AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO.: RULE TITLE:
59G-4.320: Therapy ServicesNOTICE OF CHANGE
Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 38 No. 54, October 19, 2012 issue of the Florida Administrative Register.
The following changes have been made to the Florida Medicaid Therapy Services Coverage and Limitations Handbook, September 2012.
Page 2-4 Requesting Prior Authorization. In the eighth bullet, the word designed is changed to designated;
Page 2-4 Review Criteria. Paragraph is changed to read:
The QIO may use a national standardized set of criteria, approved by the Agency for Health Care Administration (AHCA), as a guide to establish medical necessity for prior authorization of therapy services at the first review level. If services cannot be approved by the first level reviewer, the QIO’s physician peer reviewer will determine medical necessity using his clinical judgment, acceptable standards of care, and AHCA’s medical necessity definition.
Page 2-20 Place of Service. The third paragraph is changed to read:
Services can also be provided in an inpatient and outpatient nursing home, PPEC, and hospital. Payment for these services is included in the facility’s per diem. The therapist cannot be reimbursed directly by fee-for-service for services provided in these locations. Respiratory services will not be reimbursed in a PPEC, because this is included in the PPEC’s per diem rate. Evaluations provided by hospitals are not counted against the recipient’s evaluation reimbursement limitations. Inpatient and outpatient hospital therapy services are reimbursed according to the Florida Medicaid Hospital Services Coverage and Limitations Handbook. Providers cannot bill the same procedure provided in the school setting and community setting in the same day.
Page 2-28 Rental-Only AAC Systems: deleted.
