The purpose of the amendment to Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to update the reimbursement percentage of the Medicare rate or the Florida Medicaid rate when the service is not covered by Medicare.....

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.005Reimbursement Methodology for Services Provided by Medical School Faculty

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to update the reimbursement percentage of the Medicare rate or the Florida Medicaid rate when the service is not covered by Medicare.

SUBJECT AREA TO BE ADDRESSED: Reimbursement Methodology for Services Provided by Medical School Faculty. An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-6.005, F.A.C., will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.908 FS.

A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: March 12, 2021, 2:30 p.m. to 3:00 p.m.

PLACE: Remote Listeners: Attendees may register for the hearing at: https://attendee.gotowebinar.com/register/8508075264721666830. After registering, a confirmation email will be received containing information about joining the webinar, and opportunities to offer comments and questions will be available.

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: [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: [e-mail]. Please note that a preliminary draft of the reference material, if available, will be posted prior to the workshop at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received until 5:00 p.m. on March 15, 2021 and may be e-mailed to [e-mail].

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

59G-6.005 Reimbursement Methodology for Services Provided by Medical School Faculty.

(1) This rule applies to all providers who are enrolled in Florida Medicaid who:

(a) Are defined as practitioners under the Centers for Medicare and Medicaid Services’ Merit-based Incentive Payment System (MIPS) Physician Quality Reporting Systems program (PQRS).

(b) Provide medical services, dental services, behavioral health services, hearing services, and vision services to Florida Medicaid recipients receiving services through the fee-for-service delivery system.

(c) Are employed by, or contracted with, a Florida public or private, non-profit, accredited medical, dental, or optometry school to provide supervision and teaching of medical, dental, or optometric students, residents, or fellows.

(2) Reimbursement.

(a) Florida Medicaid reimburses providers for covered medical, hearing, vision, dental, and behavioral health services listed on the applicable Florida Medicaid fee schedule, incorporated by reference in rule 59G-4.002, F.A.C., at either:

1. Two hundred-three One-hundred-ninety percent of the Medicare rate, based on Florida locality code 0910299, listed on the 2018 January-June 2015 Medicare Part B physician fee schedule – Loc 03, 04, and 99 (01/02), incorporated for reference, and available at http://medicare.fcso.com/Data_files, and at http://www.flrules.org/Gateway/reference.asp?No=Ref-_________08250, https://ahca.myflorida.com/medicaid/review/Reimbursement/2018-01-01_Fee_Schedules/Practitioner_Fee_Schedule_2018.pdf, and at  Physician Fee Schhttps://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspxedule Search (cms.gov).

2.  Two hundred-three One-hundred-ninety percent of the Florida Medicaid rate if the service is not covered by Medicare.

(b) Florida Medicaid reimbursement to providers for clean claims submitted to the Florida Medicaid Management Information System specified in this rule shall not exceed the amount specified in the General Appropriations Act.$36,543,054 for Fiscal Year 2017-2018 and shall not exceed $47,676,137 for Fiscal Year 2018-2019.

(c) Florida Medicaid will reconcile claims reimbursed in accordance with this rule on a quarterly basis. Any claims reimbursed after the maximum reimbursable amount is reached will be recouped, or adjusted to the standard Florida Medicaid rate, as appropriate.

(3) Exclusions. Florida Medicaid does not reimburse providers in accordance with this rule for the following:

(a) Services rendered to dually eligible Medicare and Medicaid recipients.

(b) Vaccine, laboratory, and radiology services.

(4) This rule is in effect for five years from its effective date.

Rulemaking Authority 409.919 FS. Law Implemented 409.908 FS. History–New 6-13-17, Amended 12-25-18,___________.