Durable Medical Equipment and Medical Supplies

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

Rule No.: RULE TITLE
59G-4.070: Durable Medical Equipment and Medical Supplies

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. 36 No. 22, June 4, 2010 issue of the Florida Administrative Weekly.

The amendment to Rule 59G-4.070, F.A.C., Durable Medical Equipment and Supplies, incorporates by reference in rule the Florida Medicaid Durable Medical Equipment and Medical Supply Services Coverage and Limitations Handbook, July 2010. The following changes have been made to the handbook.

Page 1-8, HME Providers Exempt from Licensure. The paragraph is changed to read: Providers exempt from holding a current, standard HME license are those operated by the federal government, nursing homes, assisted living facilities, home health agencies, hospices, intermediate care facilities, hospitals and ambulatory surgical centers, pharmacies, manufacturers, or wholesale distributors when not selling directly to consumers, and licensed health care practitioners who utilize HME in the course of their practice, but do not sell or rent HME to their patients.

Page 1-10, Requirements for Medical Oxygen Providers and Retailers. The third paragraph is changed to read: Oxygen providers must have a licensed certified respiratory therapist (CRT), registered respiratory therapist (RRT), registered nurse (RN), or respiratory care practitioner (RCP) under contract or on staff to provide management and consumer instruction, at the provider’s physical DME business location or in the recipient’s home.

Page 1-24, Solicitation. The paragraph is changed to read: Providers are not permitted to knowingly solicit, offer, pay, or receive any remuneration, including any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in kind, in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made, in whole or in part, under the Medicaid program, or in return for obtaining, purchasing, leasing, ordering, or arranging for or recommending, obtaining, purchasing, leasing, or ordering any goods, facility, item, or service, for which payment may be made, in whole or in part, under the Medicaid program. A person who violates this subsection commits a felony as reference in Section 400.93, F.S.

Page 2-17, Prior Authorization (PA) Process. The first paragraph is changed to read: Except for the items specified below, PA requests for durable medical equipment must be submitted to the Medicaid fiscal agent on a Florida Medicaid Authorization Request, PA01, 07/08. The Florida Medicaid Authorization Request, PA01, is incorporated by reference in Rule 59G-4.001, F.A.C. After initial processing, the Medicaid fiscal agent forwards the PA request packets to the appropriate office for review.