The purpose of the amendment to Rule 59G-4.100 is to update provider requirements, specify fee-for-service reimbursement information, align the rule with the Florida Medicaid Statewide Medicaid Managed Care program, and change the title to Federally ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.100Federally Qualified Health Center Services

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.100 is to update provider requirements, specify fee-for-service reimbursement information, align the rule with the Florida Medicaid Statewide Medicaid Managed Care program, and change the title to Federally Qualified Health Center.

SUBJECT AREA TO BE ADDRESSED: Rules 59G-4.100, F.A.C., Federally Qualified Health Center Services; 59G-4.055, F.A.C., County Health Department Clinic Services; and 59G-4.280, F.A.C., Rural Health Clinic Services. An additional area to be addressed during the workshop will be the potential regulatory impact Rules 59G-4.100, 59G-4.055, and 59G-4.280, Florida Administrative Code, will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.905, 409.906, 409.908, 409.9081 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: November 12, 2015, 10:00 a.m. ‒ 11:30 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, 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: Mary Cerasoli. 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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Mary Cerasoli, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

Comments will be received until 5:00 p.m., on November 13, 2015

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-4.100 Federally Qualified Health Center Services.

(1) This rule applies to all federally qualified health centers (FQHC) that are enrolled in or registered with the Florida Medicaid program.

(2) All FQHCs federally qualified health center services providers enrolled in the Medicaid program must comply be in compliance with:

(a) Title 42, Code of Federal Regulations, Parts 440 and 491.

(b) The Florida Medicaid service-specific coverage policy, as applicable, incorporated by reference in Rule Chapter 59G-4, Florida Administrative Code. the Florida Medicaid Federally Qualified Health Center Services Coverage and Limitations Handbook, January 2007, updated April 2008, 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 available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Provider Contact Center at 1(800) 289-7799 and selecting Option 7.

(3) Florida Medicaid reimburses for services provided through the fee-for-service delivery system at an encounter rate. Providers may be reimbursed for up to one medical, one dental, and one behavioral health visit provided to a recipient on the same day. For rates, see http://ahca.myflorida.com/Medicaid/Finance/finance/institutional/index.shtml.

Rulemaking Authority 409.919 FS. Law Implemented 409.905, 409.906, 409.908, 409.9081 FS. History–New 6-27-93, Formerly 10P-4.100, Amended 4-16-95, 5-28-96, 6-24-98, 12-31-01, 11-17-03, 2-19-07, 9-29-08, _________.