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. 40, No. 46, March 7, 2014 issue of the Florida Administrative Register.
59G-4.130 Home Health Services.
(3) The following forms are included in the Florida Medicaid Home Health Services Coverage and Limitations Handbook and are incorporated by reference: Medicaid Instructions for CMS Form 485 – Plan of Care, AHCA Form 5000-3544 500-3544, Revised ___________ April 2013; Home Health Certification and Plan of Care, Form CMS-485(C-3)(02-94) (Formerly HCFA-485); Authorization for Private Duty Nursing Provided by a Parent or Legal Guardian, AHCA Form 5000-3541, February 2013; Physician Visit Documentation Form, AHCA Form 5000-3502, Revised February 2013; Parent or Legal Guardian Medical Limitations, AHCA Form 5000-3501, Revised February 2013; Parent or Legal Guardian Work Schedule, AHCA Form 5000-3503, Revised February 2013; Parent or Legal Guardian Statement of Work Schedule, AHCA Form 5000-3504, Revised February 2013; Parent or Legal Guardian School Schedule, AHCA Form 5000-3505, Revised __________; Instructions for the Personal Care Services Plan of Care, AHCA Form 5000-3506, Revised __________; Physician’s Written Prescription for Home Health Services, AHCA Form 5000-3525, Revised February 2013; Review Criteria for Private Duty Nursing Services, AHCA Form 5000-3543, Revised ___________; and Review Criteria for Personal Care Services, AHCA Form 5000-3542, Revised ____________. 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.
Page 1-9 Branch Offices and Subunits
This section is deleted.
Page 2-8 Required Document(s)
The first sentence in the last paragraph will now read:
Note: See Appendix I for a copy of the Personal Care Services Plan of Care form and instructions, AHCA Form 5000-3506, Revised __________.
Page 2-20 Parental Responsibility, continued
The first sentence in 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 __________.
Page 2-25
Parental Responsibility
The first sentence in 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 __________.
Page 2-32
Requesting Prior Authorization, continued
The third dash, first sentence will now read:
Note: See Appendix H for a copy of the Parent or Legal Guardian School Schedule Form, AHCA-Med Serv Form 5000-3505, Revised __________.
Page 2-33 Review Criteria
The first sentence in the third paragraph will now read:
Note: See Appendix K for a copy of the Review Criteria for Private Duty Nursing Services, AHCA Form 5000-3543, Revised __________.
The first sentence in the last paragraph will now read:
Note: See Appendix L for a copy of the Review Criteria for Personal Care Services, AHCA Form 5000-3542, Revised__________.
Page 3-2 Diagnosis Code
The last sentence in the first paragraph is deleted.
Page B-2 through B-6
The form will have a revised date and April 2013 is deleted.
Page B-3
ITEM 11 – PRINCIPAL DIAGNOSIS
The first paragraph will now read:
Enter a valid diagnosis code which best describes the principal reason for home health services. The code is the full diagnosis code including all digits.
ITEM 12 – SURGICAL PROCEDURE, DATE and ICD-9-CM Code
The title now reads:
ITEM 12 – SURGICAL PROCEDURE
In the first paragraph, ICD-9-CM is changed to diagnosis.
