AGENCY FOR HEALTH CARE ADMINISTRATION
RULE NO.:RULE TITLE:
59G-4.320Therapy 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. 38 No. 54, October 19, 2012 issue of the Florida Administrative Register.
The following changes have been made to the Florida Medicaid Therapy Services Coverage and Limitations Handbook, ____________ 2013.
Page 1-2 Adaptive Behavior
The section is deleted.
Page 1-2 Physical Therapy Assistant
The section is deleted.
Page 1-3 On-Site Supervision
The label is changed to Supervision.
Page 2-4 Requesting Prior Authorization
The 10th bullet now reads:
- A copy of the documentation demonstrating the recipient has been examined or received medical consultation by the ordering or attending physician before initiating services and every 180 days thereafter.
Page 2-7 Submission of a Claim for Payment
The section is deleted.
Page 2-10 Description
The second paragraph now reads:
Evaluation results should be used to develop baseline data to identify the need for early intervention for therapeutic services and to address the recipient’s functional abilities, capabilities, and activity level deficits and limitations.
Page 2-19 Service Requirements
Two additional paragraphs are added at the end of the section:
To be reimbursed by Medicaid, respiratory therapy services provided in a PPEC center must be:
- Authorized via a written prescription from the primary care provider, ARNP or PA designee, or a designated physician specialist in accordance with the Florida Statutes and licensing requirements;
- Authorized in the recipient’s valid and approved plan of care; and
- Submitted for medical review by the Medicaid contracted Quality Improvement Organization.
For respiratory therapy services provided in a PPEC center, authorization will be valid for up to six months and the medical review authorization must be maintained in the recipient’s case files.
The following additional changes have been made to the Notice of Change, published in the Vol. 39, No. 11,
January 16, 2013, issue of the Florida Administrative Register:
Page 2-20 Place of Service
The section now reads:
Physical, occupational, and respiratory therapy and speech language pathology treatment services can be provided in the recipient’s place of residence or other community setting, such as schools, Prescribed Pediatric Extended Care (PPEC) centers, or day care centers. Reimbursement for services provided in the recipient’s place of residence or community setting is paid directly to the provider on a fee-for-service basis in accordance with the Therapy Services Procedure Codes and Maximum Fee Schedule in Appendix A.
Respiratory therapy services provided in a PPEC center is limited to children who have a complex respiratory diagnosis or condition, requiring extensive airway management, for example, ventilator support, while attending a PPEC center. Respiratory therapy services will be reviewed by the Medicaid contracted Quality Improvement Organization based on the medical needs of the child.
Place of residence is the location in which a recipient resides for an extended or a permanent period of time and is considered the recipient’s home. Place of residence may include:
- Recipient’s private home;
- Assisted Living Facility (ALF);
- Developmental disabilities group home;
- Foster or medical foster care home; or
- Any home where unrelated individuals reside together in a group.
Services can also be provided in an inpatient and outpatient hospital. Payment for these services is included in the facility’s per diem. The therapist cannot be reimbursed directly by fee-for-service for services provided in these locations. Evaluations provided by hospitals are not counted against the recipient’s evaluation reimbursement limitations. Inpatient and outpatient hospital therapy services are reimbursed according to the Florida Medicaid Hospital Services Coverage and Limitations Handbook.
Providers cannot bill the same procedure provided in the school setting and community setting in the same day.
Note: See the Florida Medicaid Home Health Services Coverage and Limitations Handbook for information specific to home health agencies. See the Florida Medicaid Hospital Services Coverage and Limitations Handbook for information about hospital services. All Medicaid handbooks are available on the Medicaid fiscal agent’s Web Site at www.mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Provider Handbooks.
