The purpose of the amendment to Rule 59G-4.060 is to incorporate by reference the Florida Medicaid Dental Services Coverage Policy,________.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.060Dental Services

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.060, F.A.C. is to incorporate by reference the Florida Medicaid Dental Services Coverage Policy,________.

SUMMARY: The incorporated coverage policy will specify recipient eligibility, provider requirements, service coverage, and reimbursement information.

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 8, 2016, 9:30 a.m. ‒ 10:30 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: Robert Reifinger. 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: Robert Reifinger, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

Please note that a preliminary draft of the reference material, if available, will be posted prior to the public hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Comments will be received until 5:00 p.m., on February 9, 2016.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59G-4.060 Dental Services.

(1) This rule applies to any person or entity prescribing or reviewing a request for dental services and to all providers of dental services dentists who are enrolled in or registered with the Florida Medicaid program for dental services under Section 409.906, F.S.

(2) All persons or entities described in subsection (1) dental services providers enrolled in the Medicaid program must be in compliance with the provisions of the Florida Medicaid Dental Services Coverage Policy,          , incorporated by reference and Limitations Handbook, November 2011, and the Florida Medicaid Provider Reimbursement Handbook, ADA Dental Claim Form, July 2008, which are incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated by reference in Rule 59G-4.001, F.A.C. The policy is All handbooks are available from the Florida Medicaid fiscal agent’s Web site at http://portal.flmmis.com/flpublic, and available at [DOS place holder Ref-_______]. www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Medicaid fiscal agent, Provider Contact Center at 1(800) 289-7799 and selecting Option 7.

(3) The following forms that are included in the Florida Medicaid Dental Services Coverage and Limitations Handbook are incorporated by reference: Medicaid Orthodontic Initial Assessment Form (IAF), AHCA-Med Serv Form 013, January 2006, five pages, located in Appendix A; and the Medical Behavioral Management Report, AHCA-Med Serv Form 012, January 2007, one page, located in Appendix F. The forms are available by photocopying them from the handbook.

(4) The following form that is included in Chapter 1 of the Florida Medicaid Provider Reimbursement Handbook, ADA Dental Claim Form, is incorporated by reference: ADA Dental Claim Form, ©2006 American Dental Association, J404. ADA Dental Claim Forms may be ordered from the American Dental Association at 1(800) 947-4746 or online at www.adacatalog.org. They may also be ordered by calling the Medicaid fiscal agent’s Provider Contact Center at 1(800) 289-7799 and selecting Option 7. The following form that is included in Chapter 3 of the handbook, Medically Needy Billing Authorization, DF-ES 2902, June 2003, is incorporated by reference in Rule 59G-4.001, F.A.C. The form is mailed by the Department of Children and Family Services to providers whose services are eligible for reimbursement.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History–New 7-10-80, Amended 2-19-81, 10-27-81, 7-21-83, Formerly 10C-7.523, Amended 9-11-90, 11-3-92, Formerly 10C-7.0523, Amended 6-29-93, Formerly 10P-4.060, Amended 7-19-94, 7-16-96, 3-11-98, 10-13-98, 12-28-98, 6-10-99, 4-23-00, 4-24-01, 7-5-01, 2-20-03, 8-5-03, 1-8-04, 10-12-04, 6-28-05, 7-2-06, 5-21-07, 2-23-09, 5-3-12, _____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Robert Reifinger

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: September 15, 2015