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. 42 No. 36, February 23, 2016 issue of the Florida Administrative Register.
(1) This rule applies to all providers rendering Florida Medicaid any person or entity prescribing or reviewing a request for physical therapy services to recipients. and all providers of physical therapy services who are enrolled in or registered with the Florida Medicaid program.
(2) All providers persons or entities described in subsection (1) must be in compliance with the provisions of the Florida Medicaid Physical Therapy Services Coverage Policy,__________, incorporated by reference. The policy is available from the Agency for Health Care Administration’s Florida Medicaid fiscal agent’s Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml, http://portal.flmmis.com/flpublic, and available at [DOS place holder Ref-_______].
Rulemaking Authority 409.919, 409.961 FS. Law Implemented 409.902, 409.905, 409.907, 409.908, 409.912, 409.913, 409.973 FS. History–New 5-24-92, Amended 4-12-93, Formerly 10C-7.068, Amended 5-4-94, 12-26-95, 3-9-99, 12-2-03, 12-3-08, 8-22-13, ________.
The Physical Therapy Services Coverage Policy has been changed as follows:
Section 1.1.1, Florida Medicaid Policies, first paragraph, second sentence, now reads:
It must be used in conjunction with Florida Medicaid’s General Policies (as defined in section 1.3) and any applicable service-specific and claim reimbursement policies with which providers must comply.
Section 1.1.1, Florida Medicaid Policies, second paragraph, second sentence, now reads:
Coverage policies are available on the Agency for Health Care Administration’s (AHCA) Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml.
Section 1.1.2, Statewide Medicaid Managed Care Plans, now reads:
Florida Medicaid managed care plans must comply with the service coverage requirements outlined in this policy, unless otherwise specified in the AHCA contract with the Florida Medicaid managed care plan. The provision of services to recipients enrolled in a Florida Medicaid managed care plan must not be subject to more stringent service coverage limits than specified in Florida Medicaid policies.
Section 1.2, Legal Authority, third bullet now reads:
•Sections 409.905 and 409.973, Florida Statutes (F.S.)
Section 1.3.1, Claim Reimbursement Policy, now reads:
A policy document found in Rule Division 59G, F.A.C. that provides instructions on how to bill for services.
Section 1.3.2, Coverage and Limitations Handbook or Coverage Policy, now reads:
A policy document found in Rule Division 59G, F.A.C. that contains coverage information about a Florida Medicaid service.
Section 1.3.3, General Policies, now reads:
A collective term for Florida Medicaid policy documents found in Rule Chapter 59G-1, F.A.C. containing information that applies to all providers (unless otherwise specified) rendering services to recipients.
Section, 1.3.5, Provider, now reads:
The term used to describe any entity, facility, person, or group enrolled with AHCA to furnish services under the Florida Medicaid program in accordance with the provider agreement.
Section 2.3, Coinsurance, Copayment, or Deductible. Section retitled Coinsurance and Copayments, now reads:
There is no coinsurance or copayment for this service in accordance with section 409.9081, F.S. For more information on copayment and coinsurance requirements and exemptions, please refer to Florida Medicaid’s General Policies on copayment and coinsurance.
Section 3.1 General Criteria, now reads:
Providers must meet the qualifications specified in this policy in order to be reimbursed for Florida Medicaid physical therapy services.
Section 3.2, Who Can Provide, lead sentence added that reads:
Services must be rendered by one of the following:
Section 4.3, Early and Periodic Screening, Diagnosis, and Treatment, last sentence now reads:
For more information, please refer to Florida Medicaid’s General Policies on authorization requirements.
Section 6.1, General Criteria, now reads:
For information on general documentation requirements, please refer to Florida Medicaid’s General Policies on recordkeeping and documentation policy.
Section 7.1, General Criteria, now reads:
The authorization information described below is applicable to the fee-for-service delivery system. For more information on general authorization requirements, please refer to Florida Medicaid’s General Policies on authorization requirements.
Section 7.2, Specific Criteria, now reads:
Providers must obtain authorization from the quality improvement organization at least every 180 days, or upon a change in the recipient’s condition requiring an alteration in services.
Section 8.1, General Criteria, now reads:
The reimbursement information below is applicable to the fee-for-service delivery system.
Section 8.5, Rate, now reads:
For a schedule of rates, incorporated by reference in Rule 59G-4.002, F.A.C., visit the AHCA Web site at http://ahca.myflorida.com/Medicaid/review/index.shtml.
