The purpose of this rule amendment is to incorporate by reference update September 2006 to the Florida Medicaid Physician Services Coverage and Limitations Handbook. The handbook update contains the policies and forms for the Recipient Assignment ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-4.230: Physician Services
PURPOSE AND EFFECT: The purpose of this rule amendment is to incorporate by reference update September 2006 to the Florida Medicaid Physician Services Coverage and Limitations Handbook. The handbook update contains the policies and forms for the Recipient Assignment Program (R.A.P.). The 2004 Florida Legislature mandated that the Florida Medicaid Program implement a program to prevent excessive and inappropriate utilization of Medicaid goods and services by recipients in the MediPass and fee-for-service programs. The new program, referred to as the Recipient Assignment Program (R.A.P.), is similar to managed care in regard to the assignment of health care services to a primary care physician (PCP). The accepting PCP will act as a case manager or “gatekeeper” for coordination of the recipient’s non-emergency medical services. Certain services are exempt from management by the PCP. The effect will be to incorporate by reference in rule update September 2006 to the Florida Medicaid Physician Services Coverage and Limitations Handbook.
In the Notice of Rule Development published in Vol. 31, Number 52, December 30, 2005, issue of the Florida Administrative Weekly, we stated that the effective date of the update was January 2006. We changed the effective date to September 2006.
SUMMARY: The purpose of this rule amendment is to incorporate by reference in the rule update September 2006 to the Florida Medicaid Physician Services Coverage and Limitations Handbook. The effect will be to incorporate by reference in rule update September 2006 to the Florida Medicaid Physician Services Coverage and Limitations Handbook.
SUMMARY OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.905, 409.907, 409.908, 409.9081 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE TIME, DATE AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
TIME AND DATE: Thursday, August 24, 2006, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building #3, Conference Room B, Tallahassee, Florida
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Kathy Canfield, Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida, 32308, [phone]

THE FULL TEXT OF THE PROPOSED RULE IS:

59G-4.230 Physician Services.

(1) No change.

(2) All physician services providers enrolled in the Medicaid program must be in compliance with the Florida Medicaid Physician Services Coverage and Limitations Handbook, January 2004, updated January 2005-1, and January 2005-2, and September 2006, which is incorporated by reference, and the Florida Medicaid Provider Reimbursement Handbook, CMS-1500, which is incorporated by reference in Rule 59G-4.001, F.A.C.  Both handbooks are available from the Medicaid fiscal agent’s website at http://floridamedicaid.acs-inc.com.  Click on Provider Support, and then on Handbooks agent.  Paper copies of the handbooks may be obtained by calling Provider Inquiry at [phone].

(3) No change.

(4)  The following forms that are included in Chapter 4 of the Florida Medicaid Physician Services Coverage and Limitations Handbook are incorporated by reference:  Enrollment Notification Letter, September 2006, two pages; Enrollment Notification Letter, Spanish version, September 2006, two pages; Request for Change of Address for Recipient Assignment Program (R.A.P.), September 2006, one page; Request for Change of Address for Recipient Assignment Program (R.A.P.), Spanish version, September 2006, one page; and the Recipient Assignment Program, Enrollee Physician Notification form, September 2006, two pages.  The forms are available from the Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop #20, Tallahassee, Florida 32308.

Specific Authority 409.919 FS. Law Implemented 409.905, 409.907, 409.908, 409.9081 FS. History–New 1-1-77, Revised 2-1-78, 4-1-78, 1-2-79, 1-1-80, Amended 2-8-82, 3-11-84, Formerly 10C-7.38, Amended 1-10-91, 11-5-92, 1-7-93, Formerly 10C-7.038, Amended 6-29-93, 9-6-93, Formerly 10P-4.230, Amended 6-13-94, 2-9-95, 3-10-96, 5-28-96, 3-18-98, 9-22-98, 8-25-99, 4-23-00, 8-5-01, 2-20-03, 8-5-03, 6-27-04, 8-3-04, 8-18-05, 8-31-05,_________.

NAME OF PERSON ORIGINATING PROPOSED RULE: Kathy Canfield
NAME OF SUPERVISOR OR PERSON WHO APPROVED THE PROPOSED RULE: Alan Levine, Secretary
DATE PROPOSED RULE APPROVED BY AGENCY HEAD: July 5, 2006
DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: December 30, 2005