Statewide Inpatient Psychiatric Program

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.120Statewide Inpatient Psychiatric Program

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. 40 No. 145, July 28, 2014 issue of the Florida Administrative Register.

The following changes have been made to the Florida Medicaid Statewide Inpatient Psychiatric Program Coverage Policy.

The table of contents was updated to reflect changes in the policy.

Section 1.2 Legal Authority, now reads:

Services are authorized by the following:

•Title 42 Code of Federal Regulations (CFR), section 441, Subpart D (for providers licensed under Rule Chapter 65E-9, F.A.C.), and 42 CFR 482 or 42 CFR 483 (as appropriate to the provider’s licensure type)

•Chapters 394 and 395, Florida Statutes (F.S.)

•Section 409.906, F.S.

•Rule 59G-4.120, Rule Chapter 59A-3, and Rule 6A-6.0361, F.A.C.

Section 1.3 Definitions, alphabetized subsection titles and renumbered based on policy update. Added beginning paragraph that reads:

The following definitions are applicable to this policy. For additional definitions that are applicable to all sections of Rule Division 59G, F.A.C., please refer to the Florida Medicaid definitions policy.

Section 1.3.2 Long-term Care Plan, term and definition removed based on standard language update. Added new term and definition that now reads:

Claim Reimbursement Policy

A policy document that provides instructions on how to bill for services.

Section 1.3.3 Managed Medical Assistance Plan, term and definition removed based on standard language update. Added new term and definition that now reads:

General Policy

A collective term for Florida Medicaid policy documents found in Rule Chapter 59G-1 containing information that applies to all providers (unless otherwise specified) rendering services to recipients.

Section 1.3.4 Medically Necessary/Medical Necessity, now reads:

As defined in Rule 59G-1.010, F.A.C.

Section 1.3.7 Provider General Handbook, term and definition removed based on standard language update.

Section 1.3.11 Reimbursement Handbook, term and definition removed based on standard language update.

Section 2.2 Who Can Receive, first sentence now reads:

Florida Medicaid recipients requiring medically necessary SIPP services who meet the following criteria:

Section 3.1 General Criteria, first paragraph now reads:

Providers must be at least one of the following to be reimbursed for services rendered to eligible recipients:

Section 3.2 Who Can Provide, now reads:

•Hospitals licensed in accordance with Chapter 395, F.S., and Rule Chapter 59A-3, F.A.C.

•Residential treatment centers for children and adolescents licensed in accordance with Chapter 394, F.S., and Rule Chapter 65E-9, F.A.C., and that:

-Qualify as a psychiatric residential treatment facility under 42 CFR 483, Subpart G.

-Comply with 42 CFR 483.374 for attestation requirements and reporting serious occurrences to AHCA.

Providers must be accredited by a nationally recognized accrediting organization such as the Joint Commission, the Commission on Accreditation of Rehabilitation Facilities, or the Council on Accreditation of Services for Families and Children.

Section 6.1 General Criteria, now reads:

For information on general documentation requirements, please refer to Florida Medicaid’s recordkeeping and documentation policy.

Section 7.1 General Criteria, second paragraph, second sentence now reads:

For recipients receiving services through the fee-for-service delivery system, providers should request authorization through the Quality Improvement Organization (QIO). For more information on general authorization submission requirements, please refer to Florida Medicaid’s authorization policy.

Section 7.2 Specific Criteria, now reads:

The authorization information described below is applicable to the fee-for-service delivery system, unless otherwise specified.

Providers must obtain authorization from the QIO and must submit the following in addition to any general requirements:

•A current Diagnostic and Statistical Manual of Mental Disorders or International Classification Diagnosis code

•A description of the initial treatment plan relating to the admitting symptoms

•Current symptoms requiring SIPP treatment

•Medication history

•Prior psychiatric inpatient admissions, if applicable

•Documentation that the recipient is mentally competent, has age appropriate cognitive ability, and is sufficiently able to benefit from cognitive-based treatment

•Documentation of the recipient’s physical health, as certified by a medical doctor, doctor of osteopathy, registered nurse, physician's assistant, or other professional who has the authority to perform physical examinations of a medical nature

•Prior alternative treatment

•Medical, social, and family histories

•Proposed placement and community-based treatments after discharge

•Suitability Assessment recommendation (for recipients in the custody of the state)

Section 7.2.1 Requesting Prior Authorization, section removed based on standard language update.

Section 7.2.2 Review Criteria, section removed based on standard language update.

Section 7.2.3 Approval Process, section removed based on standard language update.

Section 7.2.4 Decision Process, section removed based on standard language update.

Section 7.2.5 Reconsideration Review, section removed based on standard language update.

Section 7.2.6 Prior Authorization Number, section removed based on standard language update.

Section 7.2.7 Termination of Services, section removed based on standard language update.

Section 8.6 Rate, now reads:

For per diem rates, see http://ahca.myflorida.com/medicaid/Finance/finance/index.shtml.