) Effective May 1, 2015:

1. Physician Injectable Medications Oncology Medications Fee Schedule

2. Physician Injectable Medications Non-Oncology Medications Fee Schedule

3. Traumatic Brain and Spinal Cord Injury Waiver Disposable Incontinence Medical Supplies Fee Schedule

(c) Effective January 1, 2015:

1. Advanced Registered Nurse Practitioner Fee Schedule

2. Ambulance Transportation Services Fee Schedule

3. Ambulatory Surgical Center Services Fee Schedule

4. Assistive Care Services Fee Schedule

5. Behavioral Analysis Fee Schedule

6. Behavioral Health Overlay Services Fee Schedule

7. Birthing Center Fee Schedule

8. Child Health Services Targeted Case Management Services Fee Schedule

9. Chiropractic Fee Schedule

10. Community Behavioral Health Services Fee Schedule

11. County Health Department Certified Match Program Fee Schedule

12. Dental General Fee Schedule

13. Dental Injectables Fee Schedule

14. Dialysis Services Fee Schedule

15. Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients Fee Schedule

16. Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid Recipients Under the Age of 21 Years

17. Early Intervention Services Fee Schedule

18. Hearing Services Fee Schedule

19. Home Health Visit Services Fee Schedule

20. Hospice Services Fee Schedule

21. Licensed Midwife Fee Schedule

22. Medicaid Certified School Match Program Fee Schedule

23. Medical Foster Care Services Fee Schedule

24. Mental Health Targeted Case Management Services Fee Schedule

25. Occupational Therapy Services Fee Schedule

26. Optometric Fee Schedule

27. Oral and Maxillofacial Surgery Fee Schedule

28. Outpatient Hospital Laboratory Fee Schedule

29. Personal Care Services Fee Schedule

30. Physical Therapy Services Fee Schedule

31. Physician Anesthesia Fee Schedule

32. Physician Assistant Fee Schedule

33. Physician Evaluation and Management Fee Schedule

34. Physician Lab Fee Schedule

35. Physician Medical Service Fee Schedule

36. Physician Pediatric Surgery Fee Schedule

37. Physician Radiology Fee Schedule

38. Physician Surgical Fee Schedule

39. Podiatry Fee Schedule

40. Portable X-Ray Fee Schedule

41. Prescribed Pediatric Extended Care Services Fee Schedule

42. Private Duty Nursing Services Fee Schedule

43. Registered Nurse First Assistant Fee Schedule

44. Respiratory Therapy Services Fee Schedule

45. Specialized Therapeutic Services Fee Schedule

46. Speech-Language Pathology Services Fee Schedule

47. Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule

48. Visual Services Fee Schedule

(4) Florida Medicaid billing codes, effective January 1, 2015.

(a) Child Health Check-up Services

(b) County Health Department Services

(c) Dental General Services

(d) Federally Qualified Health Center and Rural Health Clinic Services

(e) Hospital Outpatient Services

(f) Intermediate Care Facility Services

(g). Non-Emergency Transportation Services

(h) Nursing Facility Services

(i) Statewide Inpatient Psychiatric Program Services

(5) The fee schedules and billing codes are available from the Florida Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flPublic, and available at [DOS place holder Ref-___, to be assigned at adoption].

(1) Medicaid providers who render advanced registered nurse practitioner, birth center, chiropractic, dental, hearing, licensed midwife, optometric, outpatient hospital laboratory, physician, physician assistant, podiatry, registered nurse first assistant, and visual services are reimbursed according to the following fee schedules, which are incorporated by reference below:

(a) Advanced Registered Nurse Practitioner Fee Schedule, Effective July 1, 2012

(b) Advanced Registered Nurse Practitioner Fee Schedule, Effective January 1, 2013

(c) Advanced Registered Nurse Practitioner Fee Schedule, Effective July 1, 2013

(d) Birthing Center Fee Schedule, Effective July 1, 2012

(e) Birthing Center Fee Schedule, Effective January 1, 2013

(f) Birthing Center Fee Schedule, Effective July 1, 2013

(g) Chiropractic Services Fee Schedule, Effective July 1, 2012

(h) Chiropractic Services Fee Schedule, Effective January 1, 2013

(i) Chiropractic Services Fee Schedule, Effective July 1, 2013

(j) Dental General Fee Schedule, Effective July 1, 2012

(k) Dental General Fee Schedule, Effective January 1, 2013

(l) Dental General Fee Schedule, Effective July 1, 2013

(m) Dental Injectables Fee Schedule, Effective July 1, 2012

(n) Dental Injectables Fee Schedule, Effective January 1, 2013

(o) Dental Injectables Fee Schedule, Effective July 1, 2013

(p) Dental Oral/Maxillofacial Surgery Fee Schedule, Effective July 1, 2012

(q) Dental Oral/Maxillofacial Surgery Fee Schedule, Effective January 1, 2013

(r) Dental Oral/Maxillofacial Surgery Fee Schedule, July 1, 2013

(s) Hearing Services Fee Schedule, Effective July 1, 2012

(t) Hearing Services Fee Schedule, Effective January 1, 2013

(u) Hearing Services Fee Schedule, Effective July 1, 2013

(v) Licensed Midwife Fee Schedule, Effective July 1, 2012

(w) Licensed Midwife Fee Schedule, Effective January 1, 2013

(x) Licensed Midwife Fee Schedule, Effective July 1, 2013

(y) Optometric Services Fee Schedule, Effective July 1, 2012

(z) Optometric Services Fee Schedule, Effective January 1, 2013

(aa) Optometric Services Fee Schedule, Effective July 1, 2013

(bb) Outpatient Hospital Laboratory Fee Schedule, Effective January 1, 2013

(cc) Physician Anesthesia Fee Schedule, Effective July 1, 2012

(dd) Physician Anesthesia Fee Schedule, Effective January 1, 2013

(ee) Physician Anesthesia Fee Schedule, Effective July 1, 2013

(ff) Physician Assistant Fee Schedule, Effective July 1, 2012

(gg) Physician Assistant Fee Schedule, Effective January 1, 2013

(hh) Physician Assistant Fee Schedule, Effective July 1, 2013

(ii) Physician Durable Medical Equipment Fee Schedule, Effective January July 1, 2013

(jj) Physician Evaluation and Management Fee Schedule, Effective July 1, 2012

(kk) Physician Evaluation and Management Fee Schedule, Effective January 1, 2013

(ll) Physician Evaluation and Management Fee Schedule, Effective July 1, 2013

(mm) Physician Immunization Fee Schedule, Effective July 1, 2012

(nn) Physician Immunization Fee Schedule, Effective January 1, 2013

(oo) Physician Immunization Fee Schedule, Effective July 1, 2013

(pp) Physician Laboratory Services Fee Schedule, Effective July 1, 2012

(qq) Physician Laboratory Services Fee Schedule, Effective January 1, 2013

(rr) Physician Laboratory Services Fee Schedule, Effective July 1, 2013

(ss) Physician Medical Fee Schedule, Effective July 1, 2012

(tt) Physician Medical Fee Schedule, Effective January 1, 2013

(uu) Physician Medical Fee Schedule, Effective July 1, 2013

(vv) Physician Pediatric Surgery Fee Schedule, Effective July 1, 2012

(ww) Physician Pediatric Surgery Fee Schedule, Effective January 1, 2013

(xx) Physician Pediatric Surgery Fee Schedule, Effective July 1, 2013

(yy)  Physician Primary Care Rate Increase Fee Schedule, Effective January 1, 2013

(zz) Physician Primary Care Rate Increase Fee Schedule, Effective July 1, 2013

(aaa) Physician Radiology Services Fee Schedule, Effective July 1, 2012

(bbb) Physician Radiology Services Fee Schedule, Effective January 1, 2013

(ccc) Physician Radiology Services Fee Schedule, Effective July 1, 2013

(ddd) Physician Surgical Fee Schedule, Effective July 1, 2012

(eee)  Physician Surgical Fee Schedule, Effective January 1, 2013

(fff)  Physician Surgical Fee Schedule, Effective July 1, 2013

(ggg) Podiatry Fee Schedule, Effective July 1, 2012

(hhh) Podiatry Fee Schedule, Effective January 1, 2013

(iii) Podiatry Fee Schedule, Effective July 1, 2013

(jjj) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule, Effective July 1, 2012

(kkk) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule, Effective January 1, 2013

(lll) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule, Effective July 1, 2013

(mmm) Regional Perinatal Intensive Care Centers (RPICC) Obstetrical Services Fee Schedule, Effective July 1, 2012

(nnn) Regional Perinatal Intensive Care Centers (RPICC) Obstetrical Services Fee Schedule, Effective January 1, 2013

(ooo) Regional Perinatal Intensive Care Centers (RPICC) Obstetrical Services Fee Schedule, Effective July 1, 2013

(ppp) Registered Nurse First Assistant Fee Schedule, Effective July 1, 2012

(qqq) Registered Nurse First Assistant Fee Schedule, Effective January 1, 2013

(rrr) Registered Nurse First Assistant Fee Schedule, Effective July 1, 2013

(sss) Visual Services Fee Schedule, Effective July 1, 2012

(ttt)  Visual Services Fee Schedule, Effective January 1, 2013 and

(uuu) Visual Services Fee Schedule, Effective July 1, 2013

(2) The fee schedules are available from the Medicaid fiscal agent’s Web site at http://mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Fee Schedules.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History–New 8-18-05, Amended 11-30-05, 4-16-06, 10-11-06, 3-27-07, 7-25-07, 9-29-08, 4-28-09, 2-11-10, 1-31-11, 7-16-13, 5-21-14,_______________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Erica Floyd-Thomas

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: January 5, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: May 22, 2014