Developmental Disabilities Waiver Services

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-13.083: Developmental Disabilities Waiver Services

NOTICE 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. 37 No. 28, July 15, 2011 issue of the Florida Administrative Weekly.

The following change was made to the Notice of Proposed Rule.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: 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. A checklist was prepared by the Agency to determine the need for a SERC. Also, based on this information at the time of the analysis and pursuant to Section 120.541, F.S., the rule will not require legislative ratification.

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

The following changes have been made to the Florida Medicaid Developmental Disabilities Waiver Services Coverage and Limitations Handbook, November 2010.

Page 1-2 Direct Provider Billing

Second paragraph is changed to read:

All claims for DD waiver services must be submitted either on the CMS-1500 Claim Form or electronically directly to the Medicaid fiscal agent.

Page 1-3 Direct Provider Billing

First paragraph is deleted.

Second paragraph is changed to read:

Instructions for completing the CMS-1500 claim form are in the Florida Medicaid Provider Reimbursement Handbook, CMS-1500.

Page 1-9 Purpose of the Handbook

First paragraph is changed to read:

This handbook is intended for use by eligible providers who furnish DD waiver services to recipients enrolled in the waiver. DD Waiver refers to all four DD Waivers (Tiers One, Two, Three, and Four). It must be used in conjunction with the Florida Medicaid Provider General Handbook, which contains information about the Medicaid program in general, and the Florida Medicaid Provider Reimbursement Handbook.

Second paragraph is changed to read:

Instructions for completing the CMS-1500 claim form are in the Florida Medicaid Provider Reimbursement Handbook, CMS-1500.

Page 1-15 Provider Responsibility Regarding HIPPA Requirements

Third paragraph is changed to read:

Note: For more information regarding claims processing changes in Florida Medicaid because of HIPAA requirements refer to Chapter 1 in the Florida Medicaid Provider Reimbursement Handbook, CMS-1500.

Page 2-3 Level of Care Requirements

Second bullet is changed to read:

The recipient is eligible under a primary disability of autism, Down syndrome, cerebral palsy, spina bifida, or Prader-Willi syndrome. In addition, the condition must result in substantial functional limitations in three or more major life activities, including self-care, learning, mobility, self-direction, understanding and use of language, and capacity for independent living.

Page 2-9 Claim Form

First paragraph is changed to read:

The CMS-1500 claim form is the standard claim form to be used when submitting claims for reimbursement for DD Waiver Services. Claim forms must be complete and legible when submitted to the Medicaid fiscal agent for reimbursement for services rendered. The provider may submit claims to the Medicaid fiscal agent either on paper claims forms or electronically by using the free software supplied by the Medicaid fiscal agent.

Note: See Chapter 3 for additional billing and reimbursement information.

Page 2-12 Medication Review

Delete paragraph

Page 2-44 Description

Fourth paragraph is changed to read:

This service is available to recipients enrolled on the DD Waiver – Tier 4 in the family home, including foster homes, and for individuals in Tiers 1, 2 and 3 living in their own home.

Page 2-88

Delete paragraph beginning “For recipients residing”, including related bullets.

Page 2-89

Delete the “Note” at the top of the page which states:

Note: Refer to the medication review service section for additional information.

Page 2-105 Documentation Requirements

Fifth paragraph is changed to read:

Transportation providers that are not CTCs, public fixed-route, fixed-scheduled bus systems, or limited transportation providers must, at the time of enrollment, be able to show proof of current Florida driver’s licenses for all drivers who will be transporting recipients, vehicle registration for all vehicles to be used in the provision of this service and 100/300 vehicle liability insurance coverage.

Page 3-2 Billing Procedures

First paragraph is changed to read:

Paper claims are submitted on the CMS-1500 claim form.

Fourth paragraph is changed to read:

Billing instructions will be in the Florida Medicaid Provider Reimbursement Handbook, CMS-1500.

Sixth paragraph is changed to read:

Note: The Florida Medicaid provider handbooks are available on the Medicaid fiscal agent’s Web Portal at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. The Florida Medicaid Provider Reimbursement Handbook, CMS-1500, is incorporated by reference in Rule 59G-4.001, F.A.C.

APPENDIX C: WAIVER ELIGIBILITY DETERMINATION: 1. A. (2) (b) is changed to read:

(b) The individual is eligible under a primary disability of autism, cerebral palsy, Down Syndrome, spina bifida, or Prader-Willi syndrome. In addition, the condition must result in substantial functional limitations in three or more major life activities, including self-care, learning, mobility, self-direction, understanding and use of language, and capacity for independent living.