The 2009 Legislature passed Senate Bill 1986 which revised laws within the jurisdiction of the Agency for Health Care Administration (“AHCA” or “Agency”). These statutory revisions will have an effect upon administrative sanctions and disincentives ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-9.070: Administrative Sanctions on Providers, Entities, and Persons
PURPOSE AND EFFECT: The 2009 Legislature passed Senate Bill 1986 which revised laws within the jurisdiction of the Agency for Health Care Administration (“AHCA” or “Agency”). These statutory revisions will have an effect upon administrative sanctions and disincentives imposed upon a provider, entity, or person for each violation of any Medicaid – related law. In pertinent summary, revised Section 409.913, F.S., requires the Agency to deny payment or require repayment for Medicaid services under certain circumstances; requires the Agency to immediately terminate a Medicaid provider’s participation in the Medicaid program as a result of certain adjudications against the provider or certain affiliated persons; requires the Agency to suspend or terminate a Medicaid provider’s participation in the Medicaid program if the provider or certain affiliated persons participating in the Medicaid program have been suspended or terminated by the Federal Government or another state; provides that a provider is subject to sanctions for violations of law as the result of actions or inactions of the provider or certain affiliated persons; requires that the Agency provide notice of certain administrative sanctions to other regulatory agencies within a specified period; requires the Agency to withhold or deny Medicaid payments under certain circumstances; requires the Agency to terminate a provider’s participation in the Medicaid program if the provider fails to repay certain overpayments from the Medicaid program; requires the Agency to post a list on its website of Medicaid providers and affiliated persons of providers who have been terminated or sanctioned; and requires the Agency to take certain actions to improve the prevention and detection of heath care fraud.
After careful assessment of those certain statutory amendments arising from passage of SB 1986, the Agency has determined that a rule modification is required to fully implement the revised and expanded statutory provisions, as summarized above. Additionally, to assist the Agency and the Legislature achieve their intended and mutual purpose of reducing and preventing fraud and abuse of the Medicaid program, it has become necessary to modify the monetary sanctions, as a disincentive for violating laws governing the Medicaid program.
SUBJECT AREA TO BE ADDRESSED: Administrative Sanctions on Providers, Entities and Persons.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.907, 409.913, 409.9131, 409.920, 812.035 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: Tuesday, March 2, 2010, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Conference Room C, Building 3, Tallahassee, Florida 32308
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 7 days before the workshop/meeting by contacting: Kimberly Noble, Office of the Inspector General, 2727 Mahan Drive, Building 3, Mail Stop 4, Tallahassee, Florida 32308-5407, [phone], or by email at [e-mail]. 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: Kimberly Noble, Office of the Inspector General, 2727 Mahan Drive, Building 3, Mail Stop 4, Tallahassee, Florida 32308-5407, [phone], or by email at [e-mail]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS NOT AVAILABLE.