The purpose of the amendment to Rule 59G-4.320 is to incorporate by reference the Florida Medicaid Therapy Services Coverage and Limitations Handbook, September 2012. The rule will update the Medicaid Therapy Services Coverage and Limitations ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-4.320: Therapy Services
PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.320 is to incorporate by reference the Florida Medicaid Therapy Services Coverage and Limitations Handbook, September 2012. The rule will update the Medicaid Therapy Services Coverage and Limitations Handbook by clarifying policy and requiring prior authorization for therapy treatment visits, effective November 2011. The prior authorization requirement will satisfy a legislative mandate requiring utilization management for therapy services reimbursed by Medicaid set forth in section 409.912(40), F.S.
SUMMARY: The Therapy Services Coverage and Limitations Handbook contains policy for therapy services reimbursed under the Medicaid program, not including therapy provided in an inpatient, outpatient, or nursing home setting or therapy provided by a school.
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, 409.905, 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: Thursday, November 15, 2012 from 2:00 p.m. to 3:00 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: Erica Floyd 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: Erica Floyd, 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-4.320 Therapy Services

(1) This rule applies to all therapy services providers enrolled in the Medicaid program.

(2) All therapy providers enrolled in the Medicaid program must be in compliance with the Florida Medicaid Therapy Services Coverage and Limitations Handbook, September  2012 2003, updated July 2008, incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated in Rule 59G-4.001, F.A.C. The Both handbooks is are available from the Medicaid fiscal agent’s Web site Portal at www.http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Handbooks. Paper copies of the handbooks may be obtained by calling the Medicaid fiscal agent at [phone] and selecting Option 4.

Rulemaking Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.912, 409.913 FS. History–New 5-24-92, Amended 4-12-93, Formerly 10C-7.068, Amended 5-4-94, 12-26-95, 3-9-99, 12-2-03, 12-3-08, ______________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Erica Floyd
NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: August 17, 2012
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 30, 2011