The purpose of the amendment to Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to update the aggregate reimbursement amount available for eligible providers. The amendment specifies the legislative appropriation for state fiscal year 2017-...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.:RULE TITLE:

59G-6.005Reimbursement Methodology for Services Provided by Medical School Faculty

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to update the aggregate reimbursement amount available for eligible providers. The amendment specifies the legislative appropriation for state fiscal year 2017-2018.

SUBJECT AREA TO BE ADDRESSED: Reimbursement Methodology for Services Provided by Medical School Faculty.

RULEMAKING AUTHORITY: 409.919 FS.

LAW IMPLEMENTED: 409.908 FS.

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

DATE AND TIME: May 30, 2018,2:00 p.m. to 2:30 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: Tanisha Feehrer. 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: Tanisha Feehrer, Bureau of Medicaid Program Finance, 2727 Mahan Drive, Mail Stop 23, Tallahassee, Florida 32308-5407, telephone: [phone] e-mail: [e-mail].

Official comments to be entered into the rule record will be received until 5:00 p.m. on May 31, 2018 and may be e-mailed to [e-mail]. For general inquiries and questions about the rule, please contact the person specified above.

 

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

 

59G-6.005 Reimbursement Methodology for Services Provided by Medical School Faculty.

(1) This rule applies to all providers who are enrolled in Florida Medicaid who:

(a) Are defined as practitioners under the Centers for Medicare and Medicaid Services’ Physician Quality Reporting Systems program (PQRS).

(b) Provide medical services, dental services, behavioral health services, hearing services, and vision services to Florida Medicaid recipients receiving services through the fee-for-service delivery system.

(c) Are employed by, or contracted with, a Florida public or private, non-profit, accredited medical, dental, or optometry school to provide supervision and teaching of medical, dental, or optometric students, residents, or fellows.

(2) Reimbursement.

(a) Florida Medicaid reimburses providers for covered medical, hearing, vision, dental, and behavioral health services listed on the applicable Florida Medicaid fee schedule, incorporated by reference in Rule 59G-4.002, F.A.C., at either:

1. One-hundred-ninety percent of the Medicare rate, based on Florida locality code 0910299, listed on the January-June 2015 Medicare Part B physician fee schedule – Loc 99 (01/02), incorporated by reference, and available at http://medicare.fcso.com/Data_files, and at http://www.flrules.org/Gateway/reference.asp?No=Ref-08250.

2. One-hundred-ninety percent of the Florida Medicaid rate if the service is not covered by Medicare.

(b) Florida Medicaid reimbursement to providers for clean claims submitted to the Florida Medicaid Management Information System specified in this rule shall not exceed $36,543,054 27,864,092 for Fiscal Year 2017-2018 2016-2017.

(c) Florida Medicaid will reconcile claims reimbursed in accordance with this rule on a quarterly basis. Any claims reimbursed after the maximum reimbursable amount is reached will be recouped, or adjusted to the standard Florida Medicaid rate, as appropriate.

(3) Exclusions. Florida Medicaid does not reimburse providers in accordance with this rule for the following:

(a) Services rendered to dually eligible Medicare and Medicaid recipients.

(b) Vaccine, laboratory, and radiology services.

Rulemaking Authority 409.919 FS. Law Implemented 409.908 FS. History–New 6-13-17, Amended ________.