The proposed rule amends Rule 59G-4.002, F.A.C. The purpose of the rule amendment is to record effective dates for practitioner procedure codes and fees. The rule amendment also excludes injectable medications from the fee schedule. This latter ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-4.002: Medicaid Provider Reimbursement Schedule

PURPOSE AND EFFECT: The proposed rule amends Rule 59G-4.002, F.A.C. The purpose of the rule amendment is to record effective dates for practitioner procedure codes and fees. The rule amendment also excludes injectable medications from the fee schedule. This latter action is pursuant to Section 409.912(37)(a), F.S.

SUMMARY: The current amendment to Rule 59G-4.002, F.A.C., incorporates by reference the Florida Medicaid Provider Reimbursement Schedule including changes to the following: 1) practitioner procedure codes and fees, effective January 1, 2011; 2) practitioner procedure codes and fees, effective January 1, 2012; 3) fees for general dental services, effective July 1, 2011; 4) physician immunization fees, effective April 1, 2011; and 5) physician immunization fees, effective October 1, 2011. As indicated, the amendment also excludes injectable medications from the fee schedule, because reimbursement rates for medications are established pursuant to Section 409.912(37)(a), F.S. and Rule 59G-4.251, F.A.C.

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, F.S., 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: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: Wednesday, June 27, 2012, 10:00 a.m. – 11:00 a.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room B, 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: Fred Lawrence at the Bureau of Medicaid Services, [phone]. 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: Fred Lawrence, Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: [e-mail]

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-4.002 Medicaid Provider Reimbursement Schedule.

Medicaid providers who provide the following services and their billing agents who submit claims on behalf of an enrolled Medicaid provider must be in compliance with the provisions of the Florida Medicaid Provider Reimbursement Schedule for the following services, January 1, 2010, which is incorporated by reference: advanced registered nurse practitioner, birth center, chiropractic, general dental, hearing, licensed midwife, optometric, outpatient hospital laboratory, physician, physician assistant, podiatry, registered nurse first assistant, and visual. Rule 59G-4.002, F.A.C., incorporates by reference changes to the Florida Medicaid Provider Reimbursement Schedule for the following services: practitioner procedure codes and fees, effective January 1, 2011, practitioner procedure codes and fees, effective January 1, 2012, fees for general dental services, effective July 1, 2011, physician immunization fees, effective April 1, 2011, and physician immunization fees, effective October 1, 2011.

The Florida Medicaid Provider Reimbursement Schedule is available from the Medicaid fiscal agent’s Web site at www. http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Fee Schedules. Paper copies of the reimbursement schedule may be obtained by calling the Provider Contact Center at [phone] and selecting Option 7.

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History– New 8-18-05, Amended 11-30-05, 4-16-06, 10-11-06, 3-27-07, 7-25-07, 9-29-08, 4-28-09, 2-11-10, 1-31-11,________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Fred Lawrence

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: May 4, 2012

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 15, 2011