The purpose of Rule 59G-4.132, Florida Administrative Code, is to describe provider requirements for the Florida Medicaid Home Health Electronic Visit Verification Program.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.: RULE TITLE:

59G-4.132  Home Health Electronic Visit Verification Program

PURPOSE AND EFFECT: The purpose of Rule 59G-4.132, Florida Administrative Code, is to describe provider requirements for the Florida Medicaid Home Health Electronic Visit Verification Program.

SUMMARY: The rule will clarify the procedures that providers must follow in order to be reimbursed by Florida Medicaid for delivering home health services.

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, Florida Statutes, 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: 409.9132 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: November 30, 2016 from 10:00 a.m. to 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, 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 Davis. 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 Davis, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft of the reference material, if available, will be posted prior to the public hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received from the date of this notice until 5:00 p.m., December 1, 2016. Comments may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-4.132 Home Health Electronic Visit Verification Program.

(1) This rule applies to providers enrolled directly in the Florida Medicaid program that furnish home health services (home health visits, private duty nursing, and personal care services) to recipients through the fee-for-service delivery system as specified on the Agency for Health Care Administration’s (AHCA) website at http://ahca.myflorida.com/Medicaid/home_health/dmv.shtml in accordance with section 409.9132, Florida Statutes (F.S.).

(2) Definition. Direct service provider – An individual who personally (face-to-face) provides services to recipients in accordance with Rules 59G-4.261, 59G-4.251, or 59G-4.130, Florida Administrative Code (F.A.C.).

(3) Home Health Electronic Visit Verification Program.

(a) All providers must comply with section 409.9132, F.S.

(b) The Agency for Health Care Administration contracts with a vendor to electronically verify the delivery of home health services provided to recipients in their residence or other authorized setting.

1. Providers must document the home health service encounter for each recipient served (in accordance with the recipient’s approved plan of care) and verify the delivery of the services rendered using AHCA’s designated vendor’s electronic visit verification (EVV) system.

2. Direct service providers must verify delivery of the service using the vendor’s system at the beginning and end of each home health service encounter.

3. Providers must submit claims through AHCA’s designated vendor’s system to the Florida Medicaid fiscal agent for services rendered and verified in accordance with the prior authorization in the Florida Medicaid Management Information System.

(4) Providers that fail to comply with the Home Health Electronic Visit Verification Program are subject to potential denial or non-payment of claims, sanctions, fines, and suspension or termination from the Florida Medicaid program.

Rulemaking Authority 409.919 FS. Law Implemented 409.9132 FS. History-New_______.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Shameria Davis

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 18, 2016

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: January 11, 2016