The purpose of the amendment to Rule 59G-5.020 is to incorporate by reference the Florida Medicaid Provider General Handbook, July 2012. The handbook is updated to add policy relating to special services necessary for children and detailing the ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION
Medicaid

RULE NO.: RULE TITLE:
59G-5.020: Provider Requirements

PURPOSE AND EFFECT: The purpose of the amendment to Rule 59G-5.020, F.A.C., is to incorporate by reference the Florida Medicaid Provider General Handbook, July 2012. The handbook is updated to add policy relating to special services necessary for children and detailing the direction on requesting these services; give providers direction on requesting non-emergency out-of-state services by providing general guidelines, adding non-emergency out-of-state services, and requiring a new form; add policy regarding enrollment of cross-over only providers; reflect Medicaid Qualified Medicare Beneficiary (QMB) cost-sharing requirements and Medicaid cost-sharing for Medicare Part A and Part C services; and increase the oversight of the Medicaid program through the provision of general guidelines on termination, suspensions, and administrative sanctioning of Medicaid providers as directed by legislation.

SUMMARY: Overall, the amendment updates policy, clarifies existing policy, updates forms, and updates fiscal agent information. Existing policies have been clarified and updated to ensure a better understanding of policy requirements.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. Based on this information at the time of the analysis and pursuant to Section 120.541, F.S., the rule will not require legislative ratification.

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.

RULEMAKING AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.905, 409.906, 409.907, 409.908, 409.9081, 409.910, 409.912, 409.913 FS.

IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:

DATE AND TIME: Monday, September 10, 2012, 1:00 p.m. – 3:00 p.m.

PLACE: Agency for Health Care Administration, 2727 Mahan Drive, Building 3, Conference Room A, Tallahassee, Florida 32308-5407

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 48 hours before the workshop/meeting by contacting: Arabella Reeves at the Bureau of Medicaid Services, [phone]. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Arabella Reeves, Agency for Health Care Administration, Bureau of Medicaid Services, 2727 Mahan Drive, Mail Stop 20, Tallahassee, Florida 32308-5407, telephone: [phone], e-mail: arabella.reeves@ahca. myflorida.com

 

THE FULL TEXT OF THE PROPOSED RULE 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, July 2012 July 2008, which is incorporated by reference and available from the fiscal agent’s Web site Portal at www. http://mymedicaid-florida.com. Select Click on Public Information for Providers, then on Provider Support, and then on Provider Handbooks. A paper copy of the handbook may be obtained by calling the Provider Services Contact Center at 1(800)289-7799 and selecting Option 7.

(2) The following forms are is incorporated by reference: Medicare Part C-Medicaid CMS-1500 Crossover Invoice AHCA Form 5000-3527, June 2012; Medicare Part C-Medicaid UB-04 Crossover Invoice AHCA Form 5000-3528, June 2012; and Medicaid Out-of-State Prior-Authorization Request Form AHCA Med Serv Form 2000-0016. The forms are available from the fiscal agent’s Web site at www. mymedicaid-florida.com. Select Public Information for Providers, then Provider Support, and then Forms. Paper copies of the forms may be obtained by calling the Provider Services Contact Center at 1(800)289-7799 and selecting Option 7. AHCA Form 2200-0004, July 2008, Medicaid Provider Change of Address Form, one page. The form is available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Secure Information for Providers. The form may also be obtained from the Medicaid fiscal agent by calling the Provider Contact Center at 1(800)289-7799 and selecting Option 7.

(3) The following forms that are included in the Florida Medicaid Provider General Handbook are incorporated by reference. In Chapter 3, Temporary Emergency Medicaid Identification Card, July 2008; one page; CF-ES 2681, Feb 2003, Notice and Proof of Presumptive Eligibility for Medicaid for Pregnant Women, one page; CF-ES Form 2014, Feb 2003, Authorization for Medicaid/Medikids Eligibility, one page; AHCA Form 5240-006, Unborn Activation Form, January 2007, one page; CF-ES 2039, Sep 2002, Medical Assistance Referral, two pages. In Chapter 4, the AHCA-Med Serv 038, July 2008, Crossover with TPL Claim and/or Adjustment Form, one page. The CF-ES forms are available from the Department of Children and Family Services. The other forms are available from the Medicaid fiscal agent’s Web Portal at http://mymedicaid-florida.com. Click on Public Information for Providers, then on Provider Support, and then on Forms. Paper copies of the forms may be obtained by calling the Provider Contact Center at [phone] and selecting option 7.

 

Rulemaking Specific Authority 409.919 FS. Law Implemented 409.902, 409.905, 409.906, 409.907, 409.908, 409.9081, 409.910, 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, 2-25-09,________.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Arabella Reeves

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: July 3, 2012

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAW: July 8, 2011