AGENCY FOR HEALTH CARE ADMINISTRATION
MedicaidRULE NO.:RULE TITLE:
59G-4.205 Practitioner 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. 39, No. 20, January 30, 2013 issue of the Florida Administrative Register.
The following changes have been made to the Florida Medicaid Practitioners Services Coverage and Limitations Handbook, December 2012.
Page 1-2 Anesthesiologist Assistant (AA)
The section will now read:
An AA is a graduate of an approved program who is licensed to perform medical services in accordance with sections 458.3475 and 459.023, F.S.
Page 1-3 General Provider Qualifications
The bullets for advanced registered nurse practitioners, physician assistants, anesthesiologist assistants, and registered nurse first assistants will now read:
ARNP licensed as an advanced registered nurse practitioner within the scope of practice of nursing as defined in Chapter 464, F.S.;
PA licensed as a physician assistant within the scope of practice as defined in Chapter 458 or 459, F.S.;
AA licensed as an anesthesiologist assistant in accordance with sections 458.3475 and 459.023, F.S.;
RNFA licensed as a registered nurse with certification as a registered nurse first assistant as defined in Chapter 464, F.S.
Page 1-8 Direct Supervision
The name of the information block will now read Personal Supervision. The section will now read:
Services provided by an ARNP or a PA under the personal supervision of a physician may be billed by the physician instead of the ARNP or PA.
Teaching physicians who seek reimbursement for oversight of patient care by a resident must personally supervise all services performed by the resident.
Personal supervision pursuant to subsection 59G-1.010(276), F.A.C., means that the services are furnished while the supervising practitioner is in the building and that the supervising practitioner signs and dates the medical records (chart) within 24 hours of the provision of the service.
Exceptions are deliveries, psychiatric services, and Child Health Check-Up screenings. The ARNP or PA who provides these services must bill using their own Medicaid ID number as the rendering provider number.
Page 1-8 ARNP Supervision
The section has been deleted.
Page 1-8 PA Supervision
The section has been deleted.
Page 2-7 Recommended Cervical PAP Screening
The name of the information block will now read Cervical Cancer Screening. The section will now read:
Medicaid reimburses for medically necessary cervical cancer screening, including Papinicoulaou (PAP screening) and human papilloma virus screening.
Page 2-7 Recommended Colon Cancer Screening
The name of the information block will now read Colon Cancer Screening. The section will now read:
Medicaid reimburses colon cancer screening procedures and for symptoms that indicate medical necessity.
Page 2-7 Recommended Laboratory Procedure
Bullet number 3 will now read:
Testing for sexually transmitted infections.
Page 2-33 Emergency Care Visits
The third paragraph will now read:
If a MediPass recipient presents at the emergency room with a condition that the emergency room practitioner determines does not meet the definition of an emergency as defined in section 409.901(10), F.S., a provider whose salary is not included in the hospital’s cost report may bill for a screening, evaluation, and examination utilizing procedure code 99281.
Page 2-44 Immunization Schedule
The section has been deleted.
Page 2-44 Vaccine Information Statements
The section has been deleted.
Page 2-45 Service Limitations
The first paragraph will now read:
Medicaid does not reimburse for investigational or experimental drugs as defined in Rule 59G-1.010, F.A.C.
Page 2-59 Who Can Perform the Screenings
The name of the information block will now read Requirements for Newborn Hearing Screening Providers. The section will now read:
All newborn and infant hearing screenings must be conducted by an audiologist licensed under Chapter 468, F.S., who meets the requirements of section 1861 [42 U.S.C.1395x(ll)(4)(B)] of the Social Security Act; a physician licensed under Chapter 458 or 459, F.S.; or an individual who has completed documented training specifically for newborn hearing screenings and who is under the supervision of a licensed physician or licensed audiologist.
Supervision means the licensed physician or licensed audiologist directs and is fully legally responsible for the actions of the provider who renders the service.
Page 2-62 Excluded Services
The section will now read:
Medicaid does not reimburse consultation and psychiatric services, including pharmacologic management rendered in a nursing facility or skilled nursing facility.
Medicaid reimbursement for evaluation and management services in a skilled nursing facility or nursing facility are limited to nursing facility evaluation and management CPT codes. Medicaid does not reimburse “office and other outpatient” codes provided in the skilled nursing and nursing facility places of service.
Page 2-66 Undocumented Non-Citizens (Aliens)
The first sentence will now read:
Medicaid reimburses providers for the treatment of undocumented non-citizens (aliens) for the treatment of emergency medical conditions as defined in Section 409.901(10), F.S.
Page 2-82 Children Enrolled in Children’s Medical Services (CMS)
The section has been moved to after the Transplant Evaluation section.
Page 2-96 Supervision Requirements
The third and fourth paragraphs will now read:
Invasive radiological studies require personal physician supervision to be reimbursed by Medicaid.
Personal supervision pursuant to subsection 59G-1.010(276), F.A.C., means that the services are furnished while the supervising practitioner is in the building, and that the supervising practitioner signs and dates the medical records (chart) within 24 hours of the provision of the service.
Page 2-113 Recipient Requirements for Non-Hysterectomy Sterilization
The section will now read:
Voluntary sterilization procedures performed for the primary purpose of rendering a recipient (male or female) incapable of reproducing are reimbursable by Medicaid.
All of the following criteria per 42 CFR, 441.253, Subpart F must be met for Medicaid reimbursement:
The recipient must be at least 21 years old at the time of signing the State of Florida Sterilization Consent Form;
The recipient must voluntarily give informed consent;
The recipient must be mentally competent and not institutionalized in a correctional, penal, or rehabilitation facility or a facility for mental diseases;
A State of Florida Sterilization Consent Form must be correctly completed and signed at least 30 days, but not more than 180 days, prior to sterilization; and
The provider must submit the State of Florida Sterilization Consent Form with the claim. Medicaid will not reimburse the provider without the required form.
A copy of the State of Florida Sterilization consent form is available in the Florida Medicaid Provider Reimbursement Handbook. The handbooks and forms are available on the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com.
Page 2-121 Emergencies: Medicaid for Undocumented Non-Citizens (Aliens)
The section will now read:
Medicaid reimburses providers for the treatment of undocumented non-citizens (aliens) for the treatment of emergency medical conditions as defined in section 409.901(10), F.S.
Pages 4-9 through 4-16 Recipient Assignment Forms
(incorporated by reference in Rule 59G-4.230, F.A.C.) will be added to each form.
Pages 5-6 through 5-8 Family Planning Waiver, continued
The heading of these pages will now read Family Planning Waiver Services, continued
Pages 5-6 through 5-10 Family Planning Waiver Services
The bold headings within the table have been revised to be consistent with the rest of the table.
