Durable Medical Equipment and Supplies

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-4.070: Durable Medical Equipment and Supplies

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. 33 No. 31, August 3, 2007 issue of the Florida Administrative Weekly.

These changes are in response to comments received from the Joint Administrative Procedures Committee and during the public hearing process.

The rule incorporates by reference the Florida Medicaid Durable Medical Equipment and Medical Supply Services Coverage and Limitations Handbook, July 2007. The following revisions were made to the handbook.

Page 1-2, Enrolled Medicaid Pharmacy Provider. We corrected the F.A.C. citation to read, “59G-4.250.”

Page 1-3, General Medicaid Enrollment Requirements. We added “Provider” to the title so it now reads, “General Medicaid Provider Enrollment Requirements.”

Page 1-3, We added the following section from the current handbook. “Qualification Requirements. To enroll as a Medicaid provider, a DME and medical supply entity must meet the following criteria:

 Be licensed by the local government agency as a business or merchant or provide documentation from the city or county authority that no licensure is required;

 Be licensed by the Department of Health, Medical Quality Assurance, Board of Orthotics and Prosthetics, if providing orthotics and prosthetic devices;

 Be licensed by the Agency for Health Care Administration, Division of Health Quality Assurance, in possession of a Home Health Equipment license;

 Be in compliance with all applicable laws relating to qualifications or licensure; and

 Have an in-state business location or be located not more than fifty miles from the Florida state line.”

Page 1-4. We deleted the sections titled “Business Location Eligibility Requirements for DME and Medical Supply Providers” and “Business Location.”

Page 1-5 (new page 1-4), General DME and Medical Supply Provider Qualifications for Enrollment and Re-enrollment. We deleted the word “General” from the title and revised the eighth bullet to read, “Be operating primarily as a walk-in DME and medical supply business location.” In the ninth bullet, we changed the effective month from “January” to “March.”

Page 1-6 (new page 1-5), General DME and Medical Supply Provider Qualifications for Enrollment and Re-enrollment. We deleted the word “General” from the title. We deleted the following accrediting organizations: Board of Certification in Pedorthics and American Board for Certification in Orthotics and Prosthetics. We added the American Board for Certification in Orthotics, Prosthetics, and Pedontics, Inc. In the first and second paragraphs, we changed the effective month from “January” to “March.”

Page 1-7 (new page 1-6), General DME and Medical Supply Provider Qualifications for Enrollment and Re-enrollment. We deleted the word “General” from the title. We revised the third bullet to read, “The provider must have a current physical DME and medical supply services business location with substantial stock, as defined in this chapter.”

Page 1-8 (new page 1-7), Home Health Services. We revised the definition to read, “Home health services are defined in section 400.462, F.S. as health and medical services and medical supplies furnished by an organization to an individual in the individual's home or place of residence. The term includes organizations that provide one or more of the following:

 Nursing care.

 Physical, occupational, respiratory, or speech therapy.

 Home health aide services.

 Dietetics and nutrition practice and nutrition counseling.

 Medical supplies, restricted to drugs and biologicals prescribed by a physician.”

Page 1-9 (new page 1-8), Orthotic and Prosthetic Providers. In the third paragraph, we revised the first sentence to read, “Representatives of product manufacturers who are not licensed by the Department of Health, Medical Quality Assurance, Board of Orthotics and Prosthetics and are not employed by the enrolled provider are not qualified to provide Medicaid DME orthotic and prosthetic services, including the assessment, adjustment and the fitting of orthotic and prosthetic devices.”

Page 1-9 (new page 1-8). We deleted the section titled, “Mail Order Providers.”

Page 1-10 (new page 1-9), Requirements for Medical Oxygen Providers and Retailers. In the seventh paragraph, we revised the second sentence to read, “The individual patient record must include clearly documented initial and quarterly home visits.” We revised the third sentence to read, “Patient records must include equipment assessments, such as oxygen concentrator hour meter readings.”

Page 1-11 (new page 1-10), Mobile DME and Medical Supply Providers. In the first sentence, first paragraph, we deleted, “Unless authorized by a competitive procurement contract agreement.”

Page 1-17 (new page 1-16), Background Screening Requirement. In the second and forth paragraphs, we change the effective month from “January” to “March.”

Page 1-23 (new page 1-22). We deleted the section titled, “Self-Referral and Conflict of Interest.”

Page 1-25 (new page 1-24). DME and Medical Supply Provider Responsibilities. In the seventh bullet, first sentence, after durable medical equipment, we added, “as required by the manufacturer’s guidelines.”

Page 1-26 (new page 1-25). Training Documentation Requirements for Provider’s Employees. We revised the fifth bullet to read, “Legible signatures of attendees and the DME business location where they are employed or the individual’s certification of completion of on-line training . . . ”

Page 1-27 (new page 1-26), Provider Responsibility and HIPAA. In the second Note, we specified that the information is found in Chapter 2.

Page 2-4, Independent Therapist or Physiatrist. We revised the Note to read, “See Provider Requirements, Illegal Remunerations, in Chapter 1 for additional information.”

Page 2-11, Time-Sensitive Medical-Necessity Redetermination Requirements for Consumable Medical Supplies. In the first paragraph, first sentence, we deleted “that are included in the monthly rental fee,” and changed the first two bullets to read, “A new and specific prescription or; A Certificate of Medical Necessity (CMN) or . . .”

Page 2-12, Time-Sensitive Medical-Necessity Redetermination Requirements for Oxygen Therapy, Oxygen-Related Equipment, and Apnea Monitors. We deleted the first paragraph. We revised the first two bullets to read, “A new prescription or; Certificate of Medical Necessity (CMN) or . . .” After the last bullet, we added the following new paragraph, “The new documentation of medically necessity must specify the type of equipment, goods, or services requested and the quantity, frequency, and the length of need. Length of need must be documented when equipment has been prescribed for less than twelve (12) months.”

Page 2-13, Delivery Documentation Requirements. In the fifth bullet, we changed “A statement,” to “Documentation.” In the ninth bullet, we added “number,” so that it reads, “Model number.” We rewrote the tenth bullet to read, “Serial or item number(s), where applicable.” We deleted the fourteenth bullet, which read, “Current condition of equipment.”

Page 2-14, Pick-up and Return Documentation Requirements. Under “Pick-up documentation must include, at a minimum, the following information,” seventh bullet, we added “or item.” We deleted the tenth bullet that read, “Oxygen tank or cylinder’s contents, if applicable;” and the eleventh bullet that read, “Current condition of equipment.”

Page 2-17, Prior Authorization (PA) Process. In the first paragraph, we added the Florida Medicaid Authorization Request, PAO1’s effective date and that it is incorporated by reference in 59G-4.160, F.A.C. In the second note, we deleted the last sentence, “The form is incorporated by reference in 59G-4.001, F.A.C.”

Page 2-18, Prior Authorization Documentation. In the fifth bullet, we added “or item number.” In the tenth bullet, we added, “or a statement why three (3) price sheets are not available.”

Page 2-25, Rental Agreement. We added a third bullet, which reads, “During the rental agreement, the recipient is enrolled in a Provider Service Network (PSN) or Health Maintenance Organization (HMO) plan and the rental services has been or is being terminated.”

Page 2-27, Limitations for Replacement of Equipment. We deleted the third bullet, which read, “Using or transporting the equipment in a way not intended or recommended by the manufacturer.”

Page 2-34, Home Visit Documentation Requirements. We revised the first sentence to read, “When an RN, CRT, or RRT conducts a face-to-face home visit, the licensed professional must document the following information in the recipient’s medical record.” We revised the third bullet to read, “Recipient’s current condition and recent changes in the recipient’s condition based upon an interview with the recipient’s family and caregiver;”

Page 2-41, Conflict of Interest. We revised the title to read, “Conflict of Interest for AAC Device.”

Page 2-60, Provider Service Requirements Regarding Oxygen and Oxygen-Related Equipment. We in the ninth bullet, we replaced, “qualified license professionals,” with “qualified individuals.”

Page 2-64, Initial and Quarterly Home Visit Requirements. We revised the first sentence to read, “When the CRT, RRT or RN conducts the initial visit and qualified technicians conduct quarterly home visits . . .” We deleted the second through the sixth bullets and the last bullet, which read, “Saturation measurement by pulse oximetry; and Recording of respiration; and Breath sounds; and Skin color; and Other significant observations; and Actions taken as a result of the respiratory assessment findings during the home visit.” We revised the tenth bullet (new fifth bullet) to read, “Oxygen concentrator meter reading, when a concentrator was delivered.”

Page 2-67, Practitioner Documentation Requirements. In the first sentence, we replaced “orders,” with “documentation of medical necessity.”

Page 2-68, Documentation Requirements. In the first bullet, we replaced “an order or prescription” with “documentation of medical necessity.” In the last bullet, we changed “month” to “quarter.”

Page 2-69, Portable Oxygen Service Criteria. In the first bullet, we replaced “Recipient qualifies,” with “Documentation of medical necessity.”

Page 2-79, Specific Diagnostic Requirements for Reimbursement. In the last paragraph, we replaced “qualified respiratory professional” with “qualified technician.”

Page 2-81, Reimbursement. We revised the first sentence to read, “Tubing and accessories necessary to operate respiratory and gastric suction equipment are reimbursable only for recipient owned equipment.” We deleted the second sentence, which read, “Claiming separate reimbursement for items included in the equipment’s scheduled monthly rental fee is not allowed.”

Page 2-85, IPPB Documentation. We deleted the sixth bullet, which read, “Quarterly follow up visit documentation, to include a respiratory assessment and vital signs;”

Page 2-86, Volume Ventilator Documentation. We revised the seventh bullet to read, ”Quarterly visit documentation.”

Page 2-87, General Documentation Requirements. We revised the eleventh bullet to read, “Visit documentation.”

Page 2-92, Customized Wheelchair Documentation. In the first bullet, we replaced “attainment cost” with “manufacturers suggested retail pricing (MSRP).”