AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-6.080Payment Methodology for Federally Qualified Health Center and Rural Health Center 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. 41 No. 24, February 5, 2015 issue of the Florida Administrative Register.
The following changes have been made to the Florida Title XIX Federally Qualified Health Center and Rural Health Clinic Reimbursement Plan:
Section I.A. now reads:
Each federally qualified health center (FQHC) and rural health clinic (RHC) in the Florida Medicaid program is subject to the Medicaid Prospective Payment System (PPS) under the authority of 1902(bb) of the Social Security Act (SSA) and Title 42, Code of Federal Regulations (CFR), Section 405.2401(b).
Section I.B.3. now reads:
Any other requirements for reimbursement under the state law which are necessary for providing FQHC or RHC services, in accordance with this rule; the Florida Medicaid Federally Qualified Health Center Services Coverage and Limitations Handbook, incorporated by reference in Rule 59G-4.100, F.A.C.; the Florida Medicaid Rural Health Clinic Services Coverage and Limitations Handbook, incorporated by reference in Rule 59G-4.280, F.A.C.; and the Florida Medicaid Provider General Handbook, incorporated by reference in Rule 59G-5.020, F.A.C.
Section IV.G.1 now reads:
The provider must demonstrate the change in cost caused by the scope of service(s) changed as defined above in Section IV.D.
Section IV.G.5. now reads:
If all requested financial data for a scope of service-related encounter rate adjustment request(s) has not been received within 12 months after the FQHC’s FYE in which costs were first affected, the encounter rate adjustment request shall be granted only when all documentation has been satisfied, and any rate adjustment will be effective as of the beginning of the month in which all information was received by AHCA.
Section IV.H.3. now reads:
If all requested financial data for a scope of service related encounter adjustment request has not been received within 12 months after the RHC’s FYE in which the costs were first affected, the encounter rate adjustment request shall be granted only when all documentation has been satisfied, and any rate adjustment will be effective as of the beginning of the month in which the information was received by AHCA.
Section VII. now reads:
The state shall pay each FQHC and RHC for services provided in accordance with the requirements of 42 CFR Section 405.2401; this rule; the Florida Medicaid Federally Qualified Health Center Services Coverage and Limitations Handbook, incorporated by reference in Rule 59G-4.100, F.A.C.; the Florida Medicaid Rural Health Clinic Services Coverage and Limitations Handbook, incorporated by reference in Rule 59G-4.280, F.A.C.; and the Florida Medicaid Provider General Handbook, incorporated by reference in Rule 59G-5.020, F.A.C. The payment amount shall be determined for each FQHC and RHC according to the standards and methods set forth in the Florida Title XIX Federally Qualified Health Center and Rural Health Clinic Reimbursement Plan.
