The purpose of this rule amendment is to incorporate by reference Update July 2007 to the Florida Medicaid Provider General Handbook. The handbook was updated to revise Medicaid’s payment methodology for nursing facility Medicare Part A coinsurance. ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO: RULE TITLE
59G-5.020: Provider Requirements
PURPOSE AND EFFECT: The purpose of this rule amendment is to incorporate by reference Update July 2007 to the Florida Medicaid Provider General Handbook. The handbook was updated to revise Medicaid’s payment methodology for nursing facility Medicare Part A coinsurance. In accordance with the General Appropriations Act for 2007-2008, Medicaid will no longer pay the Medicare Part A coinsurance for nursing facility services if the Medicare payment equals or exceeds what Medicaid would have paid if it had been the sole payer.
The Provider General Handbook update also includes the revised policy that Medicaid will pay for Medicare Part B deductibles and coinsurance on services that are not covered by the Medicaid Program and the full Medicare Part A coinsurance for inpatient hospital stays for recipients who are eligible as Qualified Medicare Beneficiaries or Qualified Medicare Beneficiary Pluses. The update also changes references from the UB-92 to the UB-04 claim form.
The effect of the rule amendment to Rule 59G-5.020, F.A.C., will be to incorporate by reference in rule update July 2007 to the Florida Medicaid Provider General Handbook.
SUBJECT AREA TO BE ADDRESSED: Provider Requirements.
SPECIFIC AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: Wednesday, July 25, 2007, 2:00 p.m.
PLACE: Agency for Health Care Administration, 2728 Fort Knox Boulevard, Building 3, Conference Room C, Tallahassee, Florida 32308
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Rinaldi, Medicaid Services, 2727 Mahan Drive, Building 3, Mail Stop 20, Tallahassee, Florida 32308-5407, [phone], [e-mail]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

59G-5.020 Provider Requirements.

(1) All Medicaid providers enrolled in the Medicaid program and billing agents who submit claims to Medicaid on behalf of an enrolled Medicaid provider must comply with the provisions of the Florida Medicaid Provider General Handbook, January 2007, updated July 2007, which is incorporated by reference and available from the fiscal agent’s website at http://floridamedicaid.acs-inc.com. Click on Provider Support, and then on Handbooks. A paper copy of the handbook may be obtained by calling Provider Enrollment at [phone].

(2) No change.

Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.912, 409.913 FS. History–New 9-22-93, Formerly 10P-5.020, Amended 7-8-97, 1-9-00, 4-24-01, 8-6-01, 10-8-03, 1-19-05, 5-24-07,________.