The purpose of the amendment to Rule 59G-4.002 is to incorporate by reference the Florida Medicaid provider reimbursement schedules and billing codes.

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-4.002Provider Reimbursement Schedules and Billing Codes

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-4.002 is to incorporate by reference the Florida Medicaid provider reimbursement schedules and billing codes.

SUMMARY: The amendment records effective dates for reimbursement schedules for certain Florida Medicaid services.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to section 120.541, Florida Statutes, the rule will not require legislative ratification.

Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: April 26, 2017, 10:30 a.m. to 11:30 a.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: Jessica Kenny.. 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 IS: Jessica Kenny, Bureau of Medicaid Policy, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail].

Please note that a preliminary draft of the reference material, if available, will be posted prior to the public hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received from the date of this notice until 5:00 p.m. April 27, 2017. Comments may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

Substantial rewording of Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes follows. See Florida Administrative Code for present text.

59G-4.002 Provider Reimbursement Schedules and Billing Codes.

(1) This rule applies to providers rendering Florida Medicaid services to recipients.

(2) Florida Medicaid reimburses for services rendered in the fee-for-service delivery system based on a fee schedule, cost report, or contract. The following fee schedules and billing codes are incorporated by reference and available on the Agency for Health Care Administration’s website at http://ahca.myflorida.com/Medicaid/review/index.shtml.

(3) Florida Medicaid Fee Schedules Effective January 1, 2017:

(a) Ambulatory Surgical Center Services Fee Schedule

https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(b) Assistive Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(c) Behavior Analysis Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(d) Behavioral Health Overlay Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(e) Birth Center Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(f) Child Health Services Targeted Case Management Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(g) Community-Based Substance Abuse County Match Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(h) Community Behavioral Health Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(i) County Health Department Certified Match Program Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(j) Dental General Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(k) Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for All Medicaid Recipients

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(l) Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for Medicaid Recipients Under the Age of 21 Years

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(m) Early Intervention Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(n) Emergency Transportation Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(o) Hearing Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(p) Home Health Visit Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(q) Immunization Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(r) Independent Laboratory Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(s) Licensed Midwife Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(t) Medicaid Certified School Match Program Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(u) Medical Foster Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(v) Mental Health Targeted Case Management Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(w) Occupational Therapy Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(x) Personal Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(y) Physical Therapy Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(z) Physician and Outpatient Laboratory Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(aa) Physician Pediatric Surgery Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(bb) Practitioner Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(cc) Prescribed Drug Fee Schedule (Not Reviewed by the Pharmaceutical and Therapeutic Committee)

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______;)

(dd) Prescribed Pediatric Extended Care Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(ee) Private Duty Nursing Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(ff) Radiology Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(gg) Regional Perinatal Intensive Care Center (RPICC) Neonatal Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(hh) Regional Perinatal Intensive Care Center (RPICC) Obstetrical Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(ii) Specialized Therapeutic Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(jj) Speech-Language Pathology Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(kk) Targeted Case Management for Children at Risk of Abuse and Neglect Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(ll) Visual Services Fee Schedule

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(4) Florida Medicaid Billing Codes Effective January 1, 2017:

(a) County Health Department Billing Codes 

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(b) Federally Qualified Health Center Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(c) Hospice Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(d) Hospital Outpatient Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(e) Intermediate Care Facility for Individuals with Intellectual Disabilities Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(f) Nursing Facility Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(g) Rural Health Clinic Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

(h) Statewide Inpatient Psychiatric Program Services Billing Codes

(https://www.flrules.org/Gateway/reference.asp?No=Ref-_______);

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History–New 8-18-05, Amended 11-30-05, 4-16-06, 10-11-06, 3-27-07, 7-25-07, 9-29-08, 4-28-09, 2-11-10, 1-31-11, 7-16-13, 5-21-14, 6-20-16,_____.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Jessica Kenny

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Justin Senior

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 28, 2017

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: September 29, 2016