AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.130Home Health Services
NOTICE 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. 28, February 11, 2013 issue of the Florida Administrative Register.
59G-4.130 Home Health Services.
(2) All home health agency providers enrolled in the Florida Medicaid program must be in compliance with the Florida Medicaid Home Health Services Coverage and Limitations Handbook, March 2013, incorporated by reference. The handbook is available from the Medicaid fiscal agent’s Web site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks. Paper copies of the handbooks may be obtained by calling the Provider Services Contact Center at 1(800)289-7799 and selecting Option 7.
(4) The following forms are included in the Florida Medicaid Home Health Services Coverage and Limitations Handbook and are incorporated by reference: Appendix B, Medicaid Instructions for CMS Form 485 - Plan of Care, AHCA Form 5000-3544, April 2013; Appendix B, Home Health Certification and Plan of Care, Form CMS-485(C-3)(02-94) (Formerly HCFA-485), July 2008; Appendix C, Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian, AHCA-Med Serv Form 5000-3541, February 2013; Appendix D, Physician Visit Documentation Form, AHCA-Med Serv Form 5000-3502, Revised February 2013; Appendix E, Parent or Legal Guardian Medical Limitations, AHCA-Med Serv Form 5000-3501, Revised February 2013; Appendix F, Parent or Legal Guardian Work Schedule, AHCA-Med Serv Form 5000-3503, Revised February 2013; Appendix G, Parent or Legal Guardian Statement of Work Schedule, AHCA-Med Serv Form 5000-3504, Revised February 2013; Appendix H, Parent or Legal Guardian School Schedule, AHCA-Med Serv Form 5000-3505, Revised February 2013; Appendix I, Personal Care Services Plan of Care, AHCA-Med Serv Form 5000-3506, Revised April 2013 September 2011; Appendix J, Medicaid Physician’s Written Prescription for Home Health Services, AHCA-Med Serv Form 5000-3525, Revised February 2013;. Appendix K, Review Criteria for Private Duty Nursing Services, AHCA Form 5000-3543, April 2013; and Appendix L, Review Criteria for Personal Care Services, AHCA Form 5000-3542, April 2013. The forms are available by photocopying them from the handbook.
The following changes have been made to the Florida Medicaid Home Health Services Coverage and Limitations Handbook, March 2013.
Table of Contents, Appendices
The title of Appendix B will now read: CMS Form 485 - Home Health Certification Plan of Care and Instructions
The title of Appendix I will now read: Personal Care Services Plan of Care Form and Instructions
Page 2-7, Required Document(s)
The section will now read:
Licensed home health agencies may use the Centers for Medicare and Medicaid Services (CMS) Form 485 (C-3)(02-94), Home Health Certification and Plan of Care, for the POC or providers may use their own form as long as all of the information in the CMS Form 485 is included in their form.
Note: See Appendix B for CMS Form 485 and instructions. The form and instructions are available by photocopying them from the appendix. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Independent personal care providers (including unlicensed agencies) are required to use the Personal Care Services Plan of Care form.
Note: See Appendix I for a blank copy of the Personal Care Services Plan of Care form and instructions, AHCA Form 5000-3506, Revised April 2013. The form and instructions are available by photocopying them from the appendix. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-22, Parental Responsibility
The last paragraph will now read:
Note: See Appendices E, F, G, and H for copies of the parent or legal guardian medical limitations, work, and school schedule forms, AHCA-Med Serv Forms 5000-3501, Revised February 2013; -3503, Revised February 2013; -3504, Revised February 2013; and -3505, Revised February 2013. The forms are available by photocopying them from the appendices. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-23, Private Duty Nursing Provided by a Parent or Legal Guardian
The last paragraph will now read:
In the note paragraph, the form number and the effective date have been updated to reflect the correct form number as 5000-3541 and the correct effective date as Revised February 2013.
Page 2-30, Parental Responsibility
The last paragraph will now read:
Note: See Appendices E, F, G, and H for blank copies of the parent or legal guardian medical limitations, work, and school schedule forms, AHCA-Med Serv Forms 5000-3501, Revised February 2013; -3503, Revised February 2013; -3504, Revised February 2013; and -3505, Revised February 2013. The forms are available by photocopying them from the appendices. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Page 2-38, Requesting Prior Authorization, continued
In the note paragraphs, the form effective dates have been updated to reflect the correct date as Revised February 2013 and the word Rule has been inserted before the rule citations.
Page 2-39, Review Criteria
The third and fourth paragraphs will now read:
Note: See Appendix K for a blank copy of the Review Criteria for the Private Duty Nursing Services, AHCA Form 5000-3543, April 2013. The criteria are available by photocopying them from the appendix. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Note: See Appendix L for a blank copy of the Review Criteria for Personal Care Services, AHCA Form 5000-3542, April 2013. The criteria are available by photocopying them from the appendix. They are incorporated by reference in Rule 59G-4.130, F.A.C.
Page 3-3, Home Health Visits for Multiple Recipients at One Location
The first paragraph will now read:
Home health visit services provided to two or more recipients with the same home address and share a dwelling space or within the same apartment building are reimbursed as follows:
Appendix B, page B-1,
The title of Appendix B will now read:
CMS Form 485 - Home Health Certification Plan of Care and Instructions
Appendix B, pages B-2 - B-6
The page will now contain:
AHCA Form 5000-3544, April 2013 (incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix B, page B-7
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix C, page C-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix D, page D-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix E, page E-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix F, page F-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix G, page G-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix H, page H-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix I, page I-1
The title of Appendix I will now read:
Personal Care Services Plan of Care Form and Instructions
Appendix I, pages I-2 - I-5
The continued statement under the page heading will now read:
Personal Care Services Plan of Care Form and Instructions, continued
Appendix I, pages I-2 - I-7
The page will now contain:
AHCA Form 5000-3506, Revised April 2013 (incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix J, page J-2
The page will now contain:
(incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix K, pages K-2 - K-4
The page will now contain:
AHCA Form 5000-3543, April 2013 (incorporated by reference in Rule 59G-4.130, F.A.C.)
Appendix L, pages L-2 - L-4
The page will now contain:
AHCA Form 5000-3542, April 2013 (incorporated by reference in Rule 59G-4.130, F.A.C.)
