The purpose of the amendment to Rule 59G-6.005, Florida Administrative Code (F.A.C.), is to update the reimbursement percentage of the Medicare rate or the Florida Medicaid rate when the service is not covered by Medicare.....

 

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 reimbursement percentage of the Medicare rate or the Florida Medicaid rate when the service is not covered by Medicare.

SUMMARY: The rule specifies Florida Medicaid’s payment methodology for services provided by medical school faculty.

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: 409.908 FS.

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

DATE AND TIME: June 15, 2021, 3:00 p.m. – 3:30 p.m.

PLACE: The Agency is offering both a remote and an in-person option to attend the hearing at the Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308-5407.

Remote Listeners: Attendees may register for the hearing at: https://attendee.gotowebinar.com/register/8171668689255494155. After registering, a confirmation email will be received containing information about joining the webinar, and opportunities to offer comments and questions will be available.

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 5 days 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 IS: [e-mail]. Please note that a preliminary draft of the reference material, if available, will be posted prior to the hearing at http://ahca.myflorida.com/Medicaid/review/index.shtml. Official comments to be entered into the rule record will be received until 5:00 p.m. on June 16, 2021 and may be e-mailed to [e-mail].

 

THE FULL TEXT OF THE PROPOSED RULE 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’ Merit-based Incentive Payment System (MIPS) 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. Two hundred-three One-hundred-ninety percent of the Medicare rate, based on Florida locality code 0910299, listed on the 2018 January-June 2015 Medicare Part B physician fee schedule – Loc 03, 04, and 99 (01/02), incorporated for reference, and available at http://medicare.fcso.com/Data_files, and at http://www.flrules.org/Gateway/reference.asp?No=Ref-_________08250, https://ahca.myflorida.com/medicaid/review/Reimbursement/2018-01-01_Fee_Schedules/Practitioner_Fee_Schedule_2018.pdf, and at  Physician Fee Schhttps://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspxedule Search (cms.gov).

2.  Two hundred-three 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 the amount specified in the General Appropriations Act. $36,543,054 for Fiscal Year 2017-2018 and shall not exceed $47,676,137 for Fiscal Year 2018-2019.

(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.

(4) This rule is in effect for five years from its effective date.

 

Rulemaking Authority 409.919 FS. Law Implemented 409.908 FS. History–New 6-13-17, Amended 12-25-18,___________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Kelly Parker

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Simone Marstiller

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 10, 2021

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: February 22, 2021