Dr. Russell Bain (the "Petitioner"); The Notice of Petition for Declaratory Statement was published in Vol. 40, No. 224, of the Florida Administrative Register. The Petition seeks the agency’s opinion regarding proper reimbursement procedures for ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.205Practitioner Services

NOTICE IS HEREBY GIVEN that Agency for Health Care Administration has issued an order disposing of the petition for declaratory statement filed by Dr. Russell Bain (the “Petitioner”) on November 4, 2014. The following is a summary of the agency’s disposition of the petition:

The Notice of Petition for Declaratory Statement was published in Vol. 40, No. 224, of the Florida Administrative Register. The Petition seeks the agency’s opinion regarding proper reimbursement procedures for the provision of allergen immunotherapy services provided pursuant to Chapter 2 of Florida Medicaid Practitioner Services Coverage and Limitations Handbook (“the Handbook”). The Petitioner sought clarification on whether allergen preparation services provided pursuant to the Handbook should be reimbursed based on the amount of immunotherapy prospectively planned to be administered to a patient, regardless of the amount actually administered to the patient. The Petition was answered: Chapter 2 of the Handbook does not prohibit Dr. Bain from being reimbursed for preparation services based on the amount of immunotherapy prospectively planned to be administered to the patient, provided all other Medicaid rules for reimbursement are met, including the medical necessity component.

A copy of the Order Disposing of the Petition for Declaratory Statement may be obtained by contacting: Richard Shoop, Agency Clerk, Agency for Health Care Administration, 2727 Mahan Drive, Building 3, MS 3, Tallahassee, Florida 32308, [phone].