The purpose of the proposed amendment to Rule 59G-4.110 is to incorporate by reference the revised Florida Medicaid Hearing Services Coverage and Limitations Handbook, October 2012. With this amendment, the submission of prior authorization requests ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.:RULE TITLE:
59G-4.110Hearing Services
PURPOSE AND EFFECT: The purpose of the proposed amendment to Rule 59G-4.110, F.A.C., is to incorporate by reference the revised Florida Medicaid Hearing Services Coverage and Limitations Handbook, October 2012. With this amendment, the submission of prior authorization requests for the repair and maintenance of the external components of cochlear and BAHA implant will be reassigned to the manufacturer/provider and no longer required of the clinicians. This will eliminate the need for clinicians to purchase the repairs and components from the enrolled manufacturer and then obtain reimbursement from Medicaid. It will also result in policy clarifications for providers and will direct them to other information resources on the Medicaid Web site.
SUMMARY: The revisions to the coverage and limitations handbook include clarification of general policy, place of service clarification, additional definitions, a new cochlear and BAHA implant policy, and updated fiscal agent 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, F.S., 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, 409.906, 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 21, 2013, 11:00 a.m. - 12:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room B,
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: Shameria Young at the Bureau of Medicaid Services, [phone]. 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: Shameria Young,
Agency for Health Care Administration, Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop 20,
Tallahassee, Florida 32308-5407, telephone: [phone], e-mail:
[e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-4.110 Hearing Services.

(1)     This rule applies to all physicians, audiologists, and hearing aid specialists who provide hearing services to Medicaid recipients.

(2)     All physicians, audiologists, and hearing aid specialists enrolled in the Medicaid program must be in compliance with the provisions of the Florida Medicaid Hearing Services Coverage and Limitations Handbook, October 2012July 2006, which is 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. Both handbooks are The handbook is available from the Medicaid fiscal agent’s Web site website at www.mymedicaid-florida.comhttp://floridamedicaid.acs-inc.com. Select Click on Public Information for Providers, then Provider Support, and then Provider on Handbooks. Paper copies of the handbooks may be obtained by calling the Provider Services Contact Center Inquiry at 1(800)289-7799 and selecting Option 7[phone].

Rulemaking Specific Authority 409.919 FS. Law Implemented 409.902, 409.906, 409.907, 409.908, 409.012, 409.913 FS. History–New 8-3-80, Amended 7-21-83, Formerly 10C-7.522, Amended 4-13-93, Formerly 10C-7.0522, Amended 12-21-97, 10-13-98, 5-7-00, 7-5-01, 2-20-03, 8-5-03, 7-27-04, 7-26-05, 8-18-05, 11-29-06, _________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Mary McCullough
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: December 4, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: November 23, 2011