AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO.: RULE TITLE:
59G-4.130: Home Health ServicesNOTICE 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. 37 No. 25, June 24, 2011 issue of the Florida Administrative Weekly.
The following revisions were made to the Notice of Proposed Rule.
59G-4.130 Home Health Services.
(1) No change.
(2) All home health agency providers enrolled in the Medicaid program must be in compliance with the Florida Medicaid Home Health Services Coverage and Limitations Handbook, December 2011 September 2011, incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated in Rule 59G-4.001, F.A.C. Both handbooks are available from the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Medicaid fiscal agent at 1(800)289-7799 and selecting Option 7.
(3) No change.
(4) The following appendices forms that are included in the Florida Medicaid Home Health Services Coverage and Limitations Handbook and are incorporated by reference: Appendix B, Home Health Certification and Plan of Care, Form CMS-485(C-3)(02-94) (Formerly HCFA-485), December 2011 in Appendix B, one page; and in Appendix C, the Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian, AHCA-Med Serv Form 046, July 2008, one page; Appendix D, Guidelines for Evaluating Family Support and Care Supplements, December 2011; Appendix E, Physician Visit Documentation Form AHCA- Med Serv Form 5000-3502, October 2010; Appendix F, Parent or Legal Guardian Medical Limitations AHCA-Med Serv Form 5000-3501, October 2010; Appendix G, Parent or Legal Guardian Work Schedule AHCA- Med Serv Form 5000-3503, December 2011; Appendix H, Parent or Legal Guardian Statement of Work Schedule AHCA-Med Serv Form 5000-3504, December 2011; Appendix I, Parent or Legal Guardian School Schedule AHCA-Med Serv Form 5000-3505, December 2011; Appendix J, Medicaid Instructions for Personal Care Services Plan of Care and Form AHCA-Med Serv Form 5000-3506, December 2011; Appendix K, Medicaid Physician’s Written Prescription for Home Health Services AHCA-Med Serv Form 5000-3525, December 2011; Appendix L, Review Criteria for Private Duty Nursing Services, December 2011; and Appendix M, Medicaid Review Criteria for Personal Care Services, December 2011. The Both forms are available by photocopying them from the handbook.
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.9081, 409.912, 409.913 FS. History– New 1-1-77, Amended 4-1-78, 9-28-78, 1-24-79, 7-17-83, Formerly 10C-7.44, Amended 6-1-88, 4-9-89, 1-1-90, 5-26-93, Formerly 10C-7.044, Amended 3-14-95, 12-27-95, 5-7-96, 2-9-98, 5-30-00, 11-24-03, 10-30-07, 12-29-08,________.
The following revisions have been made to the Florida Medicaid Home Health Services Coverage and Limitations Handbook, December 2011.
Home Health Services Coverage and limitations Handbook
Table of Contents
Appendices are changed to read:
Appendix A: Home Health Services Fee Schedule……………….......….……………………………………A-1
Appendix B: Medicaid Instructions for CMS Form 485–Plan of Care……………….………….……………B-1
Appendix C: Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian……...………C-1
Appendix D: Guidelines for Evaluating Family Support and Care Supplements……………………..………D-1
Appendix E: Physician Visit Documentation Form………………………………………………….…..……E-1
Appendix F: Parent or Legal Guardian Medical Limitations Form……………….………………….….…....F-1
Appendix G: Parent or Legal Guardian Work Schedule Form……………………………………….…..……G-1
Appendix H: Parent or Legal Guardian Statement of Work Schedule Form…………………….….………...H-1
Appendix I: Parent or Legal Guardian School Schedule Form…………………………………………..……I-1
Appendix J: Medicaid Instructions for Personal Care Services Plan of Care……………………….……...…J-1
Appendix K: Medicaid Physician’s Written Prescription for Home Health Services……………….…...……K-1
Appendix L: Medicaid Review Criteria for Private Duty Nursing Services………………………….….……L-1
Appendix M: Medicaid Review Criteria for Personal Care Services………………………………….………M-1
Page 1-1 Footer is changed to December 2011
Page 1-2 Footer is changed to December 2011
Page 1-3 Purpose and Definitions
The following is inserted:
Babysitting: The act of providing custodial care, daycare, afterschool care, supervision, or similar childcare unrelated to the services that are documented to be medically necessary for the recipient.
Page 1-3 Footer is changed to December 2011
Page 1-4 Purpose and Definitions
The following is inserted:
Instrumental Activities of Daily Living
Instrumental activities of daily living (IADLs) are tasks which enable a recipient to function independently in the community.
Page 1-4 Quality Improvement Organization (QIO)
Paragraph is changed to read: The vendor contracted with the Agency for Health Care Administration to monitor the appropriateness, effectiveness, and quality of care provided to Medicaid recipients. The vendor performs prior authorizations of services based on medical necessity determinations.
Page 1-4 Footer is changed to December 2011
Page 1-5 Purpose and Definitions
Caregiver
Paragraph is changed to read: An individual such as a parent, foster parent, head of household or family member who attends to the needs of a child or dependent adult. This individual generally provides care without compensation.
Page 1-5 Provider Qualifications
Home Health Agency Provider Qualifications
Second to last paragraph is changed to read: Home health agencies receiving accreditation and deemed status by JCAHO or CHAP or ACHC are responsible for providing accreditation documentation to HQA.
Page 1-5 Footer is changed to December 2011
Page 1-6 Provider Qualifications
Independent Personal Care Provider Qualifications
Last paragraph inserted to read: Independent personal care group providers must meet the home health licensure exemption requirements defined in 400.464, Florida Statutes in order to be reimbursed for personal care services provided to Medicaid recipients.
Page 1-6 Footer is changed to December 2011
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Page 1-9 Who May Provide Home Health Services
Qualified Home Health Agency Staff
Paragraph is changed to read: Home health services are provided by qualified health care professionals. The home health agency must ensure that all staff (employed or contracted) who provide home health services are qualified and licensed.
Page 1-9 Subcontracting category and corresponding paragraph are deleted.
Page 1-9 Footer is changed to December 2011
Page 1-10 Who May Provide Home Health Services
Skill Level of Staff
Paragraph is changed to read: The home health services provider must provide staff with the skill level designated or appropriate for each medically necessary covered home health service prescribed in the physician order and approved plan of care. Skill level designation must be reflective of the standards outlined in the Nurse Practice Act. See Florida Statutes Chapter 464. Requests for a skill level higher than the less costly alternative must justify the need.
Page 1-10 Footer is changed to December 2011.
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Page 2-1 Overview
In This Chapter
Page numbers change as follows:
Covered, Limited and Excluded Services 2-11
Licensed Nurse and Home Health Aide Services 2-15
Personal Care Services 2-24
Durable Medical Equipment and Therapy Services 2-29
Required Documentation 2-30
Prior Authorizations for Home Health Services 2-32
Prior Authorization for Medically-Needy Recipients 2-38
Page 2-1 Requirements to Receive Services: Introduction.
Paragraph one is changed to read: Medicaid reimburses home health services provided to an eligible Medicaid recipient when it is medically necessary to provide those services in his place of residence or other authorized setting.
Paragraph two is inserted to read: Medicaid does not reimburse for home health services when the service duplicates another provider’s service under the Medicaid program or other state or local program or if a comparable home and community-based service is provided to the recipient at the same time on the same day.
Page 2-1 Footer date is changed to December 2011
Page 2-2 Requirements to Receive Services
New section and corresponding paragraphs are inserted as follows:
Early, Periodic, Screening, Diagnosis and Treatment (EPSDT)
EPSDT is a federal requirement that the state Medicaid agency cover diagnostic services, treatment, and other measures described in 42 USC 1396d(a) for Medicaid recipients under 21 years of age if the service is medically necessary to correct or ameliorate a defect, physical or mental illness, or a condition identified through a screening examination.
The fact that the recipient is under 21 years of age does NOT eliminate the requirement for prior authorization through the Quality Improvement Organization (QIO).
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Page 2-7 Plan of Care Requirements
Description
Paragraph one is changed to read: A plan of care (POC) is an individualized written program for a recipient that is developed by health care providers including the attending physician. The POC is designed to meet the medical, health and rehabilitative needs of the recipient. The POC must identify the medical need for home health care, appropriate interventions, and expected health outcomes.
Required Plan of Care Document
Paragraph four is changed to read: Note: See Appendix J for a copy of the Personal Care Services Plan of Care form, AHCA-Med Serv Form 5000- 3506, December 2011.
Paragraph five is changed to read: AHCA-Med Serv Form 5000-3506, December 2011 is available by photocopying it from Appendix J. It is incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-7 Footer date is changed to December 2011
Page 2-8 Plan of Care Requirements
Plan of Care Components
Bullet nine is changed to read:
●Approval by the attending physician as evidenced by his signature.
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Page 2-10 Footer date is changed to December 2011
Page 2-11 Plan of Care Requirements
Compliance Review
Paragraph two is inserted to read: During such reviews, AHCA or its designee will request from the provider copies of certain records.
Page 2-11 Footer date is changed to December 2011
Page 2-12 Footer date is changed to December 2011
Page 2-13 Covered, Limited and Excluded Services
Exclusions
Paragraph one is changed to read: Listed below are examples of services that are not reimbursable under the Medicaid home health services program:
Bullet eleven is changed to read:
●Transportation services (except when necessary to protect the health and safety of the recipient and no other transportation service is available).
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Page 2-14 Footer date is changed to December 2011
Page 2-15 Footer date is changed to December 2011
Page 2-16 Footer date is changed to December 2011
Page 2-17 Footer date is changed to December 2011
Page 2-18 Footer date is changed to December 2011
Page 2-19 Private Duty Nursing Services
Following the term “Services” INSERT: (For recipients under age 21 years old)
Private Duty Nursing Definition
Paragraph is changed to read: Private duty nursing services are medically-necessary skilled nursing services that may be provided to recipients under age 21 years old in their home or other authorized settings to support the care required by their complex medical condition.
Page 2-19 Footer date is changed to December 2011
Page 2-20 Private Duty Nursing Services
Parental Responsibility
Paragraph one is changed to read: Private duty nursing services are authorized to supplement care provided by parents and caregivers. Parents and caregivers must participate in providing care to the fullest extent possible. Training must be offered to parents and caregivers by the home health services provider to enable them to provide care that they can safely render without jeopardizing the health or safety of the recipient. The home health services provider must document the methods used to train a parent or caregiver in the medical record.
Paragraph two is changed to read: Medicaid may reimburse private duty nursing services rendered to a recipient whose parent or caregiver is not available or able to care for him. Supporting documentation must accompany the prior authorization request in order to substantiate a parent or caregiver’s inability to participate in the care of the recipient (i.e., work or school schedules and medical documentation*). If a parent or caregiver is unable to provide a work schedule, a statement attesting to the work schedule must be presented to the QIO when requesting authorization.
Paragraph three is changed to read: Medicaid does not reimburse private duty nursing services provided primarily for the convenience of the child, the parents or the caregiver.
Paragraph four is changed to read: Medicaid does not reimburse private duty nursing for respite care. Examples are parent or caregiver recreation, socialization, and volunteer activities, or periodic relief to attend to personal matters unrelated to the medically necessary care of the recipient.
Paragraph five is changed to read: Note: See Appendix F, G, H, and I for copies of the Parent or Legal guardian medical limitations, work, and school schedule forms, AHCA-Med Serv Forms 5000: 3501, October 2010; 3503, December 2011; 3504, December 2011; and 3505, December 2011. The forms are available by photocopying them from Appendix F, G, H, and I. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-20 Footer date is changed to December 2011
Page 2-21 Private Duty Nursing Services
Private Duty Nursing Provided by a Parent or Legal Guardian
Paragraph six is changed to read: Medicaid may authorize additional hours for the parent or legal guardian to sleep if the child’s medical condition requires an awake caregiver to provide continuous or frequent intervention or medically-necessary observation during the night. See Appendix D, Guideline for Evaluating Family Support and Care Supplements, December 2011.
Note is changed to read: See Appendix C for a copy of the Authorization for Private Duty Nursing Provider by a Parent or Legal Guardian, AHCA-Med Serv Form 046, July 2008. The form is available by photocopying it from Appendix C. It is incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-21 Footer date is changed to December 2011
Page 2-22 Private Duty Nursing Services
PPEC Services
Paragraph two is inserted to read: Medicaid may reimburse private duty nursing services for a period of 30 calendar days in order for PPEC services to become established.
Paragraph three is inserted to read: If additional time is needed, the provider, recipient, or physician can request a reconsideration. Information or documentation must be submitted to justify the additional time.
Paragraph four is changed to read: The QIO will evaluate whether the child’s needs can be met by a PPEC center in consultation with the child’s physician and parent or legal guardian. After the review for PPEC services, private duty nursing may be provided as a wraparound alternative for an individual needing additional services when PPEC is not available.
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Page 2-23
Private Duty Nursing Services
The section titled “Authorization Process” is changed to read: “Prior Authorization Process”
Paragraph one is changed to read: Private duty nursing services will be prior authorized by the Medicaid QIO if the services are determined to be medically necessary. The request for the authorization must be submitted prior to the delivery of services.
The section titled “Prior Authorization” is entirely deleted.
Page 2-23 Footer date is changed to December 2011
Page 2-24
Footer date is changed to December 2011
Page 2-25 Personal care Services
Following the term “Services” INSERT: (For recipients under age 21 years old)
Personal Care Services Definition
Paragraph one is changed to read: Personal care services provide medically necessary assistance with activities of daily living (ADL) and age appropriate instrumental activities of daily living (IADL) that enable the recipient to accomplish tasks that they would normally be able to do for themselves if they did not have a medical condition or disability.
Who Can Receive Personal Care Services
First bullet is changed to read:
●Have a medical condition or disability that substantially limits their ability to perform their ADLs or IADLs; and
Page 2-25 Footer date is changed to December 2011
Page 2-26 Personal Care Services
Personal Care Services Requirements
Insert fifth bullet to read:
●Supervised by the recipient if the services are provided by a non-home health agency and the recipient is a legal adult between the ages of 18 and 21 years of age with no legal guardian;
Parental Responsibility
First paragraph is changed to read: Personal care services are authorized to supplement care provided by parents, and caregivers. Parents and caregivers must participate in providing care to the fullest extent possible. Training must be offered by the home health service provider to parents and caregivers to enable them to provide care they can safely render without jeopardizing the health or safety of the recipient. The home health services provider must document the methods used to train a parent or caregiver in the medical record.
Third paragraph is changed to read: Note: See Appendix F, G, H, and I for copies of the Parent or Legal guardian medical limitations, work, and school schedule forms, AHCA-Med Serv Forms 5000: 3501, October 2010; 3503, December 2011; 3504, December 2011; and 3505, December 2011. The forms are available by photocopying them from Appendix F, G, H, and I. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-26 Footer is date is changed to December 2011
Page 2-27 Personal Care Services
Prior Authorization
First paragraph is inserted to read: Personal Care services will be prior authorized by the Medicaid QIO if the services are determined to be medically necessary. The request for the authorization must be submitted prior to the delivery of services.
Second paragraph is changed to read: Initial requests for personal care services will be authorized for up to 60 days to allow for reassessment of the recipient’s condition.
Third paragraph is inserted to read: Personal care services will be decreased over time as parents and caregivers are taught skills to care for their child and become capable of safely providing the care or if the child’s condition improves.
Page 2-27 Footer date is changed to December 2011
Page 2-28 Personal Care Services
Reimbursable Personal Care Services
First paragraph and bullets are changed to read:
Medicaid reimburses for the following personal care services when they are medically necessary.
ADLS include:
●Eating (oral feedings and fluid intake);
●Bathing;
●Dressing;
●Toileting;
●Transferring; and
●Maintaining continence (examples include taking care of a catheter or colostomy bag or changing a disposable incontinence product when the recipient is unable to control his bowel or bladder functions.
IADLs (when necessary for the recipient to function independently) include:
●Personal hygiene;
●Light housework;
●Laundry;
●Meal preparation;
●Transportation;
●Grocery shopping;
●Using the telephone to take care of essential tasks (examples include paying bills and setting up medical appointments);
●Medication management; and
●Money management.
Last paragraph is inserted to read: Medically necessary personal care services may be authorized when a recipient has a documented cognitive impairment which prevents him from knowing when or how to carry out the personal care task. Assistance may be in the form of hands on assistance (actually performing the task for the person) or cuing, along with supervision to ensure the recipient performs the personal care task properly. Additional supporting documentation may be required to substantiate the functional limitations associated with the cognitive impairment.
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Page 2-30 Durable Medical Equipment and Therapy Services
Footer date is changed to December 2011
Page 2-31
Footer date is changed to December 2011
Page 2-32
Footer date is changed to December 2011
Page 2-33
Prior Authorization for Home Health Services
General Requirements
Third bullet is changed to read: For initial service requests, it is recommended that the home health services provider submit the request to the QIO at least ten business days prior to the start of care.
Fourth bullet is inserted to read: For subsequent authorization requests (continued stay requests), the home health services provider must submit the request to the QIO at least ten business days prior to the new certification period.
Footer date is changed to December 2011
Page 2-35 Prior Authorization for Home Health Services
Requesting Prior Authorization
Second paragraph changed to read:
At a minimum, each prior authorization request must include all of the following:
●Recipient’s name, address, date of birth, and Medicaid ID number;
●Home health agency or independent personal care provider’s Medicaid provider number, name and address;
●Procedure code(s), with modifier(s) if applicable, matching the services reflected in the plan of care;
●Units of service requested;
●Summary of the recipient’s current health status, including diagnosis(es);
●Planned dates and times of service;
●Ordering provider’s Medicaid provider number, National Provider Identifier, or Florida Medical License number, name, and address;
●The nursing assessment (for services provided by a licensed home health agency);
●A copy of the active plan of care signed by the attending physician; and
●Patient condition summaries that substantiates medical necessity and the need for requested services, such as a hospital discharge summary (if services are being requested as a result of a hospitalization), physician or nurse progress notes, or history and physical;
●A copy of the documentation that demonstrates that the recipient has been examined or received medical consultation by the ordering or attending physician at least 30 days before initiating services and every 180 days thereafter Note: See Appendix E for a copy of the Physician Visit Documentation Form, AHCA-Med Serv Form 5000-3502, October 2010. The form is available by photocopying it from Appendix E. It is incorporated by reference in Rule 59G-4.130, F.A.C;
●A copy of the current physician’s order. Note: See Appendix K for a copy of the Medicaid Physician’s Written Prescription For Home Health Services Form. AHCA-Med Serv Form 5000-3525, December 2011. The form is available by photocopying it from Appendix K. It is incorporated by reference in Rule 59G-4.130, F.A.C.
●For private duty nursing and personal care services, the following supportive documentation must be furnished regarding the caregiver’s availability and ability to provide care, as applicable:
●Medical information validating limitations in providing care Note: See Appendix F for a copy of the Parent or Legal Guardian Medical Limitations Form, AHCA-Med Serve Form 5000-3501, October 2010. The form is available by photocopying it from Appendix F. It is incorporated by reference in Rule 59G-4.130, F.A.C.;
●Work schedules Note: See Appendix G and H for a copy of the Parent or Legal Guardian Work Schedule Forms, AHCA-Med Serv Forms 5000: 3503, December 2011 and 3504, December 2011. These forms are available by photocopying them from Appendix G and H. They are incorporated by reference in Rule 59G-4.130, F.A.C.; and
●School schedules Note: See Appendix I for a copy of the Parent or Legal Guardian School Schedule Form, AHCA-Med Serv Form 5000-3505, December 2011. The form is available by photocopying it from Appendix I. It is incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-35 Footer date is changed to December 2011
Page 2-36 Prior Authorization for Home Health Services
Bullet is inserted to read:
●The QIO may request a copy of the assessment developed by the Florida Department of Health, Children’s Medical Services (CMS) when private duty nursing services are requested for children who are enrolled in the CMS Network.
Review Criteria
First paragraph is changed to read: The QIO may use a national standardized set of criteria, or other set of criteria*, approved by the AHCA, as a guide to establish medical necessity for prior authorization of home health services at the first review nurse level.
Fourth paragraph is changed to read: Note: See Appendix D for a copy of the Guidelines for Evaluating Family Support and Care Supplements, December 2011. The guideline is available by photocopying it from Appendix D. It is incorporated by reference in Rule 59G-4.130, F.A.C.
Fifth paragraph is changed to read: Note: See Appendix L for a copy of the Review Criteria for Private Duty Nursing Services, December 2011. The criteria are available by photocopying it from Appendix L. It is incorporated by reference in Rule 59G-4.130, F.A.C.
Sixth paragraph is changed to read: Note: See Appendix M for a copy of the Review Criteria for Personal Care Services, December 2011. The criteria are available by photocopying it from Appendix M. It is incorporated by reference in Rule 59G-4.130, F.A.C.
Approval Process
Second paragraph is changed to read: Prior authorization requests for home health services that appear to deviate from treatment norms, established standards of care, or utilization norms may be subject to a more intensified review by the QIO prior to rendering a determination. This may include a telephonic or face-to-face contact with the Medicaid recipient in his place of residence, interviews with the ordering physician, and a review of the recipient’s medical record.
Page 2-36 Footer is date is changed to December 2011
Page 2-37 Prior Authorization for Home Health Services
Reconsideration Review
First paragraph is changed to read: If a denial determination is rendered, the provider, recipient, or physician may request reconsideration. If reconsideration is requested, additional information must be submitted to the QIO to facilitate the approval process.
Second paragraph is changed to read: A reconsideration review of the denial decision must be requested via the Medicaid QIO Internet system within five business days of the date of the final denial or modified approval determination.
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Page 2-38
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Page 2-39
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Page 3-1
Footer date is changed to December 2011
Page 3-2
Footer date is changed to December 2011
Page 3.3
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Page 3-4
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Page 3-5
Footer date is changed to December 2011
Appendix A: Footer date is changed to December 2011
Appendix B: Medicaid Instructions for CMS Form 485-Plan of Care
The footer now reads December 2011
Appendix C: Authorization for Private Duty Nursing Provided by a Parent or legal Guardian
The footer on the form now reads: AHCA-Med Serv Form 046, July 2008
Appendix D: Guidelines for Evaluating Family Support and Care Supplements
Insert the following requirements:
Activity Affecting Parental Availability
●Caring for Other Dependents. Approval Guidelines: The QIO may approve up to 2 hours per day if there are other minor dependents in the home under the age of 18. The QIO will also take into consideration any special needs that the other children may have and the availability of other caretakers in the home.
●Ancillary tasks critical to the health and well-being of the child receiving private duty nursing services. Tasks may include grocery shopping picking up medications, laundry, and light housekeeping to maintain a safe environment for the child. Approval Guidelines: Up to 4 hours per week. The QIO will consider the availability of other caregivers in the home who can assist with these tasks.
The footer now reads: December 2011
Appendix E: Physician Visit Documentation Form
The footer now reads: AHCA-Med Serv Form 5000-3502, October 2010
Appendix F: Parent or Legal Guardian Medical Limitations
The footer now reads: AHCA-Med Serv Form 5000-3501, October 2010
Appendix G: Parent or Legal guardian Work Schedule
The following statement is inserted in bold letters.
Any person who makes, presents or submits a document that is false or fraudulent is subject to a reduction or termination of Medicaid services.
The footer now reads: AHCA-Med Serv Form 5000-3503, December 2011
Appendix H: Parent or Legal Guardian Statement of Work Schedule
The following statement is inserted in bold letters.
My signature below certifies that I am self-employed and that the schedule above is true and accurate. I understand that any person who makes, presents, or submits documentation that is false or fraudulent is subject to a reduction or termination of Medicaid services.
The footer now reads: AHCA-Med Serv Form 5000-3504, December 2011
Appendix I
The footer now reads: AHCA-Med Serv Form 5000-3505, December 2011
Appendix J: Medicaid Instructions for the Personal Care Services Plan of Care
Physician Certification
First paragraph is changed to read: Enter the name of the attending physician that prescribed the services. The plan of care must be signed and dated by the attending physician prior to submission of a prior authorization request.
Personal Care Services Plan of Care: Service Information
Item 33 is changed to read: Discharge Plan
The footer now reads: AHCA-Med Serv Form 5000-3506, December 2011
Appendix K: Medicaid Physician’s Written Prescription for Home Health Services
The footer reads: AHCA-Med Serv Form 5000-3525, December 2011
Appendix L: Medicaid Review Criteria for Private Duty Nursing Services
The footer reads: December 2011
Appendix M: Medicaid Review Criteria for Personal Care Services
The footer reads: December 2011
