The purpose of the amendment to Rule 59G-4.132, Florida Administrative Code (F.A.C.), is to update language relating to providers who must comply with the Florida Medicaid Home Health Electronic Visit Verification Program, and revises the rule title....

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.132Home Health Electronic Visit Verification Program

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.132, Florida Administrative Code (F.A.C.), is to update language relating to providers who must comply with the Florida Medicaid Home Health Electronic Visit Verification Program, and revises the rule title. The amendment specifies that providers of behavior analysis services must render services to recipients in accordance with Rule 59G-4.132, F.A.C. The rule title is changed to Electronic Visit Verification Program.

SUBJECT AREA TO BE ADDRESSED: Home Health Electronic Visit Verification Program.

An additional area to be addressed during the workshop will be the potential regulatory impact Rule 59G-4.132, Florida Administrative Code, will have as provided for under sections 120.54 and 120.541, Florida Statutes.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.9132 FS.

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

DATE AND TIME: May 14, 2019, 1:30 p.m. to 2:00 p.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308-5407.

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 48 hours 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]. Official comments to be entered into the rule record will be received from the date of this notice until 5:00 p.m., May 15, 2019. Comments may be e-mailed to [e-mail].

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-4.132 Home Health Electronic Visit Verification Program.

(1) This rule applies to providers enrolled directly in the Florida Medicaid program that furnish home health services (home health visits, private duty nursing, and personal care services, and behavior analysis services) to recipients through the fee-for-service delivery system as specified on the Agency for Health Care Administration’s (AHCA) website at http://ahca.myflorida.com/Medicaid/home_health/dmv.shtml in accordance with Section 409.9132, Florida Statutes (F.S.).

(2) Definition. Direct service provider – An individual who personally (face-to-face) provides services to recipients in accordance with Rule 59G-4.261, 59G-4.215, or 59G-4.130, or 59G-4.125, Florida Administrative Code (F.A.C.).

(3) Home Health Electronic Visit Verification Program.

(a) All providers must comply with Section 409.9132, F.S.

(b) The Agency for Health Care Administration contracts with a vendor to electronically verify the delivery of home health services provided to recipients in their residence or other authorized setting.

1. Providers must document the home health service encounter for each recipient served (in accordance with the recipient’s approved plan of care) and verify the delivery of the services rendered using AHCA’s designated vendor’s electronic visit verification (EVV) system.

2. Direct service providers must verify delivery of the service using the vendor’s system at the beginning and end of each home health service encounter.

3. Providers must submit claims through AHCA’s designated vendor’s system to the Florida Medicaid fiscal agent for services rendered and verified in accordance with the prior authorization in the Florida Medicaid Management Information System.

(4) Providers that fail to comply with the Home Health Electronic Visit Verification Program are subject to potential denial or non-payment of claims, sanctions, fines, and suspension or termination from the Florida Medicaid program, in accordance with Rule 59G-9.070, F.A.C.

Rulemaking Authority 409.919 FS. Law Implemented 409.9132 FS. History–New 2-22-17, Amended ______.