AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.170Intermediate Care Facility for the Developmentally Disabled Services, ICF/DD
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. 42 No. 31, February 16, 2016 issue of the Florida Administrative Register.
59G-4.170 Intermediate Care Facility for Individuals with Intellectual Disabilities Services.
(1) This rule applies to any person or entity prescribing or reviewing a request for intermediate care facility for individuals with intellectual disabilities services and to all providers of intermediate care facility services who are enrolled in or registered with the Florida Medicaid program.
(2) All persons or entities described in subsection (1) must be in compliance with the provisions of the Florida Medicaid Intermediate Care Facility for Individuals with Intellectual Disabilities Services Coverage Policy,_________, incorporated by reference. The policy is available on from the Agency for Health Care Administration’s (AHCA) Medicaid fiscal agent’s Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml http://portal.flmmis.com/flpublic, and available at [DOS place holder Ref-_______].
(3) The Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Utilization Review (UR) Plan - 5000-3009,____, is incorporated by reference. The plan is available on the AHCA Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml, and available at http://www.flrules.org/Gateway/reference.asp?No=Ref-____.
The following changes have been made to the Intermediate Care Facility for Individuals with Intellectual Disabilities Services Coverage Policy, which is incorporated by reference into the rule:
All references to Intermediate Care Facility Services (ICF) were changed in the rule text and coverage policy to Intermediate Care Facility for Individuals with Intellectual Disabilities Services (ICF/IID).
Section 1.3 Definitions:
Alphabetized subsection titles and renumbered based on policy update.
Added new definitions as follows:
Continued Stay Review
An assessment to determine the appropriateness of continuing ICF/IID services.
Utilization Review
A process to determine if ICF/IID services are of the quality and cost to meet professionally recognized standards of health care for recipients.
Section 1.3.9, Patient Responsibility, definition removed.
Section 1.3.10, Provider, now reads:
The term used to describe any entity, facility, person, or group that is enrolled to furnish services under the Florida Medicaid Program.
Section 4.2, Specific Criteria:
42 CFR 483, Subpart B reference was corrected to Subpart I.
Section 4.3, Early and Periodic Screening, Diagnosis, and Treatment:
Replaced “SSA” with Social Security Act.
Section 6.2, Specific Criteria, now reads:
Providers must document services in accordance with Rule 59A-26, F.A.C.
Providers must maintain a completed Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Utilization Review (UR) Plan, incorporated by reference, and available at http://ahca.myflorida.com/Medicaid/review/index.shtml.
Section 9.0, Appendix added to include The Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Utilization Review (UR) Plan.
